A sign that interest is high and research is progressing on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) was a plenary session lecture devoted entirely to the topic. For a large audience, J. Curtis Nickel, MD, from Queen’s University, in Kingston, Ontario, detailed how the research is evolving and what today’s best treatments are.
Thanks in large part to NIH sponsorship, there has been a “literal tsunami” of research on CP/CPPS in the last 5 years, said Dr. Nickel. The literature includes 11 randomized, placebo controlled trials, and in those, many treatments have performed well, but so have placebos. A better measure of what therapies might be effective, he said, is a difference in improvement between treatment and placebo, called “treatment effect,” that is at least 4 to 6 points on the NIH Chronic Prostatitis Symptom Index (NIH-CPSI). Alpha blockers have passed that threshold. So have mepartricin and quercetin, but in small, single center trials. Saw palmetto and the rye-pollen extract Cernilton, which was tested in a study presented at this meeting, need a closer look, he said.
Antibiotics don’t work in heavily pretreated men with longstanding disease, and anti-inflammatories simply don’t work, said Dr. Nickel. He suggested that urologists could still try antibiotics, but only early in the disease and for not more than 4 weeks.
He urged urologists to catch and treat the problem early, since research implies that various damaging events, from infection to trauma, can start the CP/CPPS process, and if that damage isn’t resolved or controlled quickly, pain can become centralized in the nervous system.
After trying alpha blockers for a minimum of 12 weeks, urologists could try adding anti-inflammatories; herbal therapies; tricyclic antidepressants, such as amitriptyline (Elavil); gabapentinoids, such as gabapentin (Neurontin) and pregabalin (Lyrica); and muscle relaxants, such as cyclobenzaprine (Flexeril), diazepam (Valium), or baclofen (Lioresal), he said. For patients who have interstitial cystitis-like symptoms—urinary symptoms and pain in the area of the bladder—pentosan polysulfate (Elmiron) might help. Then, if patients still don’t do well, he urged his colleagues to “think outside the box” and try physical therapy and cognitive behavioral therapy.
New thinking is emerging in the CP/CPPS research community that is getting away from focusing on the prostate alone and is including the organs around it—the bladder, muscles, ligaments, joints, and nerves—as well as the central nervous system. Future research by the Chronic Prostatitis Collaborative Research Network (CPCRN) will be focused on these new ideas, testing treatments including pregabalin (Lyrica) and alpha blockers in early disease, physical therapy, and cognitive behavioral therapy.
In specialty sessions at the meeting, investigators presented some 20 research studies. Among the treatments studied were physical therapy and relaxation, injections of botulinum toxin A (Botox) into the prostate and pelvic floor, the rye-pollen extract Cernilton, and an alpha blocker. Stanford researchers using the physical and relaxation therapy presented their results last year on the overall effects of therapy, and this year, they demonstrated that the therapy can also improve sexual function. The therapy doesn’t work for every man with severe CP/CPPS, but when it does, the decrease in sexual dysfunction can be substantial. Cernilton has become a popular herbal remedy, but results have been equivocal in benign prostatic hyperplasia (BPH or prostate enlargement). In the study presented here, although the effects on urinary symptoms were not significant, the effects on pain and quality of life were. Based on a preliminary study presented here, Botox seems to have the most promise for controlling pain and also for frequency. Similar to previous studies, improvements with an alpha blocker were modest.
Studies on cost, prevalence, and risk factors were revealing and even controversial. Direct medical costs for men who have CP/CPPS are about a quarter more to double the costs for other men, highlighting the need for more effective therapy. In a study of CP/CPPS in African American men, the prevalence diagnosed prostatitis was 7%. Odds of having prostatitis were higher in men who had had moderate to severe lower urinary tract symptoms and lower in men who were physically active. Potentially controversial was an analysis of the Boston Area Community Health Survey indicating that men who had CP/CPPS symptoms were two to three times more likely to have been abused as children or adults than other men. How abuse might play into CP/CPPS is unclear.
Evidence of the trend to look at the socioeconomic effects of CP/CPPS was a study that showed female partners of patients suffered more depression and had poorer physical and mental health overall than other women.
The cause or causes of CP/CPPS are still speculative, but there’s more evidence for dysfunction in the “fight or flight” neural-hormonal systems of the body. The idea that CP/CPPS is an inflammation of the prostate gland took a blow from an analysis of prostate samples and rates of CP/CPPS in men who were participating in a large trial of a treatment for BPH.
