Correlates and prevalence of prostatitis in a large community-based cohort of older men

Acute and Chronic Infectious Prostatitis in Older Adults

Acute and chronic bacterial prostatitis are clinically significant entities that can be difficult to diagnose and appropriately treat. Herein, we review when to suspect these clinical conditions, how to diagnose them, and how to effectively treat them based on the extant literature. Our aim was to equip the practicing clinician with the ability to proficiently diagnose and manage acute and chronic bacterial prostatitis, particularly in older patients.

A potential therapeutic strategy for prostatic disease by targeting the oral microbiome

Nowadays, human microbiome research is rapidly growing and emerging evidence has witnessed the critical role that oral microbiome plays in the process of human health and disease. Oral microbial dysbiosis has been confirmed as a contributory cause for diseases in multiple body systems, ranging from the oral cavity to the gastrointestinal, endocrine, immune, cardiovascular, and even nervous system. As research progressing, oral microbiome‐based diagnosis and therapy are proposed and applied, which may represent potential drug targets in systemic diseases. Recent studies have uncovered the possible association between periodontal disease and prostatic disease, suggesting new prevention and therapeutic treatment for the disease by targeting periodontal pathogens. Thus, we performed this review to first explore the association between the oral microbiome and prostatic disease, according to current knowledge based on published articles, and then mainly focus on the underlying molecular and cellular mechanisms and the potential prevention and treatment derived from these mechanistic studies.

The Crosstalk between Prostate Cancer and Microbiota Inflammation: Nutraceutical Products Are Useful to Balance This Interplay?

The human microbiota shows pivotal roles in urologic health and disease. Emerging studies indicate that gut and urinary microbiomes can impact several urological diseases, both benignant and malignant, acting particularly on prostate inflammation and prostate cancer. Indeed, the microbiota exerts its influence on prostate cancer initiation and/or progression mechanisms through the regulation of chronic inflammation, apoptotic processes, cytokines, and hormonal production in response to different pathogenic noxae. Additionally, therapies' and drugs' responses are influenced in their efficacy and tolerability by microbiota composition. Due to this complex potential interconnection between prostate cancer and microbiota, exploration and understanding of the involved relationships is pivotal to evaluate a potential therapeutic application in clinical practice. Several natural compounds, moreover, seem to have relevant effects, directly or mediated by microbiota, on urologic health, posing the human microbiota at the crossroad between prostatic inflammation and prostate cancer development. Here, we aim to analyze the most recent evidence regarding the possible crosstalk between prostate, microbiome, and inflammation.

GRB2-associated binding protein 2 regulates multiple pathways associated with the development of prostate cancer

The development of prostate cancer is complicated and involves a number of tumor-associated gene expression level abnormalities. Gene chip technology is a high-throughput method that can detect gene expression levels in different tissues and cells on a large scale. In the present study, gene chip technology was used to screen differentially expressed genes in PC-3 human prostate cancer cells following GRB-associated binding protein 2 (GAB2) gene knockdown, and the corresponding biological information was analyzed to investigate the role of GAB2 in prostate cancer. The PC-3 human prostate cancer cell GAB2 gene was knocked out and gene chip hybridization and bioinformatics methods were used to analyze the classical pathway and predict upstream regulatory molecules, disease and function associations and genetic interaction networks. According to the screening conditions |fold change|>1 and P<0.05, 1,242 differential genes were screened; 665 genes were upregulated, and 577 genes were downregulated. Ingenuity Pathway Analysis software demonstrated that GAB2 regulates pathways, such as the superpathway of cholesterol biosynthesis and p53 signaling in cells, and serves a role in diseases and functions such as 'non-melanoma solid tumors', 'viral infections' and 'morbidity or mortality'. In the occurrence and development of prostate cancer, factors such as the activation of genes involved in the proliferative cycle, abnormalities in metabolism-associated enzyme gene activities and viral infection play key roles. The present study provides novel research directions and therapeutic targets for prostate cancer.

The Lifetime Risk and Prognosis of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in the Middle-Aged Chinese Males

Knowledge is limited about the lifetime risk of chronic pelvic pain syndrome (CPPS) occurrence in Chinese middle-aged males and the prognosis of CPPS patients with and without treatment. Noninstitutionalized Chinese males aged 40 to 81 years were enrolled in this study from a total of 76 local communities across 30 provinces of China. Information about the occurrence of CPPS, symptom relief, and previous treatment was collected. Based on completed answers to specific questions about self-reported and physician-diagnosed CPPS, the lifetime risk of CPPS occurrence was 25.3% (1,091 out of 4,315) in Chinese males aged 40 to 81 years. Over 77% of patients with CPPS had received treatment. The symptom relief rate was not significantly different between the treatment (57.3%, 142/248) and nontreatment (50.1%, 422/843) groups. Regardless of whether patients had received medical treatment, engagement in sedentary work and regular alcohol consumption had a significant negative influence, while marriage had a positive influence, on the prognosis of CPPS. A good prognosis could be achieved without treatment for some cases of CPPS, while others required a timely symptom-orientated treatment using adequate medications combined with lifestyle adjustment and follow-up.

