Bartoletti R, Gavazzi A, Cai T, Mondaini N, Morelli A, Del Popolo G, Geppetti P. Prostate growth and prevalence of prostate diseases in early onset spinal cord injuries. Eur Urol. July 2009 (Vol. 56, Issue 1, Pages 142-150)

ABSTRACT:

SOURCE

Department of Urology, University of Florence, Florence, Italy. riccardo.bartoletti@asf.toscana.it

BACKGROUND

Controversial data on modifications of prostate size, function and disease of spinal cord injury (SCI) patients has been previously reported.

OBJECTIVE

An analytical observational cohort study on male SCI patients was planned in order to evaluate prostate gland growth, including benign prostatic hyperplasia in relation to the age of the patient at SCI onset. Additional evaluations considered hormonal and biochemical parameters and prostate cancer.

DESIGN, SETTING AND PARTICIPANTS

113 SCI patients (mean age 61.3) and 109 age-matched able bodied subjects (mean age 65.4) were enrolled and stratified according to the patient age at SCI onset (< or = 30, 31-49, and > or = 50 years).

INTERVENTION

A complete medical history was then collected from all SCI patients and able bodied subjects.

MEASUREMENTS

Total prostate antigen (PSA) and testosterone (T) serum levels and urine culture were collected. Digital rectal examination and transrectal ultrasonography were performed.

RESULTS AND LIMITATIONS

Patients with SCI showed PSA value and prostate size significantly lower than those observed in able bodied subjects, and an inverse relationship was observed in SCI patients between these two parameters and patient age at the time of lesion onset. T serum levels were lower in SCI patients when compared to able bodied subjects. No SCI patient presented prostate cancer, while 9.7% of control subjects were affected by prostate cancer.

CONCLUSIONS

Prostate volume and PSA levels are lower in SCI patients and are inversely related to the patient age at lesion onset. Whether this effect is mediated directly or indirectly by a impaired nerve supply to the prostate remains to be determined. Despite the present observation of reduced prostate disease, as during the last twenty years life expectancy in SCI patients has improved significantly, the need to screen these patients for the occurrence of prostate disease should not be disregarded.