These and all the other studies related to CP/CPPS and prostate inflammation presented at the 2006 meeting are summarized here.
Sexual dysfunction in men with chronic pelvic pain syndrome: improvements after trigger point release and paradoxical relaxation training
Rodney U Anderson*, Stanford, CA; David Wise, Sebastapol, CA; Timothy Sawyer, Los Gatos, CA; Christine A. Chan, Stanford, CA
A combination physical therapy and relaxation exercise can not only significantly decrease pain and urinary symptoms in CP/CPPS, it can also improve sexual function, say these investigators at Stanford, where the protocol was developed. The therapy includes release of trigger points in internal pelvic floor and external muscles through massage as well as a type of relaxation therapy termed “paradoxical” because it involves accepting tension. One hundred forty-six CP/CPPS patients (mean age 42) who had had their symptoms for a mean of 6 years and had not responded to other therapy underwent the treatment. At an average of five months after starting therapy, the men rated any change in their condition with a Global Response Assessment questionnaire. At the beginning of therapy and at follow-up, the patients also answered a Pelvic Pain Symptom Survey (PPSS) questionnaire that documented the severity and frequency of sexual, pain, and urinary symptoms. At the beginning of treatment, 133 (92%) of the men had one or more sexual dysfunction symptoms: 81 (56%) reported having ejaculatory pain or discomfort within the past month, 66% had decreased libido, and 31% had erectile and ejaculatory dysfunction. After therapy, pain, urinary, and sexual symptoms improved by as much or more than 50% in approximately 40% of the men. Scores for different sexual symptoms decreased by a mean of 77% to 87% in the men who responded to treatment. Overall sexual scores improved by 43% in men who rated their condition as markedly improved, but only 10% (which was not statistically significant) in the men who rated their condition as moderately improved. Overall, treatment was successful (with patients saying they were moderately or markedly improved) in 70% of the men.
Multiregional injections of low-dose botulinum toxin A for men with chronic pelvic pain syndrome
Seung Mok Shin, Seoul, Republic of Korea; Dong Soo Park*, Sungnam, Republic of Korea
In this trial, injection of botulinum toxin A improved symptoms for more than half of men with CP/CPPS category IIIB (noninflammatory, with no white cells in the prostatic fluid). The investigators used low-doses (generally, 40 IU) injected transrectally in 78 and perineally (using 200 IU) in 6 men. Most received injections into eight sites: four points in the prostate, two around the urethral sphincter, and two in the pelvic floor muscles. Twenty-four patients got repeat injections after about 9 months. The investigators used the NIH-CPSI to assess the effects. Two patients had acute epididymitis develop. Among the 78 patients who got transrectal injections, 46 (59%) had improved symptoms, and in those, NIH-CPSI scores dropped from a mean of 27 to 12 after the first injection. In the six patients who got the transrectal injections, scores dropped from a mean of 29 to 18. The patients who got more than one injection showed better results than those who got one. The biggest improvement was in pain. The next best improvements were in ejaculation-related pain and frequency. Quality of life was also improved in patients who did respond. The effects lasted from 6 to 18 months in the responders. The optimal dose seems to be 40 IU, but that needs to be studied further, said the researchers.
The efficacy of Cernilton in patients with chronic pelvic pain syndrome (CP/CPPS) type NIH IIIA: a randomized, prospective, double-blind, placebo controlled study
Henning Schneider*, Martin Ludwig, Giessen, Germany; Andreas Horstmann, Hamburg, Germany; Jörg Schnitker, Bielefeld, Germany; Wolfgang Weidner, Giessen, Germany
In a placebo-controlled trial, men with CP/CPPS who took the rye pollen extract Cernilton had significant reductions in pain and improvements in quality of life. The study included 122 patients with CP/CPPS type IIIA, (inflammatory nonbacterial prostatitis, with white cells in prostate fluid); 59 took Cernilton (two tablets three times a day) and 63 took a placebo for 12 weeks. Neither patients nor investigators knew which was which. NIH-CPSI pain scores dropped significantly in the Cernilton group (from 10 to 5) compared with the placebo group (from 10 to 7). Quality of life scores also improved significantly with Cernilton, dropping from 6 to 4 in the Cernilton group compared with 7 to 5 in the placebo group. Urinary symptoms, however, did not improve significantly. There were no severe side effects, and two men reported mild side-effects, such as burning in the abdomen.