Correlation between Prostatitis, Benign Prostatic Hyperplasia and Prostate Cancer: A systematic review and Meta-analysis

Background: No consensus has been reached on the definite associations among prostatitis, benign prostatic hyperplasia (BPH) and prostate cancer (PCa). Hence, this meta-analysis was conducted to explore their triadic relation by summarizing epidemiological evidence.

Methods: Systematical and comprehensive retrieval of online databases PubMed, PMC, EMBASE and Web of Science was performed to acquire eligible studies, up to April 1st, 2019. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to clarify their correlations.

Results: A total of 42 studies were enrolled in the quality assessment and 35 were finally included in the meta-analyses. Among them, 27 studies were included to describe the association between prostatitis and PCa (OR=1.72, 95% CI=1.44-2.06, I²=90.1%, P<0.001). 21 studies presented significant evidence about the relation between BPH and PCa (OR=2.16, 95% CI=1.75-2.88, I²=97.1%, P<0.001). Due to the huge heterogeneity among studies, those with obvious outliers were excluded based on the Galbraith plots. Ultimately, 17 studies were screened out to assess the association between prostatitis and PCa (OR=1.59, 95% CI=1.48-1.70, I²=29.4%, P=0.123). Meanwhile, 8 studies were retained to evaluate the association between BPH and PCa (OR=3.10, 95% CI=2.87-3.35, I²=8.4%, P=0.365). As for the relation between prostatitis and BPH, a case-control study and a cohort study both supported that prostatitis could enhance the risk of BPH.

Conclusions: Significant correlations were revealed among prostatitis, BPH and PCa. Prostatitis or BPH could lead to escalating risks of PCa. Meanwhile, people with a history of prostatitis might be more vulnerable to BPH.

The human gastrointestinal microbiota and prostate cancer development and treatment

The human gastrointestinal microbiome contains commensal bacteria and other microbiota that have been gaining increasing attention in the context of cancer development and response to treatment. Microbiota play a role in the maintenance of host barrier surfaces that contribute to both local inflammation and other systemic metabolic functions. In the context of prostate cancer, the gastrointestinal microbiome may play a role through metabolism of estrogen, an increase of which has been linked to the induction of prostatic neoplasia. Specific microbiota such as Bacteroides, Streptococcus, Bacteroides massiliensis, Faecalibacterium prausnitzii, Eubacterium rectalie, and Mycoplasma genitalium have been associated with differing risks of prostate cancer development or extensiveness of prostate cancer disease. In this Review, we discuss gastrointestinal microbiota's effects on prostate cancer development, the ability of the microbiome to regulate chemotherapy for prostate cancer treatment, and the importance of using Next Generation Sequencing to further discern the microbiome's systemic influence on prostate cancer.

The effect of mast cells on the biological characteristics of prostate cancer cells

Aim of the study

To investigate the effects of mast cells on the proliferation, invasion, and metastasis of prostate cancer cells.

Material and methods

The mast cell P815 and prostate cancer LNCaP cells were chosen using a Transwell chamber to construct a two-cell cocultured in vitro model to observe the migration of mast cells to prostate cancer cells.

Results

In the migration experiment, the migration rate of mast cells from the experimental group (%) was 10.167 ±0.833, the mast cell migration rate (%) of the control group was 0.833 ±0.208, and the difference was statistically significant (p < 0.05). The MTT test showed that the OD value of cells in each group over time increased gradually, and 24 h after LNCaP cells were cocultured with different concentrations of mast cells, the OD value was significantly higher than that of the control group (p < 0.05). QRT-PCR and western blot results showed that, compared with the control group, E-cad expression from the experimental group was significantly weakened; N-cad and vimentin expression increased (p < 0.05), and c-kit and SCF expression from experimental group were significantly higher than that of the control group (p < 0.05). After the addition of c-kit neutralising antibodies, compared with the control group, the mast cell migration rate of experimental group decreased significantly and prostate cancer cell proliferation significantly decreased (p < 0.05).

Conclusions

Mast cells could promote the proliferation of prostate cancer cells and the occurrence of epithelial mesenchymal transition (EMT), which could promote the invasion and metastasis of prostate cancer cells.

Twist1/Dnmt3a and miR186 establish a regulatory circuit that controls inflammation-associated prostate cancer progression

Increasing evidences suggest that inflammatory microenvironment has a crucial role in prostate cancer (PCa) progression; however, the underlying mechanisms are unclear. Here, we used the inflammation-associated prostate cellular transformation model to screen out a crucial microRNA, miR186, which was significantly downregulated in the transformed cells and effectively rescued the transformed phenotype. On stimulation of inflammatory cytokines, the activated nuclear factor kappa B (NF-κB)/p65 was able to induce miR186 expression through binding to its promoter in non-transformed cells, whereas this pathway was lost in transformed cells. Interestingly, Twist1, which is a reported downstream target of miR186, was responsible for the loss of NF-κB/p65-miR186 pathway. Twist1 downregulated miR186 expression in a novel negative feedback loop binding to the E-box and simultaneously recruiting Dnmt3a, which facilitated the site-specific CpG methylation of the miR186 promoter, thereby blocked the transcriptional activity of NF-κB/p65 and the responsiveness of miR186 to inflammatory signals. The high level of Twist1 triggered this feedback loop that underlies the epigenetic switch, which was essential for maintaining transformed and advanced PCa state. Finally, our clinical data confirmed that the CpG methylation and miR186 expression levels were closely related with inflammation-associated human PCa progression.

