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AUA Abstract Summaries 07

Although there were no breakthroughs in chronic prostatitis reported at the 2007 American Urological Association annual meeting, some of the presentations hinted at future ones. Other studies helped refine existing treatment approaches and painted a more complete picture of the burden of CP/CPPS for patients.

Certain proteins, nerve growth factor (NGF), and prostatic stones may all prove to be useful markers. The potential protein markers were discovered through proteomics, which uses large-scale protein identification to find differences in protein production between healthy people and those with a disease. A proteomics study of pre- and postprostatic massage urine in men with CP/CPPS identified a number of proteins that could not only be diagnostic markers but might also be involved in cause of CP/CPPS. One protein that was more common men with the disease is neprilysin, which actually neutralizes one of the body's natural painkillers, enkephalin. A drug that blocks this protein is already being researched as a therapy in other diseases and could prove to be a helpful treatment for the pelvic pain of CP/CPPS. Researchers also found that men with the disease produce more NGF than healthy men, that higher levels correlate with higher levels of pain, and that levels go down with successful treatment, meaning NGF could be a good way to evaluate symptoms and response to treatment and could also be a target for drugs therapy. Men with CP/CPPS who have prostatic stones had symptoms longer, had more bacteria and inflammation, and had less pelvic floor tenderness than other men with CP/CPPS. That may mean that men with the stones could benefit from antibiotics and men without them might benefit from pelvic floor physical therapy.

Socioeconomic studies showed that doctors need to be better educated about CP/CPPS, that the cost of the disease is high, and that sexual dysfunction is common (and doesn't depend on inflammation status). Epidemiologic studies showed that certain other medical problems are associated with CP/CPPS, hinting that they may share a cause. The dysfunction that was demonstrated in the hypothalamic-pituitary-adrenal axis in men with CP/CPPS might be responsible for some of that, but much more research is needed on the connections.

Pelvic floor physical therapy, which has already proved to be a helpful treatment, seems to have long-term effects. Alpha blocker therapy, known to be helpful, did well in clinical studies, which also indicated that long-term (six-month) therapy works better than short-term therapy. Alpha blocker therapy ran neck and neck with phytotherapy using a combination of saw palmetto and Pygeum africanum, but the combination did even better.

These studies and more related to CP/CPPS, chronic bacterial prostatitis, and prostate inflammation are summarized below.

EPIDEMIOLOGY, SOCIOLOGY, AND ECONOMICS

Costs are High, Similar for CP/CPPS and IC/PBS

Comparison of the economic impact of chronic prostatitis/ chronic pelvic pain syndrome and interstitial cystitis/ painful bladder syndrome

J. Quentin Clemens, Sheila O Brown, Elizabeth A Calhoun, Chicago, IL

Researchers at Northwestern University took an economic snapshot of their CP/CPPS and interstitial cystitis/painful bladder syndrome (IC/PBS) patients and saw a costly picture for both groups. Extensive questionnaires for 62 men with CP/CPPS and 43 women with IC/PBS detailed the patients' hospitalizations, tests, visits, phone calls, medications, lost productivity, and symptom scores. The investigators estimated costs using both Medicare and non-Medicare rates. The patients' mean age was 51, and in 74%, their yearly income was at least $50,000. Mean annualized direct costs for CP/CPPS were $3,017 at Medicare rates and $6,534 at non-Medicare rates. For IC/PBS, the direct costs were $3,632 at Medicare rates and $7,044 at non-Medicare rates. The direct costs of these conditions are significantly higher than the mean yearly costs reported for many other chronic pain conditions (peripheral neuropathy, $917; low back pain, $2,144; fibromyalgia, $2,274; rheumatoid arthritis, $2,533). Indirect costs accounted for a high proportion of the total. Mean annualized indirect costs for CP/CPPS were $3,248 and for IC/PBS were $4,216. Sixteen CP/CPPS patients (26%) and eight IC/PBS patients (19%) reported lost wages because of their condition in the last three months.