Efficacy of alfuzosin for chronic prostatitis/chronic pelvic pain syndrome in young and middle aged patients; a prospective, randomized, controlled study
Hyung-Jee Kim*, Inho Sohng, Cheonan, Republic of Korea; Jeong Gu Lee, Seoul, Republic of Korea; Duck Yoon Kim, Daegu, Republic of Korea; Kwan Joong Choo, Seoul, Republic of Korea
Alpha blockers have had mixed results in CP/CPPS, so this Korean team conducted a randomized, single-blind trial of the alpha blocker alfuzosin (Uroxatral) in men in their 30s to 50s to help exclude men with benign prostatic hyperplasia (BPH). Of the 57 men with CP/CPPS, 15 were assigned to take an antibiotic, and 42 were assigned to take an antibiotic and the alpha blocker. The team used the NIH-CPSI, the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF) questionnaire to track symptoms and quality of life at the start of the study and after 1 and 2 months. Although scores on the NIH-CPSI and IPSS improved only modestly and weren’t significantly different in the two groups, the urinary and quality of life factors in the group that took both drugs showed more improvement, with statistically significant improvement in the IPSS total score. Voiding factors on the NIH-CPSI and IPSS improved significantly in the group that took alfuzosin.
Analysis of medical costs associated with prostatitis
J. Quentin Clemens*, Chicago, IL; Richard T Meenan, Maureen C O'Keeffe Rosetti, Sara Y Gao, Portland, OR; Elizabeth A Calhoun, Chicago, IL
Prostatitis patients have medical costs from about a quarter higher to twice as high as the costs for other men. The information was gleaned from the electronic medical records of participants in the HMO Kaiser Permanente Northwest in Portland, Oregon. The researchers compared costs for 5,241 men with a diagnosis of either chronic prostatitis or “prostatitis not otherwise specified” with costs for 15,723 other men the same age who had been in the health plan for the same amount of time. The men ranged in age from 25 to 80. The differences almost entirely attributable to outpatient care (doctor visits) and prescriptions and not to hospital care, indicating that the increased costs were, in fact, because of prostatitis. The mean annual costs were $4,387for men with prostatitis versus $2,689 for other men, and the median annual costs were $1,506 for men with prostatitis compared with $948 for other men. Because prostatitis is such a common diagnosis, the cost to society is substantial, the investigators pointed out.
PREVALENCE, POPULATIONS, AND RISK FACTORS
Prevalence of and risk factors for prostatitis in African American men: the Flint Men’s Health Study
Lauren P Wallner*, Stephanie Daignault, James E. Montie, John T. Wei, Aruna V. Sarma, Ann Arbor, MI
Because African American men have often not been included in studies of the prevalence of and risk factors for prostatitis, these researchers surveyed 703 African American men aged 40 to 79 years in Genesee County, Michigan, which includes the city of Flint. The investigators found that about 7% of the men reported their doctor had diagnosed prostatitis. The odds of prostatitis were higher in men who had had moderate to severe lower urinary tract symptoms, and the odds were lower in men who were physically active. Smoking and alcohol consumption did not appear to be risk factors. These results suggest a role for BPH and prior infection and inflammation in the development of prostatitis, said the researchers. Also, they noted that this is the first study to show reduced odds of prostatitis with increased physical activity.
The association of previous sexual, physical, and emotional abuse and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): Results from the Boston Area Community Health (BACH) Survey
Jim C. Hu*, Michael J. Barry, Boston, MA; Carol L. Link, Watertown, MA; Mary McNaughton-Collins, Boston, MA; John B. McKinlay,, Boston, MA
In the Boston Area Community Health (BACH) study, researchers surveyed a diverse, urban sample of men about their history of sexual, physical, emotional abuse. They also interviewed a random sample of 2,301 men, including 700 black, 766 Hispanic, and 835 white men, about prostatitis symptoms with questions that were based on the NIH-CPSI. One hundred nineteen men scored 10 or more on the pain and urinary symptom scales, indicating they may have had CP/CPPS. Statistical analysis showed that men who had CP/CPPS symptoms were two to three times more likely than the other men to have been abused as children or adults.