Prostate cancer incidence in men with self-reported prostatitis after 15 years of follow-up

Controversy exists regarding a possible association between prostatitis and prostate cancer. To further evaluate the incidence of prostate cancer following prostatitis, a study of prostate cancer incidence in a cohort of Finnish men was performed. The original survey evaluating self-reported prostatitis was conducted in 1996-1997. A database review was conducted focusing on prostate cancer diagnoses in the cohort. In 2012, there were 13 (5.2%) and 27 (1.8%) prostate cancer cases among men with (n=251) and without (n=1,521) prostatitis symptoms, respectively. There were no significant differences in age, primary therapy distribution, prostate-specific antigen levels, Gleason score, clinical T-class at the time of prostate cancer diagnosis, or time lag between the original survey and prostate cancer diagnosis. The standardized incidence ratio (SIR) of prostate cancer was 1.16 [95% confidence interval (CI), 0.62-1.99] and 0.44 (95% CI, 0.29-0.64) among men with and without prostatitis symptoms, respectively. After 15 years of follow-up subsequent to self-reported prostatitis, no evident increase in incidence of prostate cancer was detected among Finnish men with prostatitis symptoms. The higher percentage of prostate cancer among men with prostatitis symptoms appears to be due to coincidentally low SIR of prostate cancer among men without prostatitis symptoms, and may additionally be due to increased diagnostic examinations. Further research is required to confirm this speculation.

Detection of DNA viruses in prostate cancer

We tested prostatic secretions from men with and without prostate cancer (13 cases and 13 matched controls) or prostatitis (18 cases and 18 matched controls) with metagenomic sequencing. A large number (>200) of viral reads was only detected among four prostate cancer cases (1 patient each positive for Merkel cell polyomavirus, JC polyomavirus and Human Papillomavirus types 89 or 40, respectively). Lower numbers of reads from a large variety of viruses were detected in all patient groups. Our knowledge of the biology of the prostate may be furthered by the fact that DNA viruses are commonly shed from the prostate and can be readily detected by metagenomic sequencing of expressed prostate secretions.

Lifestyle and Risk of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in a Cohort of United States Male Health Professionals

PURPOSE

Although chronic prostatitis/chronic pelvic pain syndrome is a prevalent urological disorder among men of all ages, its etiology remains unknown. Only a few previous studies have examined associations between lifestyle factors and chronic prostatitis/chronic pelvic pain syndrome, of which most were limited by the cross-sectional study design and lack of control for possible confounders. To address these limitations we performed a cohort study of major lifestyle factors (obesity, smoking and hypertension) and chronic prostatitis/chronic pelvic pain syndrome risk in the HPFS (Health Professionals Follow-up Study), a large ongoing cohort of United States based male health professionals.

MATERIALS AND METHODS

The HPFS includes 51,529 men who were 40 to 75 years old at baseline in 1986. At enrollment and every 2 years thereafter participants have completed questionnaires on lifestyle and health conditions. In 2008 participants completed an additional set of questions on recent chronic prostatitis/chronic pelvic pain syndrome pain symptoms modified from the NIH (National Institutes of Health)-CPSI (Chronic Prostatitis Symptom Index) as well as questions on approximate date of symptom onset. The 653 participants with NIH-CPSI pain scores 8 or greater who first experienced symptoms after 1986 were considered incident chronic prostatitis/chronic pelvic pain syndrome cases and the 19,138 who completed chronic prostatitis/chronic pelvic pain syndrome questions but did not report chronic prostatitis/chronic pelvic pain syndrome related pain were considered noncases.

RESULTS

No associations were observed for baseline body mass index, waist circumference, waist-to-hip ratio, cigarette smoking and hypertension with chronic prostatitis/chronic pelvic pain syndrome risk (each OR ≤1.34).

CONCLUSIONS

In this large cohort study none of the lifestyle factors examined was associated with chronic prostatitis/chronic pelvic pain syndrome risk. As the etiology of chronic prostatitis/chronic pelvic pain syndrome remains unknown, additional prospective studies are needed to elucidate modifiable risk factors for this common condition.

The Differential Expression and Function of the Inflammatory Chemokine Receptor CXCR5 in Benign Prostatic Hyperplasia and Prostate Cancer

BACKGROUND

Chemokine and chemokine receptors could have played an important role in tumor angiogenesis and distant metastasis. The mechanism of inflammation, expression and function of chemokines and chemokine receptors in benign prostatic hyperplasia (BPH) and prostate cancer (PCa) remain unclear. The purpose of present study is to detect differential expression and function of chemokines and chemokine receptors (CCRs) in BPH and PCa.

METHODS

BPH-1 and peripheral blood mononuclear cells (PBMCs) were co-cultured in Transwell chambers, and human normal prostate (NP) tissues, BPH tissues and PCa tissues were collected. CCR gene-chips were used to analyze and compare the differential expression of CCRs in BPH-1 cells, BPH-1 cells co-cultured with PBMCs, and LNCaP cells. The differential expression of CCRs was detected and validated using real-time PCR, western blotting and immunofluorescence (IF). The proliferation of LNCaP cells was also investigated after the knockdown CXCR5.

