Prostate Growth and Prevalence of Prostate Diseases in Early Onset Spinal Cord Injuries

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 (<= 30, 31-49, and >= 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. (C) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.