Primary Care Docs Need Education on Chronic Prostatitis

Primary care physician practice patterns in the management of chronic prostatitis/ chronic pelvic pain syndrome

J. Quentin Clemens, Elizabeth A Calhoun, Chicago, IL; Mark S Litwin, Los Angeles, CA; Mary McNaughton Collins, Boston, MA

To see how familiar primary care doctors are with CP/CPPS, these researchers mailed a questionnaire to 556 primary care physicians at Harvard, UCLA, and the ACCESS Community Health Network in Chicago, a large federally qualified health center group. The questionnaire included a vignette that described a man with typical CP/CPPS symptoms and then asked questions about the doctors' familiarity with the disorder, what they thought the causes were, and how they would treat it. The researchers got 52% of their questionnaires back. Of the doctors who replied, 53% were men and had graduated medical school an average of 19 years earlier (range 1-51). They saw an average of 3.2 patients like the one described (but the range was wide—0 to 50) and said they had an average of 3.4 patients in their practice with the CP/CPPS diagnosis (also a wide range—0 to 30). Approximately half (48%) of respondents were "not at all" familiar with the NIH classification of prostatitis, and 33% reported "never" having seen a patient like the one described. But a majority—65%—correctly identified the hallmark symptom of CP/CPPS as pelvic pain. Nearly three quarters—71%—correctly indicated that CP/CPPS was noninfectious, but 37% incorrectly reported that it was caused by a sexually transmitted disease, and 35% incorrectly indicated that it was caused by a psychiatric illness. Male physicians and physicians who see a higher percentage of male patients answered more of the questions correctly. About 39% never or rarely referred the men to a specialist, and only 25% did so more than half the time or almost always. Seventy-one percent tested for gonorrhea or chlamydia most of the time. Only 23% got cultures of pre- and post-prostatic massage urine. Even though most physicians knew CP/CPPS was not an infectious disease, 72% prescribed antibiotics more than half the time or almost always. Only 21% used alpha blockers more than half the time or almost always. Eighty-four percent rarely or never used complementary or alternative therapies. Because primary care physicians' experience with and knowledge of CP/CPPS are limited and because the doctors have varying diagnostic and treatment practices, these researchers suggested that education targeting primary care doctors could improve care of patients with CP/CPPS.

Prostatitis Is Common, Associated with Other Disorders

Prevalence and risk factors for prostatitis in a managed care population

J Quentin Clemens, Chicago, IL; Richard T Meenan, Maureen C O'Keeffe Rosetti, Teresa M Kimes, Portland, OR; Elizabeth A Calhoun, Chicago, IL

These researchers estimated how common prostatitis is and what other medical problems men with prostatitis had by analyzing the claims database of a large managed care organization, Kaiser Permanente Northwest in Portland, OR. They included "acute prostatitis," which would likely be an acute bacterial infection, as well as chronic prostatitis and prostatitis that wasn't otherwise specified. The prevalence of prostatitis was 4.5% overall (1 out of 22 men), and the prevalence increased with age. Approximately 10% of men older than 70 had had prostatitis at some time. Men who had prostatitis also had various other conditions more frequently than patients who didn't have prostatitis. The most common additional problems in men with prostatitis were urologic problems such as benign prostatic hyperplasia (enlarged prostate or BPH), bladder or genital problems, high PSA levels, and sexual problems. Men with prostatitis had various unexplained medical problems more frequently than other men, such as digestive problems, soft tissue problems, esophageal reflux, migraine, back problems, and joint disorders. They also had more psychiatric diagnoses, including anxiety and depression. More studies are needed to help explain the connection with prostatitis, said the researchers.

Three-quarters of Men with Chronic Prostatitis Have Sexual Dysfunction

Sexual dysfunction in chronic prostatitis/chronic pelvic pain syndrome: prevalence, characteristics and impact

Shaun W H Lee, Men Long Liong, Kah Hay Yuen, Wing Seng Leong, Phaik Yeong Cheah, Nurzalina AK Khan, Penang, Malaysia; John N Krieger, Seattle, WA

These researchers surveyed 298 men with CP/CPPS about sexual dysfunction and its effects on their quality of life. The men, whose average age was 42, had had symptoms for an average of two years. Seventy-three percent of the men said they had sexual dysfunction, with 25% of those reporting erectile dysfunction only, 33% reporting ejaculatory dysfunction only, and 42% reporting both. The men who had sexual dysfunction had worse CP/CPPS symptoms and worse quality of life than the patients who didn't have sexual dysfunction. Sexual dysfunction plays an important role in the illness and may be important to measure in treatment studies, said the investigators.