RESULTS

RESULTS of gene-chips indicated that there was low or no expression of CCR10, CXCR1, CXCR3 and CXCR5 in BPH-1 cells, whereas the expression of these receptors in BPH-1 cells was increased by PBMCs, and the expression was high in LNCaP cells. Furthermore, real-time PCR and western blotting confirmed the above mentioned results. IF verified no or low expression of CXCR1, CXCR3 and CXCR5 in NP tissues, low or moderate expression in BPH and high expression in PCa. However, CCR10 was not expressed at detectable levels in the three groups. The growth and proliferation of LNCaP cells was markedly inhibited after down-regulation of CXCR5.

CONCLUSIONS

PCa cells expressed high levels of CCR10, CXCR1, CXCR3 and CXCR5. Although BPH cells did not express these factors, their expression was up-regulated when BPH-1 cells were incubated with inflammatory cells. Finally, down-regulation of CXCR5 inhibited the growth and proliferation of LNCaP cells.

Comparison of results after fluoroquinolones and combination therapies in type IIIA chronic prostatitis

PURPOSE

We investigated retrospectively the clinical outcomes of the patients with type iii inflammatory chronic prostatitis, who were treated with fluoroquinolones with and without an α-blocker between 2009-2011.

MATERIAL AND METHODS

Diagnosis was established with medical history (symptoms presented longer than 3 months within previous 6 months), physical examination, Meares-Stamey test and the questionnaire of the NIH-CPSI. The responses to the treatment were assessed with uroflowmetry test and the questionnaire of NIH-CPSI at initial and after 4 weeks of the treatment. The patients with incomplete data and treatment and who treated with α-blockers and/or antibiotics in the period 4 weeks prior to the therapy started in our clinic and had any surgery of lower urinary tract previously were excluded. The patients were classified under 6 groups; group1=ciprofloxacin, group2=ofloxacin, group3=levofloxacin, group4=ciprofloxacin+tamsulosin, group5=ofloxacin+tamsulosin, group 6=levofloxacin+tamsulosin. Wilcoxon Signed Ranks and Kruskal Wallis test were used for comparison of results. Mann Whitney U test with Bonferroni correction made was used as posthoc (P<.05).

RESULTS

The median scores of NIH-CPSI decreased significantly in all groups (P<.05). Levofloxacin reduced the median total scores of NIH-CPSI more than ciprofloxacin and ofloxacin monotherapies. The combination therapies were better than antibiotic therapies alone and best result was obtained in levofloxacin+tamsulosin combination.

CONCLUSION

Tamsulosin+fluoroquinolone (especially tamsulosin+levofloxacin) combinations yielded better results in both NIH-CPSI scores and peak flow rates.

Changing trends in symptomatology, diagnostics, stage and survival of prostate cancer in Northern Finland during a period of 20 years

BACKGROUND

Prostate cancer is the most common cancer among men in many countries. The aim of the present study was to find out how the symptoms leading to a diagnosis, diagnostic procedures and stages of the disease among prostate cancer patients have changed over a period of 20 years.

METHODS

This retrospective chart review consisted of 421 prostate cancer patients whose treatment was started in the years 1982, 1987, 1992, 1997 and 2002 at the Oulu University Hospital. Earlier prostatic disorders, specific urological symptoms, diagnostic procedures, the TNM classification and histological grade were recorded.

RESULTS

The number of symptom-free prostate cancer patients increased over the 20 years, as did the number of men suffering from chronic prostatitis, although the latter increase was not statistically significant. A drop in the number of clinical T4 cases and increase of clinical T1 and clinical T2 cases was recorded but no clear change in the histological distribution occurred. The 5-year prostate cancer-specific survival improved significantly over the 20 years. The urologist was found to be the person who was contacted first most often.

CONCLUSIONS

Our data indicate that the number of prostate cancer patients has increased hugely over the period from 1982 to 2002 and although the clinical T stage has moved towards earlier stages, the proportion of well differentiated cancers remains low, so that most patients have clinically significant cancer with the need of some form of therapy. Further, prostate cancer-specific survival improved significantly over the period.

The effect of benign lower urinary tract symptoms on subsequent prostate cancer testing and diagnosis

BACKGROUND

Lower urinary tract symptoms (LUTS) are common and have been associated with the subsequent diagnosis of prostate cancer (PCa) in population cohorts.

OBJECTIVE

To determine whether the association between LUTS and PCa is due to the intensity of PCa testing after LUTS diagnosis.

DESIGN, SETTING, AND PARTICIPANTS

We prospectively followed a representative, population-based cohort of 1922 men, aged 40-79 yr, from 1990 until 2010 with interviews, questionnaires, and abstracting of medical records for prostate outcomes. Men were excluded if they had a previous prostate biopsy or PCa diagnosis. Self-reported LUTS was defined as an American Urological Association symptom index score >7 (n=621). Men treated for LUTS (n=168) were identified from review of medical records and/or self report. Median follow-up was 11.8 yr (interquartile range: 10.7-12.3).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Associations between self-reported LUTS, or treatment for LUTS, and risk of subsequent prostate biopsy and PCa were estimated using Cox proportional hazard models.

