Prostatitis In Men Research Articles

CELL RELATIONSHIP IN A WISTAR RAT MODEL OF SPONTANEOUS PROSTATITIS

Prostatitis in men is a painful, noninfectious inflammatory condition. It is similar to interstitial cystitis which is associated with increased bladder mast cell and sensory nerve fiber density as well as suprapubic pain. Certain strains of rats may provide a useful model for studies of the development of spontaneous prostatitis. We evaluated the time course, and involvement of mast cells and sensory nerve fibers in this process using Wistar rats. The prostates of 4, 6, 8, 10 and 13-week-old male Wistar rats were examined for the degree of inflammation, innervation, mast cell density and nerve mast cell relationship using histochemical and immunocytochemical studies. Bacterial cultures of tissue were performed at 13 weeks. The inflammatory cell index increased progressively with age. Inflammation was moderate and consisted mostly of lymphocytes and macrophages associated with occasional glandular epithelial necrosis and edema. The density of nerve fibers immunoreacting with the neuronal marker protein gene produce 9.5 increased gradually with age and fibers immuno-positive for the sensory neuropeptide calcitonin gene-related peptide more than doubled by 13 weeks compared with by 4 weeks. The density of visible mast cells declined after 4 weeks in a pattern that corresponded with the increased percent of mast cells undergoing degranulation. For the mast cells with calcitonin gene-related peptide immuno-positive nerve fibers within a distance of 40 microm. distance correlated significantly with the degree of degranulation. Bacterial cultures were negative at 13 weeks. Our results confirm previous reports of spontaneous prostatitis in Wistar rats and indicate that moderate inflammation may occur in 80% of rats at as early as age 13 weeks. While the correlation of the nerve mast cell axis with mast cell degranulation does not prove our hypothesis of mast cell mediated inflammatory mediator release in the development of nonbacterial prostatitis, it suggests that such a relationship is possible.

PROSPECTIVE IDENTIFICATION OF NATIONAL INSTITUTES OF HEALTH CATEGORY IV PROSTATITIS IN MEN WITH ELEVATED PROSTATE SPECIFIC ANTIGEN

Although prostatitis may cause elevated prostate specific antigen (PSA), asymptomatic patients are not routinely screened for this diagnosis before transrectal biopsy is performed to rule out cancer. Many negative biopsies reveal evidence of prostatitis classified as National Institutes of Health (NIH) category IV prostatitis or asymptomatic inflammation. To our knowledge this report represents the initial study of the incidence of NIH category IV prostatitis in men before biopsy and its clinical significance. From 1996 to 1998 asymptomatic men with elevated PSA levels were evaluated for laboratory signs of prostatitis. Patients with expressed prostatic secretions or post-prostate massage urine (voiding bottle 3 [VB3]) positive for greater than 20 and greater than 10 white blood cells per high power field, respectively, received antibiotics for 4 weeks and were reevaluated after 6 to 8 weeks. Men without these clinical signs promptly underwent biopsy. Those with acute urinary tract infection and PSA greater than 30 ng./ml., without a rectum or who refused biopsy were excluded from study. Of the 187 study patients 122 were evaluable with a mean PSA of 9.35 ng./ml., including 51 (42%) with laboratory signs of prostatitis. After treatment PSA was normal in 22 cases and remained elevated in 29, including 9 in which biopsy revealed cancer. The change or improvement in PSA was significantly greater in men with benign results than in those with prostate cancer (-21.32 versus -1.33%, p = 0.001). In the cohort with negative expressed prostatic secretion and VB3 results transrectal ultrasound guided biopsy was done promptly. Screening decreased the number of biopsies by 18% (22 of 122 cases). The positive predictive value of PSA for detecting biopsy proved cancer improved with screening for prostatitis (45 of 122 cases or 37% versus 36 of 71 or 51%). Long-term followup revealed continued normal or stable PSA in the prostatitis cohort. Screening for NIH category IV prostatitis should be considered in men with elevated PSA. Although patients may be asymptomatic, anxiety caused by prostate cancer and diagnostic procedures contributes to the clinical significance of this disorder.