Sexual Dysfunction Common in Both Chronic Prostatitis Types

Inflammation does not influence erectile dysfunction in patients with CP/CPPS-NIH IIIA and B

Kersten Wilbrandt, Henning Schneider, Giessen, Germany; Elmar Braehler, Leipzig, Germany; Wolfgang Weidner, Giessen, Germany

Sexual dysfunction is common in CP/CPPS patients, and it doesn't matter which type. Among 134 men with CP/CPPS, 35 were determined to have type IIIA (inflammatory) prostatitis and 99 type IIIB (noninflammatory) prostatitis. Of the total, 47% (63) had erectile dysfunction. Seven patients had no sexual activity. Mean scores on the international index of erectile function were no different between the two types (22.5 for inflammatory and 21 for noninflammatory). The dysfunction was most typically moderate (in 46% of patients), although 25% of the men had severe dysfunction, 11% had mild to moderate dysfunction, and 18% had mild dysfunction.

Men with Chronic Prostatitis Have HPA Abnormalities, Psychosocial Dysfunction

Variations in psychometric profiles and awakening cortisol responses in men with chronic prostatitis/chronic pelvic pain syndrome

Rodney U Anderson, Christine A Chan, Elaine K Orenberg, Veronica Flores, Stanford, CA

The hypothalamic-pituitary-adrenal axis is the endocrine system in the body connected to stress and the "fight or flight" nervous system. Some researchers theorize that in CP/CPPS, this system is out of whack and may play a role in the disease. It may also have a relationship with related mental effects, although whether those problems, such as stress, are a cause or effect of the HPA abnormalities isn't clear. This study took a preliminary look at the HPA and mental aspects of CP/CPPS without drawing conclusions about the relationships, which the researchers may address in further studies. To look at the HPA axis, the investigators measured levels of cortisol, a stress hormone, throughout the day in 33 men with CP/CPPS and 18 controls. Typically, levels rise in the morning and fall through the day to a low in the evening. The men with CP/CPPS, however, had bigger responses in morning cortisol levels. They were waking up "ready to go." Men with CP/CPPS also had much higher scores on measurements of "somatization," obsessive/compulsive behavior, depression, anxiety, hostility, interpersonal sensitivity, phobic anxiety, paranoid ideation, and psychoticism than the controls. (Somatization is psychologic distress expressed as physical symptoms.) There was no difference in type A behavior. The researchers noted that they didn't know what the men scored before they had their CP/CPPS symptoms.

Understanding Patients' Situations Key to Helping them Cope

Biopsychosocial factors in quality of life in men with chronic prostatitis/chronic pelvic pain syndrome

J. Curtis Nickel, Dean Tripp, Kingston, ONCanada; Shannon Chuai, Philadelphia, PA; Mark S Litwin, Los Angeles, CA; Mary McNaughton-Collins, Boston, MA

It's important to understand patients' environment and how they cope to help men with CP/CPPS adjust, said these researchers. They had 253 men in the NIH Chronic Prostatitis Cohort answer quality-of-life questionnaires and questions about their symptoms, depression, current pain, coping and "catastrophizing," pain control, social support, and solicitous responses from a partner. Men who had worse urinary symptoms and who rested as a way to cope with pain had poorer physical quality-of-life scores. Men who had greater pain "catastrophizing" and those who had less social support had worse mental quality-of-life scores.

TREATMENTS

Physical Therapy Can Have Long-term Benefits for Chronic Prostatitis

Long term follow-up of Chronic Pelvic Pain Syndrome treated with biofeedback physical therapy

Erik B Cornel, Hengelo, The Netherlands; Ernst P van Haarst, Amsterdam, The Netherlands

A pioneer in the use of physical therapy for men with CP/CPPS, Dr. Cornel was the first to present a study of this type of therapy at the annual AUA meeting (in 2004). Twenty-four of the men who had biofeedback and pelvic floor re-education have now been followed up for at least a year and for as long as five years (mean 32 months). (The men who could not be evaluated had initial NIH-CPSI scores that were no different from these men.) On average, the men still had significant improvements in their NIH-CPSI scores and in all the subdomains. Four of the men did have worse scores, but they didn't feel the need to have more therapy. The other 20 patients were still doing better than they were initially by 1 to 24 points. Compared with scores immediately after treatment, 11 patients had scores increase by 4 to 17 points, 3 had no change, and 11 had further improvements of 1 to 15 points. Overall, the long-term results were good, with only a minority of patients worsening, but not so much that it was unacceptable, concluded the investigators.