RESULTS AND LIMITATIONS

Fifty-five percent of eligible men enrolled in the study. Men treated for LUTS were more likely to undergo a prostate biopsy (hazard ratio [HR]: 2.4; 95% confidence interval [CI], 1.7-3.3). Men younger than 65 yr who were treated for LUTS were more likely to be diagnosed with PCa (HR: 2.3, 95% CI, 1.5-3.5), while men aged >65 yr were not (HR: 0.89, 95% CI, 0.35-1.9). Men with self-reported LUTS were not more likely to be biopsied or diagnosed with PCa. Neither definition of LUTS was associated with subsequent intermediate- to high-risk cancer. The study is limited by lack of histologic or prostate-specific antigen level data for the cohort.

CONCLUSIONS

These results indicate that a possible cause of the association between LUTS and PCa is increased diagnostic intensity among men whose LUTS come to the attention of physicians. Increased symptoms themselves were not associated with intensity of testing or diagnosis.

Inflammation and prostate carcinogenesis

Quite a few epidemiological studies including meta-analyses indicate that prostate inflammation is associated with increased risk of prostate cancer. The cause of inflammation in the prostate is speculated to be several microorganisms that cause prostatitis or sexually transmitted infections. Other specific microorganisms, such as xenotropic murine leukemia virus-related virus, are also reported to relate to the development of prostate cancer; however, the contribution of this microorganism to prostate cancer development needs to be carefully interpreted. Environmental factors, especially dietary factors, might also be associated with prostate cancer development. Among related dietary factors, charred meat carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine might be a link between environmental factors and inflammation, because 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine has the potential to accelerate prostate inflammation through its estrogenic effect. In light of these findings, preventing or reducing prostate inflammation might be one strategy for chemoprevention of prostate cancer.

Identification, pharmacologic considerations, and management of prostatitis

BACKGROUND

Prostatitis is a collection of signs and symptoms that occur as a result of inflammation or swelling of the prostate gland. There are many different causes for prostatitis, including infection; occasionally no clear etiology for the inflammation is found. Effective treatment often depends on identification of the cause, but a microbiologic organism is not always detectable, especially in cases of chronic prostatitis.

OBJECTIVE

The aim of this article was to review identification and treatment options for prostatitis, including pharmacologic and nonpharmacologic interventions.

METHODS

Relevant information was identified through a search of MEDLINE (1966-June 2010), International Pharmaceutical Abstracts (1970-June 2010), and EMBASE (1947-June 2010). Randomized, controlled trials that examined prostate cancer, benign prostatic hypertrophy, or procedures related to the prostate (ie, biopsies) were excluded.

RESULTS

A working classification system for prostatitis was developed in 1999, but there are few randomized controlled trials that distinguish between the various treatment options. Bacterial prostatitis can be acute or chronic but always requires some degree of antimicrobial therapy. Pharmacologic features of fluoroquinolones make them the preferred agents for most patients. These antibiotics can become trapped in a chronically inflamed prostate due to pH differences between prostatic tissue and serum. Many fluoroquinolones have penetration ratios (prostate level:serum level) of up to 4:1. A study in European men (N = 117) who received levofloxacin 500 mg/d with a diagnosis of chronic bacterial prostatitis demonstrated clinical success rates of 92% (95% CI 84.8%-96.5%), 77.4% (95% CI, 68.2-84.9%), 66.0% (95% CI, 56.2%-75.0%), and 61.9% (95% CI, 51.9%-71.2%) at 5-12 days, 1 month, 3 months, and 6 months after treatment. Additionally, there have been numerous randomized, placebo-controlled trials in patients with chronic prostatitis that have studied α-blockers, steroid inhibitors, anti-inflammatory agents, and bioflavonoids. Treatment responses to α-blockers appear to be greater with longer durations of therapy in α-blocker-naïve patients (National Institutes of Health-Chronic Prostatitis Symptom Index [NIH-CPSI] score reduction of at least 3.6 points after 6 weeks of tamsulosin therapy [P = 0.04] and up to 14.3 and 9.9 point NIH-CPSI score reductions with 14 weeks of terazosin and 24 weeks of alfuzosin therapy, respectively [P = 0.01 for both]). Combination therapy with an α-blocker, an anti-inflammatory, and a muscle relaxant does not appear to offer significant advantages over monotherapy (12.7 vs 12.4 point reduction in NIH-CPSI scores) and a stepwise approach to therapy involving antibiotics followed by bioflavonoids and then α-blockers appears to effectively reduce symptoms for up to 1 year in patients with chronic prostatitis (mean NIH-CPSI point reduction of 9.5 points compared with baseline, P < 0.0001). Patients who have had multiple unsuccessful treatment regimens may benefit from direct stimulation of the pelvic muscles through electromagnetic or electroacupuncture therapy.

CONCLUSIONS

Prostatitis can resemble various other medical conditions but proper classification and an understanding of the pharmacologic features and expectations of the medications used to treat it can help identify effective treatment strategies. Fluoroquinolones are the preferred agents for treating bacterial causes of prostatitis and have demonstrated efficacy in some cases of chronic prostatitis when an organism has not been identified. However, the use of agents with anti-inflammatory or antiadrenergic properties may be necessary in combination with or after trying antimicrobial agents.

