Prostate stiffness is a risk factor for voiding dysfunction

Mar 24 2014

By Joanna Lyford, Senior medwireNews Reporter

Prostate elasticity is an independent risk factor for urinary voiding symptoms, although not for lower urinary tract symptoms (LUTS) in general or storage symptoms, clinical research indicates.

Koon Ho Rha (Yonsei University, Seoul, Republic of Korea) and colleagues undertook a post-hoc analysis of the Indenter Study, which included 48 men undergoing radical prostatectomy. The study used a novel robotic palpation system to measure prostate tissue elasticity, with the aim of developing a “tissue elasticity map” for prostate cancer localisation.

Using the system, prostate specimens are assessed within 30 minutes of surgical excision, with elasticity being defined as the mean elastic modulus in kPa at 21 sites across the posterior surface of the prostate. A higher elastic modulus indicates greater stiffness.

The men’s median age was 66 years, the median prostate volume was 43.4 mL and the median elastic modulus of the prostate was 20.8 kPa, report Rha and co-authors in Urology.

Compared with the 22 men with a below-median prostate elastic modulus, the 26 men with an above-median elastic modulus (greater prostate stiffness) were older, had higher levels of prostate-specific antigen (PSA), larger prostates and larger tumour volumes. These differences were not statistically significant, however.

Men with higher prostate stiffness had a significantly higher incidence of LUTS (84.6 vs 59.1%) and voiding symptoms (84.6 vs 54.5%) compared with men with below-median stiffness. The incidence of storage symptoms did not differ between groups.

In multivariate analysis, higher stiffness was a significant independent risk factor for voiding symptoms. Prostate stiffness did not predict either LUTS or storage symptoms, however. Also, older age was an independent risk factor for storage symptoms.

The researchers note that prostate stiffness may reflect fibrotic changes in the periurethral tissue, or may be associated with prostate inflammation.

“Additional studies investigating various factors that affect the elasticity of the prostate would be helpful”, the authors write. “In addition, it is important to consider prostate elasticity when interpreting and managing lower urinary tract dysfunction in clinical practice.”

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