Combining Alpha Blockers, Phytotherapy Could Improve CPPS Treatment Results

Alpha blockers versus phytotherapy in the treatment of chronic non-bacterial prostatitis

Mahmoud H Sherief, Ahmed M El-Nashar, Gamal El-Atrash, Ismaillia, Egypt

An alpha blocker and a combination phytotherapy performed equally well—and better than placebo—against CPPS symptoms. Furthermore, the combination was even more effective, showed this randomized, controlled study. Alpha blockers did, however, ease urinary symptoms better than the phytotherapy. In the study, one group of 35 men took the alpha blocker doxazosin (Cardura) 2 mg/day, another group of 35 took saw palmetto and Pygeum africanum (African plum) in a "standard dose," a third group took the combination, and a fourth group took placebo. All the men filled out the NIH-CPSI questionnaire before and two months after treatment. In the alpha blocker, phytotherapy, and combination groups, symptoms improved by 66.8%, 41.3%, and 72.2% respectively. The combination therapy scores were significantly better than the phytotherapy scores. Quality of life improved 59.3% in the alpha blocker group, 58.4% in the phytotherapy group, and 71.4% in the combination group. Average urinary symptom scores were 6.1, 5.9, 6.5 and 6.2, respectively

Longer Alpha Blocker Therapy Proves Better for Chronic Prostatitis

Initial and long term responses to terazosin according to treatment periods in men with chronic prostatitis/chronic pelvic pain syndrome

In R Cho, JongGu Kim, KeonCheol Lee, JoonSeong Jeon, Koyang/ Kyunggido, Republic of Korea

This research team pitted long-term therapy with the alpha blocker terazosin (Hytrin) against short-term therapy and against either anti-inflammatory agents or muscle relaxants in men with CP/CPPS. All the men were age 45 or younger and had small prostates (to avoid confusion with BPH). All 128 patients evaluated in the study received levofloxacin (Levaquin) 300 mg/day for 12 weeks. One group took terazosin 3 to 4 mg/day for 3 months, one group for 24 months, and one group took either anti-inflammatory agents or muscle relaxants. Evaluations using the NIH-CPSI were done at the beginning of the study and three months and one year later. Clinical improvement was defined as a minimum 33% decrease in total NIH-CPSI score or a score of 2 or less on NIH-CPSI quality of life item. At three months, reductions in total scores and pain scores for the men taking terazosin were significantly greater than for those taking anti-inflammatories or muscle relaxants. One year later, 62% of the patients who had taken terazosin for six months had clinical improvement compared with 32% of those who had taken the short-term terazosin and 22% of those who took other therapies. This was not a blinded study.

Alpha Blockers Enhance Thermotherapy Results in Chronic Prostatitis

Minimal invasive treatment of men with cathegory IIIb (CPPS) prostatitis. A prospective multicenter trial: Results of the MICP study

Bob Djavan, Christian Seitz, Martina Nowak, Michael Dobrovits, Mike Harik, Alireza Nouri, Vienna, Austria; Vincent Ravery, Paris, France; Andreas Reisiegl, Vienna, Austria; Piotr Dobronski, Warsaw, Poland; Micheal Marberger, Vienna, Austria

This multicenter study showed long-term improvements after transurethral microwave thermotherapy (TUMT, which is also used for BPH) in 64 men with noninflammatory CP/CPPS. Alpha blocker therapy enhanced the results. The proportions of patients having at least "mild" improvement in their condition overall were 75% at one year, 67% at three years, and 42% at five years, and the proportions having "marked" improvement were 55% at one year, 48% at 3 years, and 31% at five years. The proportions who had "mild" improvement in NIH-CPSI scores were 82% at one year, 77% at three years, and 56% at five years, and the proportions who had marked improvement were 60% at one year, 49% at three years, and 36% at five years. On their poster, the researchers did not detail what criteria they used for "mild" and "marked" improvement. At five years, prostate volume had not changed significantly, but total PSA decreased 20%. Adding alpha-blocker therapy enhanced the "cumulative improvement rates" by 16% at five years. At two years, better-than-50% improvements in international prostate symptoms scores occurred in 51% of the men who received thermotherapy alone versus 64% of the combination therapy group. At three years, the comparable figures were 62% versus 71%, and at 5 years, they were 57% versus 65%. Quality-of-life score improvements of more than 50% occurred in 62% versus 84% at two years, 60% versus 85% at three years, and 54% versus 63% at five years. The investigators said that the combination therapy may offer a suitable option when medical therapy fails.