Infection, inflammation and prostate carcinogenesis

Several reports have shown that the incidence of prostate cancer is on the increase and that more men would be diagnosed of prostate cancer in the next decades. Many approaches are being applied towards reducing the cases of prostate cancer, especially in the very rich countries. However, these have not been effective due to the poor current understanding of the pathophysiology of prostate carcinogenesis. The current work presents a review of how chronic infection and inflammation may contribute to prostate carcinogenesis.

Role of bacteria in oncogenesis

Although scientific knowledge in viral oncology has exploded in the 20th century, the role of bacteria as mediators of oncogenesis has been less well elucidated. Understanding bacterial carcinogenesis has become increasingly important as a possible means of cancer prevention. This review summarizes clinical, epidemiological, and experimental evidence as well as possible mechanisms of bacterial induction of or protection from malignancy.

Increased p53 immunoreactivity in proliferative inflammatory atrophy of prostate is related to focal acute inflammation

Proliferative inflammatory atrophy (PIA) of prostate has been proposed as a precursor lesion of prostate cancer. The aim of the current study was to evaluate the expression of p53 protein in PIA lesions and to investigate the relationship between p53 staining and Ki-67, glutathione S-transferase-pi (GSTP1) and cyclooxygenase-2 (COX-2) immunohistochemical expression. The results revealed that p53 nuclear immunostaining appeared in PIA lesions in 2.1+/-3.4% (mean+/-SD) of the basal and 0.9+/-2.3% of the luminal epithelial cells. Both these values were significantly higher than those in normal-appearing acini (p<0.0001). Increased p53 expression in luminal cells was related to focal infiltration of polymorphonuclear leucocytes. A positive correlation between p53 expression and Ki-67 was found in COX-2-positive PIA lesions (r=0.610, p<0.0001). Half of the p53-positive epithelial cells expressed diffuse GSTP1 immunostaining in the same lesions. The present study demonstrates an increased p53 expression in PIA lesions, and inflammation, especially acute inflammation, may play a role in the induction of p53 over-expression, particularly as cells in PIA lesions are known to have a reduced defence against DNA damage.

The association of bone mineral density with prostate cancer risk in the Osteoporotic Fractures in Men (MrOS) Study

We investigated the association of bone mineral density (BMD) measures with prostate cancer (PCa) risk in older men enrolled in the Osteoporotic Fractures in Men Study. We hypothesized that men with higher BMD, a marker of exposure to endogenous sex hormones, would have an increased incidence of PCa. The cohort included 4,597 men (89% White, 65 years or older) with no prior history of PCa. Baseline total body, total hip, and spine BMD were assessed using dual energy X-ray absorptiometry. Prostate cancer was confirmed by review of medical records. Cox regression was used to assess the association of BMD quartiles with incident PCa, adjusting for age, body mass index, and other covariates. During an average follow-up of 5.2 years, 5.6% (n = 255) of men developed PCa. Total body BMD was inversely associated with incident PCa, with a significant trend for decreasing PCa risk with increasing BMD quartiles (P(trend) = 0.007). Men in the highest total body BMD quartile had a 41% reduced risk for PCa (hazard ratio, 0.59; 95% confidence interval, 0.40-0.86), compared with men in the lowest quartile. Total hip and spine BMD did not exhibit significant relationships with PCa. Associations of BMD measures differed for low-grade (Gleason sum, 2-6) versus high-grade tumors (Gleason sum, >or=7). Significant inverse relationships with high-grade disease were noted at the total body and total hip sites. However, no associations were observed with low-grade disease. Our results provide support for an inverse association between BMD and PCa risk. Possible pathophyisological mechanisms linking BMD and PCa should be elucidated.

Is there evidence of a relationship between benign prostatic hyperplasia and prostate cancer? Findings of a literature review

CONTEXT

More than half the male population aged >50 yr have histologic evidence of benign prostatic hyperplasia (BPH), while prostate cancer (PCa) is among the most common male cancers according to recent registry data. Understanding the aetiologies of both conditions is crucial to reduce the resulting burden of mortality and morbidity.

OBJECTIVE

This review aims to examine the available data on the epidemiology, pathology, risk factors, and genetic markers involved in BPH and PCa; to discuss their clinical implications for management of both conditions; and to discuss their implications for PCa prevention. Our primary objective was to clarify the relationship between BPH and PCa by bringing together evidence from diverse areas of research.

EVIDENCE ACQUISITION

The primary source of data was PubMed, which was searched using Boolean strategies and by scanning lists of related articles. We also examined secondary sources from reference lists of retrieved articles and data presented at recent congresses.

EVIDENCE SYNTHESIS

Accumulating evidence suggests that BPH and PCa share important anatomic, pathologic, and genetic links in addition to the well-established epidemiologic association between these conditions. We also found data that suggest interactions between apparently diverse factors, such as dihydrotestosterone levels and inflammation. Recent publications support the hypothesis that both BPH and PCa are part of the metabolic syndrome, while inflammation is emerging as a major contributor to the development of both BPH and PCa. Although many of the findings are preliminary and require further research, they offer new insight into the mechanisms of disease underlying the development of BPH and PCa.