Comparison of demographic and clinical characteristics of the Malaysian and National Institutes of Health chronic prostatitis cohort
Shaun W H Lee*, Phaik Yeong Cheah, Men Long Liong, Kah Hay Yuen, Penang, Malaysia; Anthony J Schaeffer, Chicago, IL; Kathleen Propert,, John N Krieger, Seattle, WA
CP/CPPS affects men similarly in North America and Malaysia. In both populations, chronic pelvic pain and urinary symptoms had severe effects on quality of life. Researchers compared NIH-CPSI scores in 488 North American men who participated in the NIH Chronic Prostatitis Cohort with those of 332 men who participated in the Malaysian Chronic Prostatitis Cohort. The North American men were recruited from seven tertiary referral centers, and the Malaysian men were drawn from six general urology practices in northern Malaysia. All met the same definition of CP/CPPS. There were some significant differences, however. The quality of life NIH-CPSI subscore was significantly worse (mean 8.6) for the Malaysian men than the North American men (mean 7.7). There were also some differences between the populations in the location, number of sites, and types of pain/discomfort. The Malaysian men were also significantly less likely to have had antibiotics (95% vs 22%), anti-inflammatory medications (40% vs 67%), phytotherapy (3% vs 54%), biofeedback (2% vs. 6%), or urologic procedures (6% vs 33%). The North American men were significantly more likely to report previous genitourinary disease, urologic surgery, psychiatric disease, dermatologic disease, gastrointestinal disease, or musculoskeletal disease. Comparing diverse populations could provide important insights into the disease and the factors that determine clinical outcomes, said the investigators.
Chronic pelvic pain syndrome patients show evidence of allostatic overload
Jaeseop Lee, Boston, MA; J. Curtis Nickel, Joe Downey, Kingston, ONCanada; Michael R Freeman, Jordan D Dimitrakov*, Boston, MA
Some researchers have theorized that painful bladder syndrome/interstitial cystitis PBS/IC is more than a pelvic problem that has a foundation in abnormalities of the neuroendocrine system, specifically in the hypothalamic-pituitary-adrenocortical (HPA) axis. That brain-pituitary gland-adrenal gland feedback system is responsible for the “fight or flight” reactions in response to stress. When adrenal gland hormones don’t put the brakes on the feedback system, the result is called “allostatic overload.” Now, a new study implies the HPA axis may also be dysfunctional in men with CP/CPPS. In the urine and expressed prostatic fluid of men with CP/CPPS, these researchers measured levels of markers thought to indicate allostatic overload. Those markers included corticotropin releasing hormone (CRH), neuropeptide Y (NPY), dehydroepiandrosterone (DHEA), epidermal growth factor (EGF), and galanin. (CRH, released from the hypothalamus, stimulates the pituitary gland to release corticotropin, which in turn stimulates the adrenal gland to release various hormones, including cortisol, which “puts the brakes” on the system, and sex steroids, such as DHEA, which is a precursor of estrogen and testosterone. NPY and galanin are nervous system transmitters. EGF is a growth factor that is elevated in IC patients’ urine.) NPY and galanin levels were significantly lower and CRH and DHEA levels were significantly higher in CP/CPPS patients than in healthy men. The investigators developed a score for allostatic overload based on the medical literature about these markers and found scores to be high in men with CP/CPPS. Therapies to treat CP/CPPS could be targeted at this system.
Heart rate variability and sympathetic skin responses in men with chronic pelvic pain syndrome
Ugur Yilmaz*, Yung Wen Liu, Claire C Yang, Richard E Berger, Seattle, WA
The autonomic nervous system, which controls involuntary functions of organs and muscles, responds to the “fight or flight” system and plays important roles in the function of pelvic organs and in pain. Heart rate is one involuntary organ function that can be an indicator of how the whole autonomic nervous system is functioning. Nerve responses in the hand and foot can also be indicators. These researchers measured variability in heart rates using electrocardiogram (ECG) recordings and recordings from electrodes on the hands and feet in 22 men with CP/CPPS and 20 healthy men. When the men were standing, one component of the ECGs was different in the two groups. In addition, men with CP/CPPS showed left-right differences in the hands, unlike the healthy men. The investigators believe these differences suggest that autonomic changes may play a role in CP/CPPS and might give insight into how to use autonomic drugs and sympathetic alpha blockers for men with CP/CPPS.