Botox Reduces Inflammation, Pain in Gland, Spinal Cord

Intraprostatic botulinum toxin A injection inhibits COX-2 expression and suppresses prostatic pain on capsaicin induced prostatitis model in rat

Yao-Chi Chuang, Kaohsiung Hsien, Taiwan; Naoki Yoshimura, Pittsburgh, PA; Chou-Cheng Huang, Po-Hui Chiang, Kaohsiung Hsien, Taiwan; Michael B Chancellor, Pittsburgh, PA

Aiming to investigate botulinum toxin A (Botox) as a potential therapy for CP/CPPS, these researchers injected a neutral substance and capsaicin, an irritant, into rat prostates. The prostates and spinal cord showed accumulation of inflammatory cells as well as an increase in COX-2, an enzyme involved in inflammation and pain, in the prostate and spinal cord at the level of the sixth lumbar vertebra. The researcher then pretreated the prostates with injection of Botox, which decreased accumulation of inflammatory cells, expression of COX-2 expression, and prostatic pain. The study was criticized for using the treatment before irritation rather than after. Other clinical studies have been done indicating Botox has potential as a treatment for CP/CPPS.

New, Old Fluoroquinolones Perform Similarly in Chronic Bacterial Prostatitis

Prulifloxacin versus Levofloxacin in the treatment of chronic bacterial prostatitis: a prospective, randomized, double-blind trial

Gianluca Giannarini, Andrea Mogorovich, Girolamo Morelli, Maurizio De Maria, Francesca Manassero, Cesare Selli, Pisa, Italy

These researchers tested a new fluoroquinolone, prulifloxacin, against levofloxacin (Levaquin) for chronic bacterial prostatitis in 96 men. They got either prulifloxacin 600 mg/day or levofloxacin 500 mg/day. The drugs did equally well at eradicating the bacteria and improving NIH-CPSI scores one week after treatment, although after two weeks, there was a trend toward lower symptom scores in the prulifloxacin group. Six months after therapy began, the reinfection rate was similar in both groups. Prulifloxacin did slightly better, although the difference was not statistically significant.

MARKERS AND BASIC RESEARCH

Prostate Stones May Point to Best Therapy for Chronic Prostatitis

Incidence and significance of prostatic stones in men with chronic prostatitis/chronic pelvic pain syndrome

Daniel A Shoskes, Chun-Te Lee, Donel Murphy, John Kefer, Hadley M Wood, Cleveland, OH

Calcifications, that is, stones in the prostate, are common in elderly men, but young men with CP/CPPS often have these. The stones have been implicated in symptoms, inflammation, and infections. In 47 new patients at this Cleveland prostatitis clinic, these researchers used transrectal ultrasound (TRUS) to look for stones. Twenty-two patients had them. There were no differences in symptoms between the men who had them and those who did not, but the men with the stones had had their symptoms for much longer (averaging a little more than seven years) than the men who didn't (averaging a little more than two years), even though the two groups were similar in age and prostate size. Men who had stones were much less likely to have pelvic floor tenderness but were more likely to have positive prostate fluid cultures for Gram-positive bacteria or known infectious bacteria and higher white blood cell counts in their prostatic fluid than men who did not have stones. Checking for these stones might tell clinicians which men could benefit from antibiotics or anti-inflammatory drugs and which ones could benefit from pelvic floor physical therapy.

Protein Search Yields Potential Markers, Treatment Target

A panel of potential diagnostic biomarkers for chronic prostatitis/chronic pelvic pain syndrome

Jordan D Dimitrakov, Boston, MA; Jayoung Kim, Jaeseop Lee, John Quackenbush, Boston, MA; Weidong Zhou, Lance Liotta, Emanuel Petricoin, III, Manassas, VA; David Zurakowski, Michael R Freeman, Boston, MA; J. Curtis Nickel, Kingston, ON, Canada

Proteomics is a fairly new approach to investigating disease using a large-scale protein identification. By identifying the differences in the particular proteins that people with a disease produce compared with healthy people, researchers can home in on disease markers, the causes of disease, and even treatments. Applying proteomics techniques to pre- and postprostatic massage urine of CP/CPPS patients and controls, these investigators identified 133 unique proteins in the postmassage urine of men with CP/CPPS. The top six protein candidates were PSA, zinc alpha 2 glycoprotein (ZA2G), neprilysin (NEP), aminopeptidase N (APN), decapentaplegic protein (DPP), and Tamm-Horsfall protein (THP). One of these may prove to be a useful biomarker. NEP is especially interesting because it is a protein that neutralizes enkephalin, one of the body's natural painkillers. This may be a basis of the pain in chronic prostatitis and also points to potential treatment.

