Histopathology and Cytology of Chronic Active Prostatitis (CAP)

J Polacheck, E Vega

Prostatitis Center and Carondelet St. Joseph's Hospital, Tucson, AZ

In order to learn more about the pathophysiology of "chronic" prostatitis, we examined the cytology of expressed prostatic secretions (EPS). In the EPS from most patients with chronic prostatitis, we have observed cohesive aggregates of polymorphonuclear (PM N) leukocytes within a proteinaceous matrix. We call these aggregates prostatic inflammatory aggregates (PlAs). PlAs are frequently associated with corpora amylacea, concretions known to form inside the prostate. We believe that PlAs may be pathognomonic for prostate inflammation because we have observed, histopathologically, remarkably similar aggregates in prostate tissue obtained surgically. These are normally ignored by surgical pathologists when they are searching for cancer. We find it remarkable that PlAs can be expressed by massage. We have observed in the surgically obtained prostate tissue that most PlAs are located in the periphery of the prostate gland. Prostatic ducts are tortuous, branching, and very long relative to their narrow diameter. In fact, prostatic ducts appear smaller in diameter than PlAs. Therefore, the ducts must expand and/or the PlAs must deform in order for the PlAs to be expressed.

Based on preliminary studies, we believe the following conclusions are likely:

• The inflammatory process is persistently active because the lifespan of PMNs is known to be short, approximately 5 days.
• The inflammatory process is likely triggered by a bacteria or a bacteria-like organism because of the predominance of PMNs, not Iymphocytes.
• PIAs in EPS may prove to be a specific clinical test of disease activity. We have already found it useful in the management of patients.

Finally, we note the disparity between the clinical disease (chronic symptoms and signs) and its pathology (an acute-inflammatory process). Perhaps this disorder, therefore, should be called "chronic active prostatitis" (CAP).