Chronic bacterial seminal vesiculitis occupies some portion of chronic prostatitis/chronic pelvic pain syndrome
Jin-Kwan Jeong, Yong-Jin Kim, Ji-Kan Ryu, Kwoan-Youb Choo, Shuguang Piao, Yeonsook Moon, Do-Hwan Seong, In-Young Hyun, Wonsick Choe, Jun-Kyu Suh*, Incheon, Republic of Korea
These Korean researchers used a new technique to detect deep-seated infections, called technetium-99(Tc-99) ciprofloxacin imaging, to look for bacterial infection in seminal vesicles in men diagnosed with CP/CPPS. They identified 50 men with CP/CPPS who showed evidence of seminal vesicle infection and compared their symptom scores, four-glass test results, and bacterial cultures with those of 8 men with CP/CPPS who did not show evidence of infection. The researchers tested aspirated seminal vesicle fluid as well as the fluids obtained in the four-glass test. In 17 of the 50 patients who showed “hot uptake” of the imaging medium in seminal vesicles, the researchers found microorganisms in their seminal vesicle fluid, most commonly Escherichia coli (in 13), followed by coagulase-negative staphylococci (in 2), E coli and Enterococcus fecalis (in 1), and Chlamydia trachomatis (in 1). The researchers found no microorganisms in any of the patients who didn’t show evidence of uptake on the scans. The investigators concluded that seminal vesicle infection definitely occurs in some men with CP/CPPS, although the impact of that on the diagnosis and treatment remains to be researched.
Lack of relationship between clinical prostatitis and prostate inflammation: baseline data from the REDUCE trial
J. Curtis Nickel*, Kingston, ON, Canada; David Granger Bostwick, Glen Allen, VA; Matthew Caden Somerville, Roger Rittmaster, Research Triangle Park, NC
CP/CPPS may not have anything to do with prostate inflammation. That’s the conclusion drawn by researchers who looked at data from a large clinical trial of a drug aimed at reducing prostate cancer risk. These researchers analyzed the data available for 5,338 men in this study who had answered the NIH-CPSI and had had their biopsy specimens graded for acute and chronic inflammation by pathologists. The researchers then looked for any correlations between inflammation and the total NIH-CPSI scores, the pain subscale, the urinary symptoms subscale, and the quality of life subscale. The only significant correlation they found between inflammation and NIH-CPSI scores was between chronic inflammation and quality of life. The investigators said the link between clinical prostatitis and actual prostate inflammation is weak, and physicians need to re-examine the traditional view that they are linked.
A preliminary analysis of calcifying particles in the serum and prostates of patients with prostatic inflammation
Jeffrey A Jones*, Houston, TX; Grant Carlson, Tampa, FL; E. Olavi Kajander, Kuopio, Finland; David Warmflash, Houston, TX; Karen Taylor, Tampa, FL; Gustavo Ayala, Houston, TX; Daniel Shoskes, Weston, FL; Meg Everett, Dan Feeback, Houston, TX; Neva Ciftcioglu, Tampa, FL
Nanobacteria are very small entities surrounded calcium apatite. The small stones or shells are often found in prostate tissue, and some speculate that they may be a cause of various prostate diseases, including CP/CPPS. Recently, an enzyme-linked immunosorbent assay (ELISA) was developed to detect antigens to these entities, which these researchers used on serum and prostate tissue in men with various prostate diseases and in men without prostate disease. Levels of antigens were higher in men with benign prostatic hyperplasia (BPH). Immunohistochemical tissue stains pointed to the presence of nanobacteria significantly more often in BPH tissue than in prostate cancer tissue. Controlled studies using more specific detection techniques and cultures of organisms in larger numbers of patients need to be done to determine if nanobacteria cause inflammatory diseases of the prostate.
Spontaneous and induced autoimmune prostatitis in the non-obese diabetic mouse
Giuseppe Penna*, Susana Amuchastegui, Chiara Cossetti, Francesca Aquilano, Roberto Mariani, Luciano Adorini, Milano, Italy
A mouse strain prone to developing autoimmune disease is showing how prostatitis might develop as an autoimmune disease. The strain is known as NOD for “nonobese diabetic.” These researchers monitored NOD mice for spontaneous development of disease in the prostate gland, evidenced by infiltration of a certain type of white blood cell. Before the spontaneous prostatitis developed, the investigators detected autoreactive T cells reacting to a prostate steroid-binding protein called prostatein, indicating that the mice could not tolerate this self antigen, which is typical in autoimmune disease. The spontaneous type of autoimmune prostatitis develops at about 20 weeks, but they found they could induce prostatitis experimentally in younger male mice by injecting homogenated prostate cells, purified prostatein, and synthetic prostatein peptides. These mice and techniques could be used to test different types of treatments for inflammatory prostate conditions.
