The Prostatitis Foundation

Bulletins from 1999 AUA Meeting

 

Webmaster's note: Two doctors attending the 1999 annual meeting of the American Urological Association in Dallas have reported in. These are their summaries of abastracts and posters at the meeting. Before not very long, we will have the complete text of the official abstracts. At that point this page will vanish and be replaced by a more permanent report.

From: Daniel Shoskes MD UCLA, Institute for Male Urology .

Here is a synopsis of several presentations made at the American Urological Association meeting yesterday (May 2, 1999)on prostatitis. I have included my own comments on some of them.

Asymptomatic inflammation and/or infection in BPH Curtis Nickel et al, Kingston, Ont Canada
Examined 100 TURP specimens from men without chronic prostatitis symptoms. All specimens had inflammation, 44% grew bacterial organisms. No correlation found between bacterial colonization, presence of white cells, serum PSA, PSA density or presence of urinary catheter.
Comment: further proof that inflammation and bacterial colonization can occur in men without chronic pelvic pain syndrome (CPPS). Therefore, positive cultures and WBC in men with CPPS may not always be causative.

CPPS: impact of inflammation on fertility parameters and seminal plasma markers Ludwig et al, Giessen Germany
112 pts with CP, 48 had >10 WBC per hpf in prostatic fluid (NBP, NIH category IIIa) and 64 had < 10 WBC (prostatodynia, NIH category IIIb). No differences between groups in sperm count, sperm density, motility or morphology. IIIa pts had higher elastase and lower gamma GT, which may be useful markers in diagnosis if EPS not available but semen is.
The NIH chronic prostatitis symptom index Litwin et al In this first abstract from the NIH study, the NIH-CPSI symptom index is presented and validated.
Comment: this will be an extremely valuable symptom score in evaluating patients' symptoms and response to treatment

Diagnosing and treating chronic prostatitis: do urologists use the 4 glass test? McNaughton-Collins et al, Farmington CT
504 urologists responded to questionnaire: Do 4 glass cultures?: almost always 4%, rarely 33%, Never 47% % of pts you treat with (all + more than half): antibiotics 82% Alpha blockers 43% Natural remedies 5%
Comment: most who treat with antibiotics don't do the appropriate cultures

International population based study of urological conditions Robertson et al (UK, Netherlands and Korea)
Prevalence of urinary symptoms in 1300 men. 36% men aged 40-59 yrs and 38% > 60 yrs reported at least 1 symptom of prostatitis. 16% of men with symptoms visited their doctor and 11% received treatment
Comment: this disease has major impact world wide

Beta Defensin expression in the human male urogenital tract Dooley et al, Boston
Defensins are newly described antimicrobial peptides. This study, using normal male urogenital tissue, demonstrated wide expression of these molecules in seminal vesicles, kidney, bladder and foreskin.
Comment: will be fascinating to see whether men with CP have altered expression of these molecules

Efficacy of transrectal microwave hyperthermia (TRMH) in the treatment of chronic prostatitis Vassily et al Moscow
100 CP pts, 80 received TRMH, 20 had sham procedure. Pts had 6 sessions every second day. Sham group 52.5% improvement Treatment group 75% improvement

Microbial aerobic studies on normal male urethra Spaine et al, Sao Paulo Brazil
Collected samples from asymptomatic men from 3 parts of urethra. 40% had bacteria in all three segments, 33% in 2 segments and 27% in 1 segment. Common bacteria: coagulase negative staph, corynebacterium, enterococcus, strep viridans
Comment: normal men have these bacteria in the urethra. Sterile prostatic fluid and semen can pick these bacteria up as they exit the penis. Cultures of EPS and semen without simultaneous culture of urethra can grow bacteria that are unrelated to the prostate and certainly unrelated to any symptoms.

Oxidant stress in prostate fluid correlates with diagnosis and treatment response in chronic prostatitis Shahed and Shoskes, UCLA
see: http://www.ben2.ucla.edu/~dshoskes and click on recent abstracts link for complete abstract

Electrical stimulation therapy in prostatodynia Park et al, Korea
20 pts with prostatodynia (NIH IIIb) treated with electrical stimulation to pelvic muscles via anal probe or surface electrode weekly for 8 weeks. 14 pts had improvement in pain score.

Myofascial release therapy for category III chronic prostatitis Anderson et al, Stanford CA
23 men with NIH type III CP. Weekly massage of pelvic floor for a median of 18 treatments. Noted improvements in pain score and urinary score
Comment: While I have found prostatic massage to be effective in many patients, I have never claimed to be sure of the mechanism. Some men with normal prostates but chronic pelvic floor myalgia may benefit from massage of the pelvic muscles rather than the prostate itself.

From: Dr. Jordan Dimitrakov
I am writing from the UroWorld Wide Web Cafe located in Rooms C251-252 of the Dallas Convention Center and must say several things. First, I did attend the Moderated Prostatitis Session on Saturday May 1, 1999 in rooms C247, 248, 254 moderated by Dr. John Krieger from Settle, Washington and another one of his colleagues(sorry, couldn't remember the name) and did see Dr. Shoskes' poster just as he was discussing it with Dr. Krieger. To be exact, the poster was the first one on the right facing the Moderator Table next to a poster entitled "Restriction of cell and molecular movement by the rat ventral prostate epithelium: Characterization of a blood-prostate barrier" presented by Dr. Terry T. Turner from Charlottesville, VA. Moreover, during the discussion that followed the 45-minute time to see the posters Dr. Shoskes was seated two seats away from me in the left-hand row facing the Moderator Table.
I was very interested in discussing and looking in detail at a poster entitled "PCR DETECTION OF POLYMORPHISMS IN A SHORT TANDEM REPEAT 3' TO THE HUMAN PHOSPHOGLYCERATE KINASE GENE IN CHRONIC PROSTATITIS PATIENTS" presented by Dr. Donald Riley from the University of Washington in Seattle. Although it might sound too complicated, the design of this study was to look at a gene (the phosphoglycerate kinase gene(PGK) that is suspected of having a role in the predisposition to prostate cancer, androgen insensitivity, hypospadia (which means non-closure of the urethra) and other genetic abnormalities. The reason for this is that the PGK gene is closely related to the androgen receptor gene and hence, mutations in this gene might serve as a mark that predisposes to chronic prostatitis. Using a very sensitive technique (PCR) they examined DNA (using blood) from 248 controls (132 males and 116 females)and from 123 prostatic biopsies. Unfortunately, "the results went just opposite to our expectations," said Dr. Riley and it was found that no connection could be demonstrated. Still, I think it is a very interesting and provocative study.
The other interesting study (located on the left-hand side of the moderator table) was entitled "TREATMENT OF COMPLICATED URINARY TRACT INFECTIONS BY SINGLE-DOSE LIPOSOMAL AMIKACIN(MIKASOME)" presented by Dr. Krieger and actually it was a multicenter study which examined the ability of MiKasome, a small unilamellar liposome-encapsulated amikacin formula, to reduce aminoglycoside renal and ototoxicity. The drug form had a circulating half-life of over 1 week following intravenous infusion in man and there was a bacteriologic cure at day 14 in 82 % of the patients and clinical cure in 92 % of them and in 92 % bacteriologic and 86 % clinical cure at day 36. Professor Weidner from Giessen, Germany asked Dr. Krieger (since the results presented concerned complicated urinary tract infections) if this drug will be useful in prostatitis and Dr. Krieger said that actually there were very good results in prostatitis patients who had taken it on compassionate basis.

 

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