Nerve Growth Factor Is Potential Biomarker

Nerve growth factor levels in prostatic fluid of patients with chronic prostatitis/chronic pelvic pain syndrome: association with diagnosis and treatment response

Toyohiko Watanabe, Shinya Uehara, Daishi Araki, Koichiro Wada, Miyabi Inoue, Ayano Ishii, Reiko Kariyama, Koichi Monden, Hiromi Kumon, Okayama, Japan

NGF is known to play a key role in several types of painful inflammatory conditions. To investigate whether it could be a biomarker in CP/CPPS, these investigators measured the levels of NGF in expressed prostatic fluid from 16 patients before and after eight weeks of treatment and in fluid from healthy controls. Levels were indeed higher in the patients than in the controls. Among the men with CP/CPPS, there were no differences in NGF levels in men with category IIIA (inflammatory) and IIIB (noninflammatory) prostatitis. The NGF levels in patients did correlate directly with levels of pain but not with urinary symptoms or quality of life. In men who responded to treatment, NGF levels went down significantly. NGF might make a good marker for evaluating CP/CPPS symptoms and response to treatment and might be involved in the disease process, the researchers concluded.

NF-kappaB Is Involved in Prostate Inflammation

Possible role of nuclear factor-kappaB in intraprostatic inflammation

Eugene V Vykhovanets, Sanjeev Shukla, Gregory T MacLennan, Martin I Resnick, Cleveland, OH; Harald Carlsen, Rune Blomhoff, Oslo, Norway; Sanjay Gupta, Cleveland, OH

NF-kappaB influences the activity of many genes involved in inflammation. To judge whether NF-kappaB is involved in prostate inflammation, the researchers injected a proinflammatory cytokine into mice with a gene that helped illuminate where NF-kappaB was in the body. They showed high levels of NF-kappaB activity in the intestine, spleen, lungs, prostate, thymus, and skin. Mononuclear cells, a type of white blood cell involved in inflammation, accumulated in the small blood vessels and in the prostate. Giving the mice the anti-inflammatory and immunosuppressive drug dexamethasone reduced the migration of the mononuclear cells and the severity of inflammation in the prostate.

PROSTATE INFLAMMATION, BPH, AND CANCER

Prostate Inflammation May Play Role in BPH

Does intraprostatic inflammation have a role in the pathogenesis and progression of benign prostatic hyperplasia?

Vibhash C Mishra, Darrell J Allen, Charles Hudd, Omer Karim, Hanif Motiwala, Marc E Laniado, Slough, United Kingdom

Inflammation in the prostate appears to plays an important role in the role in benign prostatic hyperplasia (BPH), also known as prostate enlargement. These researchers reached this conclusion based on their finding that among men who underwent surgery for BPH (transurethral resection of the prostate), 69% of the men who had urinary retention had acute or chronic prostate inflammation compared with 43% of the men who had only lower urinary tract symptoms.

Prostate Inflammation May Be Related to BPH

The relationship between prostate inflammation and lower urinary tract symptoms: examination of baseline data from the REDUCE trial

J. Curtis Nickel, Kingston, ON, Canada; Claus G. Roehrborn, Dallas, TX; Michael P. O'Leary, Boston, MA; David G. Bostwick, Glen Allen, VA; Matthew C. Somerville, Roger S. Rittmaster, Research Triangle Park, NC

This study looked for a relationship between the degree of prostate inflammation (other than acute inflammation) in biopsy specimens and scores for lower urinary tract symptoms typical of BPH. There was a correlation between the severity of symptoms and the degree of inflammation, but the relationship wasn't strong. However, the researchers will be looking more closely at the relationship between inflammation and symptoms during a four-year follow-up.

Prostate Inflammation Shows Relationship with BPH, but Not Cancer

Evaluation of inflammation in autopsied prostates: Is prostatitis more associated with BPH or cancer?

Nicolas B Delongchamps, Vishal Chandan, Richard Jones, Gregory Threatte, Mary Jumbelic, Gustavo de la Roza, Syracuse, NY; Vincent Ravery, Paris, France; Gabriel P Haas, Syracuse, NY

These researchers looked at the relationship between prostate cancer, BPH, and chronic and acute inflammation in the prostates of men who had died and who didn't have a clinical history of prostate cancer. Chronic inflammation proved to be common (occurring in 68%). It wasn't associated with prostate cancer, but it was with BPH. In prostate glands that showed BPH, inflammation was evident closer to BPH nodules and wasn't near the cancer.

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