Lower urinary tract symptom improvement after radical prostatectomy correlates with degree of prostatic inflammation.
OBJECTIVE
To determine if prostatic inflammation at the time of radical prostatectomy (RP) was associated with the International Prostate Symptom Score (IPSS).


METHODS
We performed a proof of principle analytic case control study of patients who underwent RP between January 2005 and August 2008 for lower urinary tract symptoms (LUTS). We reviewed pathology slides of those who had a change of 4 points or greater, as measured by the IPSS and correlated inflammation with change in IPSS. Multivariate linear regression analyses were performed to determine the association of IPSS with degree of inflammation based on the number of inflammatory cells.


RESULTS
Of 249 patients, 136 had complete data and 47 (18.8%) underwent pathologic review. The median change in IPSS for the study cohort was -7.0 points compared to +1.0 point for the control cohort. On univariate analysis, the average improvement in IPSS in patients with severe inflammation was (r = -6.02, 95% confidence interval [CI] -11.0 to -1.1, P = .018) after RP. On multivariate analysis, adjusting for age, body mass index (BMI), year of surgery, history of prostatitis, Gleason score, prostate-specific antigen (PSA), prostate weight, and nerve sparing status, only patients with severe prostatic inflammation had significant improvement in their IPSS (r = -5.93, 95% CI -10.81 to -1.04, P = .004).


CONCLUSIONS
Prostatic inflammation measured in prostatectomy specimens is associated with worse baseline IPSS than matched cohorts. Specifically, severe inflammation is an independent predictor of IPSS improvement at 1 year after RP.
Department of Urology, University of Virginia Health System, Charlottesville, VA.
Michael B
MB
Burris
Department of Urology, University of Virginia Health System, Charlottesville, VA.
Helen P
HP
Cathro
Institute of Urology, Lahey Clinic, Burlington, MA.
Casey G
CG
Kowalik
Department of Urology, University of Virginia Health System, Charlottesville, VA.
Drew
D
Jensen
Department of Urology, University of Virginia Health System, Charlottesville, VA.
Stephen H
SH
Culp
Department of Urology, University of Virginia Health System, Charlottesville, VA.
William D
WD
Steers
Department of Urology, University of Virginia Health System, Charlottesville, VA. Electronic address: TLK6F@virginia.edu.
Tracey L
TL
Krupski
D000368:Aged; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy; D011472:Prostatitis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index