Effects of prostatic inflammation on LUTS and alpha blocker treatment outcomes

Abstract

ARTICLE INFO ______________________________________________________________ ______________________Purpose: To evaluate the association between prostatic inflammation and lower urinary tract symptoms (LUTS), and to identify the effects of prostatic inflammation on the treatment with an alpha blocker. Materials and Methods:111 Participants who were aged ≥ 50 years, the presence of LUTS (maximal flow rate < 20 m/s, IPSS ≥ 11), and an elevated PSA level (3-20ng/mL) were treated with tamsulosin 0.2mg once daily for 3 months after prostate biopsies. Prostatic inflammation was scored as none (0), mild (I), moderate (II), or marked (III). LUTS parameters including urine flow rates, IPSS, PSA, and prostate volume were evaluated.Results: Inflammation grading resulted in 25, 60, and 26 patients that were grade 0, I, and II, respectively. Lower grade inflammation was related to higher urine flow rate at baseline. Patients with higher inflammation grades had larger prostate volumes, larger total and transitional zone volumes, and higher PSA levels. Overall, urine flow rates and residual urine volume were improved after 3 months of alpha blocker therapy. Eighty percent of patients with grade 0 inflammation, 73% of patients with grade I inflammation, and 92.3% of patients with grade II inflammation showed improvement of LUTS after treatment. Longer duration of treatment was related to a decreased chance of improvement of LUTS. Patients with increased IPSS voiding subscales could be predictive of improvement of LUTS. Conclusions: Patients with high grade inflammation had lower flow rates and higher prostatic volumes than patients with low grade inflammation. Inflammation grade did not affect the outcomes of alpha blocker treatment.

Inflammation is a target of medical treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia

“…However, this study did not distinguish between the effect of α 1 -adrenoceptor antagonists and 5ARIs. Another retrospective Korean study in 111 LUTS/BPH patients treated with the α 1 -adrenoceptor antagonist tamsulosin 0.2 mg/day for only 3 months indicated that the improvement in LUTS was independent of the inflammation grade [ 39 ]. However, multivariate analysis suggested that longer duration of treatment was associated with decreased symptomatic improvement (odds ratio 0.92; 95% CI 0.85–0.99).…”

An observational study of the use of beclomethasone dipropionate suppositories in the treatment of lower urinary tract inflammation in men

“…The mean change from baseline was 2.1 ± 7.9 ( P = 0.0767) in patients taking only BDP and 4.7 ± 7.9 ( P <.0001) in patients also taking SR. This may indicate a worsening of IPSS, especially in patients taking both treatments, although a temporary increase in score prior to final improvement is quite common in inflammations of the lower urinary tract [ 23 ]. In fact, IPSS is more accurate for the evaluation of voiding symptoms, whereas BDP is an anti-inflammatory medication and is therefore meant to act mainly on symptoms of the lower urinary tract defined as storage symptoms [ 24 ].…”