CONCLUSIONS

Available data suggest that epidemiologic and pathologic links exist between BPH and PCa. Evidence of links between the conditions and contributory factors may offer common preventative strategies for BPH and PCa and common therapeutic approaches to their management.

Epidemiology of prostatitis

BACKGROUND

Prostatitis describes a combination of infectious diseases (acute and chronic bacterial prostatitis), chronic pelvic pain syndrome, and asymptomatic inflammation.

MATERIALS AND METHODS

We employed evidence-based methods to review the epidemiology of prostatitis syndromes.

RESULTS

The prevalence of prostatitis symptoms could be compared in five studies surveying 10,617 men. Overall, 873 participants met various criteria for prostatitis, representing an overall rate of 8.2%, with prevalence ranging from 2.2 to 9.7%. A history of sexually transmitted diseases was associated with an increased risk for prostatitis symptoms. Men reporting a history of prostatitis symptoms had a substantially increased rate of benign prostatic hyperplasia, lower urinary tract symptoms and prostate cancer. In one study, the incidence of physician-diagnosed prostatitis was 4.9 cases per 1000 person-years. Two studies suggest that about one-third of men reporting prostatitis symptoms had resolution after 1 year. Patients with previous episodes and more severe symptoms are at higher risk for chronic pelvic pain.

DISCUSSION

The prevalence of prostatitis symptoms is high, comparable to rates of ischaemic heart disease and diabetes. Clinical evaluation appears necessary to verify that prostatitis is responsible for patients' symptoms. Prostatitis symptoms may increase a man's risk for benign prostate hypertrophy, lower urinary tract symptoms and prostate cancer. We need to define natural history and consequences of prostatitis, develop better algorithms for diagnosis and treatment, and develop strategies for prevention.

The role of inflammation and infection in the pathogenesis of prostate carcinoma

Prostatitis and prostate carcinoma are both frequent entities of prostatic diseases. Epidemiological studies show significant associations between infection and inflammation and prostatic carcinoma. However, because of various confounding factors the results of these studies are inconclusive. Further findings are therefore needed to confirm the hypothesis that prostatic infection and inflammation might be a cause of prostatic carcinoma. We reviewed selected reports on the role of inflammation and infection in the pathogenesis of prostate carcinoma. Extensive genetic analyses show that several gene products, e.g. 2'-5'-oligoadenylate (2-5 A)-dependent Rnase, macrophage scavenger receptor 1 and Toll-like receptor-4, influence the susceptibility of prostate cells to infectious agents. Proliferative inflammatory atrophy (PIA) could be a connection between prostatitis and prostatic carcinoma. In the transition from PIA to prostatic intraepithelial neoplasia, the function of cellular detoxification is gradually lost by silencing of glutathione-S transferase, a detoxifying enzyme. This cellular feature leads to an increased susceptibility of the prostatic epithelial cells to genomic damage by inflammatory oxidants or nutritional carcinogens. Consecutive somatic genome damage might then arise which modulates the further pathogenesis of prostate carcinoma. Summarising these epidemiological, genetic and cell biological aspects, infectious prostatitis might have a causative role in the complex and multifactorial process of prostate carcinogenesis.

Prevalence of and risk factors for prostatitis: population based assessment using physician assigned diagnoses

PURPOSE

Previous studies to assess risk factors for prostatitis used patient self-reported data and, therefore, they were subject to recall bias. We 1) used coded physician diagnoses to calculate the prevalence of prostatitis and 2) compared these patients with matched controls to identify medical conditions that are associated with prostatitis. Subjects were male enrollees in the Kaiser Permanente Northwest, Portland, Oregon health maintenance organization.

MATERIALS AND METHODS

A computer search of the Kaiser Permanente Northwest administrative database was performed for May 1, 1998 to April 30, 2004 to identify men with a coded diagnosis of prostatitis. Prostatitis cases were each age matched with 3 controls and the medical diagnoses (using 3-digit International Classification of Diseases, 9th Revision codes) assigned to these 2 groups were compared.

RESULTS

A prostatitis diagnosis was present in 4.5% of the male population. There were 37 diagnoses that were significantly more common in cases than in controls (p <0.0001). Most of them were other urological codes to describe prostatitis symptoms, unexplained physical symptoms in other organ systems and psychiatric diagnoses. The strongest observed associations were with benign prostatic hyperplasia (OR 2.7), functional digestive disorders (OR 2.6), dyspepsia (OR 2.1), anxiety disorders (OR 2.0), other soft tissue disorders (OR 2.0), esophageal reflux (OR 1.8) and mood disorders (OR 1.8).

CONCLUSIONS

Prostatitis is a commonly diagnosed condition in the community setting, affecting approximately 1/22 men. The diagnosis is associated with multiple other unexplained physical symptoms and certain psychiatric conditions. Studies to explore possible biological explanations for these associations are needed.

Gonorrhea, syphilis, clinical prostatitis, and the risk of prostate cancer

BACKGROUND

Although previous case-control studies have observed positive associations among gonorrhea, syphilis, clinical prostatitis, and prostate cancer, many may have been susceptible to recall and interviewer biases due to their retrospective designs. Therefore, to investigate these associations without concerns of recall and interviewer biases, we conducted a large, prospective investigation in the Health Professionals Follow-up Study.