Intraprostatic capsaicin injection as a novel model for non-bacteria prostatitis
Yao-Chi Chuang*, Kaohsiung Hsien, Taiwan Republic of China; Fermando DeMiguel, Pittsburgh, PA; Moya Wu, Po-Hui Chiang, Kaohsiung Hsien, Taiwan Republic of China; Naoki Yoshimura, Michael B Chancellor, Pittsburgh, PA
These researchers used injection of capsaicin (the substance that makes hot peppers hot) to create a mouse model of prostatitis resulting from neurogenic inflammation. The injections produced pain responses in mice and increased the accumulation of polymorphonuclear (PMN) cells and expression of the COX-2 enzyme in the prostate. Injection of botulinum toxin A (Botox) reduced the accumulation of PMN cells, COX-2 expression, and pain behavior. This mouse model of prostatitis may be useful in studying prostatic inflammation and visceral pain.
Up-regulation of Rho-kinase-associated proteins and altered nerve-mediated functions in experimental autoimmune prostatitis
Enrico Baroni*, Milano, Italy; Karl-Erik Andersson, Lund, Sweden; Giuseppe Penna, Susana Amuchastegui, Luciano Adorini, Milano, Italy; Petter Hedlund, Lund, Sweden
In this study of NOD mice, the researchers found that the inflammatory changes experimental autoimmune prostatitis involved increased activity of a chemical pathway called the Rho kinase pathway, which plays a role in contraction of smooth muscle and various cellular functions, including migration, proliferation, and natural cell death. The increased activity in the chemical pathway might also have something to do with nerve signaling from the prostates. A relative of vitamin D that interferes with the chemical pathway is being tested in clinical trials for BPH and CP/CPPS. Trials for interstitial cystitis are planned.
Depression mediates poorer quality of life in partners of men with chronic prostatitis/chronic pelvic pain syndrome
Dean A Tripp*, J. Curtis Nickel, Ashley K Soryal, Kelly Smith, Caroline Pukall, Lee Fabrigar, Kingston, ON, Canada
Partners of men with CP/CPPS need help, too, and ought to be included in treatment programs, said researchers who studied their physical and mental health. Twenty-five female partners of men with CP/CPPS as well as 25 control women answered a survey on mental health and quality of life. CP/CPPS partners had higher levels of depression and poorer overall physical and mental health than the control women. Analysis showed that being the partner of a man with CP/CPPS had a direct impact on the woman’s depression and physical health quality of life.
Does chronic inflammation influence prostate carcinogenesis? A five-year follow-up study
Gregory T MacLennan, Rosana Eisenberg, Ranleigh L Fleshman, J Michael Taylor, Pingfu Fu, Martin I Resnick, Sanjay Gupta*, Cleveland, OH
Whether chronic prostate inflammation contributes to prostate cancer isn’t clear, so these researchers took a close look at five year’s worth biopsy specimens from patients who underwent biopsies to look for cancer. Among the 177 patients, 81% (144) showed chronic inflammation, and 19% (33) had no inflammation. In the specimens that showed inflammation, 20% had adenocarcinoma, and 50% had other histologic characteristics that have been associated with the development of cancer, whereas in the specimens without inflammation, 46% had no diagnostic findings. Also, PSA correlated with the grade of inflammation. Repeat biopsies in the patients with chronic inflammation showed adenocarcinoma in more than 20% of patients with other suspicious characteristics, whereas in the patients with no inflammation, only 6% had adenocarcinoma. The investigators concluded that chronic inflammation may be a significant risk factor for development of adenocarcinoma.
Trial of 45 days of antibiotic therapy in patients with asymptomatic biopsy-proven prostatitis
Jeffrey R. Springer*, M. Scott Wingo, Thomas E. Keane, Harry S. Clarke, Charleston, SC
Because prostate inflammation may have a relationship with prostate cancer, physicians often treat men who have inflammation in their biopsy specimens and elevated PSA levels (above 4.0 ng/mL) with antibiotics in an attempt to reduce PSA to normal levels. But among 66 veterans who had elevated PSAs and who were given 45 days of fluoroquinolone antibiotics, PSA levels did not change significantly. Among the 66 patients, 33 elected to undergo a repeat biopsy because their PSAs were still high. In the 38 biopsy samples, 11 showed prostate cancer, and 24 showed persistent inflammation. Using antibiotics does not significantly affect PSA or inflammation, concluded the investigators.