EVALUATION OF THE BACTERIAL FLORA OF THE PROSTATE USING A 16S rRNA GENE BASED POLYMERASE CHAIN REACTION

The role of bacteria in the chronic pelvic pain syndrome (nonbacterial prostatitis and prostatodynia) is controversial and difficult to assess because the bacterial flora of the prostate is not well defined. Polymerase chain reaction (PCR) is a highly sensitive molecular method of bacterial detection. It confirms the sterility of tissue with a high level of confidence and detects small numbers of microbial agents that may represent pathogens. We performed PCR to determine bacterial colonization of the prostate in presumably healthy men and in those undergoing simple or radical prostatectomy. We analyzed 28 prostate samples from 18 organ donors from whom prostate tissue was obtained under sterile surgical conditions at organ withdrawal, 14 sterile surgical prostate specimens from 7 patients undergoing radical prostatectomy for prostate cancer who previously underwent transrectal biopsy and 6 sterile surgical specimens from 2 men who underwent simple prostatectomy for benign prostatic hyperplasia (BPH), including 1 with an indwelling catheter for several weeks. For PCR we used 2 sets of primers to detect bacterial 16S rRNA gene sequences. Normal prostate tissue seeded in vitro with known numbers of Escherichia coli was used to assess the sensitivity of PCR. Only 3 of the 28 organ donor samples had histological signs of minimal inflammation and all other samples appeared to be normal without evidence of inflammatory reaction. All of these samples were PCR negative. Of several PCR control reactions the mixture of prostate tissue seeded with known numbers of E. coli demonstrated the high sensitivity of the assay, allowing the detection of as few as 6 bacteria in the presence of 25 mg. of prostate tissue. A focal and heterogeneous distribution of inflammation and infection was noted in the 14 radical prostatectomy specimens. In the prostate cancer and BPH groups there was a strong association of inflammation with positive PCR findings. Of 11 samples 3 without but all 9 with inflammation were PCR positive. PCR is a highly sensitive method for detecting bacteria in the prostate. In our study negative PCR reactions in the prostate tissue of apparently healthy men made the presence of normal bacterial flora in the prostate extremely unlikely. The presence of bacteria and/or inflammation in radical prostatectomy specimens was found to be a localized process. Concordance between inflammation and positive PCR results in simple and radical prostatectomy specimens suggests that bacteria may frequently have a role in histologically inflammatory prostatitis.

Prostate-specific antigen and prostatitis in men under fifty.

To evaluate the occurrence of increased prostate-specific antigen (PSA) serum concentration in patients with prostatitis and low incidence of benign prostatic hyperplasia and prostatic cancer, PSA was measured in a selected population. PSA levels were evaluated in 72 patients with prostatitis under 50 years of age. An increased PSA (> 4 ng/ml) was found in 5/7 (71%) patients with acute prostatitis, and in 2/13 (15%) and 2/32 (6%) patients with chronic bacterial and abacterial prostatitis, respectively. No patient with prostatodynia had an increased PSA. In patients with bacterial prostatitis PSA level decreased to normal value after effective antibiotic therapy in most cases. Prostatitis must be considered when using PSA as tumor marker.

Complicated UTI and prostatitis in men.

Complicated UTI and prostatitis in men.

Prostatitis: A Review

Although prostatitis is a common affliction of man, correct therapy depends upon the physician's recognition of the specific type of prostatitis with which he is dealing. Acute bacterial prostatitis, with its characteristic symptom complex, is generally easy to recognize and demands organism-specific antibacterial therapy. Chronic bacterial prostatitis, however, is variable in clinical manifestation and is now recognized as perhaps the most common cause of relapsing urinary tract infection in men. Techniques of bacteriologic localization cultures are presented for the accurate diagnosis of chronic bacterial prostatitis. The cure of chronic bacterial prostatitis is difficult to achieve with most antibacterial agents because most of these agents do not diffuse from plasma across relatively uninflamed prostatic epithelium to enter into the prostatic fluid where the bacteria reside. Until recently therapy for patients who have chronic bacterial prostatitis has been limited to either attempts to remove all infected foci of tissue by surgical means or maintenance of the patient on continuous, low dose suppressive antibacterial therapy. A new antibacterial agent, trimethoprim, meets all of the theoretical requirements for diffusion into prostatic fluid and has been shown to actually concentrate in the prostatic fluid of dogs. Because combining trimethoprim with sulfonamides results in synergistic antibacterial activity, for clinical use in this country trimethoprim has been combined with sulfamethoxazole, a sulfonamide that has a similar half-life in plasma. Research protocols to date have shown that this drug combination can cure chronic bacterial prostatitis in some patients. Abacterial prostatitis (“prostatosis”) is characterized by increased numbers of leukocytes and oval fat bodies in the expressed prostatic secretions and symptoms that often simulate those of chronic bacterial prostatitis; however, an infectious agent cannot be demonstrated. Therapy must be directed towards reassurance and symptomatic relief and antibacterial agents should not be used. Although recent years have produced speculation regarding a viral etiology to cases of prostatitis, studies to date have failed to confirm viral prostatitis. Prostatitis due to Trichomonas vaginalis organisms may occur, but is difficult to prove. Rare cases of prostatitis due to specific fungi have been reported but are generally secondary to a generalized mycosis. Nonspecific granulomatous prostatitis is occasionally seen and must be differentiated clinically from carcinoma of the prostate. The discovery of an antibacterial factor in both canine and human prostatic fluid that is highly bactericidal against most urinary pathogens is exciting and suggests that this factor may play a role as a natural defense mechanism against the development of urinary tract infections and prostatitis in men. Preliminary work has shown either total absence or markedly reduced amounts of this factor in patients who have chronic prostatitis.