METHODS

In 1992, participants were asked to report their histories of gonorrhea, syphilis, and clinical prostatitis by mailed questionnaire. Prostate cancer diagnoses were ascertained by self-report on the 1994 and each subsequent biennial follow-up questionnaire and confirmed by medical record review.

RESULTS

Of the 36,033 participants in this analysis, 2,263 were diagnosed with prostate cancer between the date of return of the 1992 questionnaire and 2002. No association was observed between gonorrhea [adjusted relative risk (RR), 1.04; 95% confidence interval (95% CI), 0.79-1.36] or syphilis (RR, 1.06; 95% CI, 0.44-2.59) and prostate cancer. Overall null results were also observed between clinical prostatitis and prostate cancer (RR, 1.08; 95% CI, 0.96-1.20), although a significant positive association was observed among younger men (<59 years) screened for prostate cancer (RR, 1.49; 95% CI, 1.08-2.06; P(interaction) = 0.006).

CONCLUSIONS

Gonorrhea and syphilis do not seem to be risk factors for prostate cancer in this cohort of men with a lower burden of sexually transmitted infections. Clinical prostatitis is also unlikely to be a risk factor, although possible roles for prostatitis in younger men and asymptomatic prostatic infection and inflammation cannot be ruled out.

Symptoms Suggestive of Chronic Pelvic Pain Syndrome in an Urban Population: Prevalence and Associations With Lower Urinary Tract Symptoms and Erectile Function

PURPOSE

We determined the prevalence of symptoms suggestive of chronic pelvic pain syndrome in an urban population and assessed associations with lower urinary tract symptoms and erectile dysfunction.

MATERIALS AND METHODS

Men participating in a voluntary health examination free of charge that was organized by the Department of Preventive Health of the City of Vienna were analyzed. All participants completed 3 validated questionnaires on chronic pelvic pain syndrome (National Institutes of Health-Chronic Prostatitis Symptom Index), lower urinary tract symptoms (International Prostate Symptom Score) and erectile dysfunction (International Index of Erectile Function-5).

RESULTS

A total of 1,765 men with a mean +/- SD age of 46.3 +/- 0.3 years (range 20 to 79) entered this study. The mean National Institutes of Health-Chronic Prostatitis Symptom Index score increased from 4.0 +/- 0.3 in the youngest age group of 20 to 29-year-old men to 6.3 +/- 0.6 in those 70 to 79 years old. The overall prevalence of symptoms suggestive of chronic pelvic pain syndrome, defined by a pain score of 4 or greater and perineal/ejaculatory pain, was 2.7% and it revealed no age dependence, such as the pain score. In contrast, urinary symptom and quality of life scores increased with age. International Index of Erectile Function-5 score was 20.6 +/- 0.3 for men without chronic pelvic pain symptoms vs 18.3 +/- 0.7 for men with mild symptoms and 16.5 +/- 1.1 for men with moderate/severe symptoms. A National Institutes of Health-Chronic Prostatitis Symptom Index score in the upper quartile was associated with 8.3-fold increased odds of erectile dysfunction.

CONCLUSIONS

The prevalence of symptoms suggestive of chronic pelvic pain syndrome in this large cohort of men participating in a health screening project was 2.7% and it revealed no age dependence. Our study suggests that chronic pelvic pain syndrome has a negative impact on erectile function.

Prostatite chronique et syndrome douloureux pelvien chronique de l’homme. Enquête auprès des urologues français

OBJECTIVE OF THE SURVEY: To determine the usual practice of French urologists in relation to the diagnostic and therapeutic management of chronic prostatitis.

MATERIAL AND METHODS

A questionnaire on the diagnostic and therapeutic management of chronic prostatitis was sent by mail in June 2003 to 810 urologists, members of the Association Française d'Urologie and working in France.

RESULTS

124 (15%) urologists returned the questionnaire. 61% of these urologists diagnosed less than 11 new cases of chronic prostatitis per year and 65% were not familiar with the new classification proposed in 1995 in the USA by the NIH (National Institutes of Heath) designed to remove this disease from the strict context of the prostate, placing greater emphasis on the concept of pain and introducing the concept of male chronic pelvic pain syndrome. 83% of urologists performed microbiological investigations often or always, but only 10% often or always performed a Meares and Stamey test comprising analysis of prostatic secretions after massage and 68% never performed this test. On the other hand, 76% of urologists ordered a first-stream urine culture, 61% ordered a second-stream urine culture and 76% ordered semen culture. 73% often or always prescribed antibiotics (82% used fluoroquinolones and 43% used the trimethoprim-sulfmethoxazole combination). Even in the absence of microbiological proof of infection, 41% of urologists often or always prescribed antibiotics, 89% sometimes or often prescribed an alpha-blocking agent, 89% sometimes, often or always prescribed a non-steroidal anti-inflammatory drug, 81% sometimes, often or always prescribed analgesics, 52% sometimes or often prescribed anxiolytics, and 66% sometimes or often referred the patient to another specialist.

CONCLUSION

This survey shows that chronic prostatitis, now generally referred to as "chronic pelvic pain syndrome", continues to raise diagnostic and therapeutic problems for French urologists.