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Prostatitis Foundation

Third International Chronic Prostatitis Network

Correlation of ß-endorphin and PGE2 levels in prostatic fluid of men with Chronic Prostatitis/CPPS

A.R. Shahed, D.A. Shoskes,
Harbor-UCLA Medical Center and Cleveland Clinic Florida, Fort Lauderdale, Florida
Chronic pelvic pain syndrome is a clinically defined symptom complex which may have infective, inflam-matory or neuromuscular components. The inability to differentiate the chronic prostatitis syndromes by symptoms alone suggests a common final pathways in symptom pathogenesis. We have shown that increased oxidative stress is present in prostatic fluid of men with categories II, IIIa and IIIb prostatitis. Since inflammation and increased oxidative stress represent injury, and immune cells have been shown to produce the natural opiod ß-endorphin (END) at the site of injury we wished to measure the levels of END and PGE2 (COX-2 product) in the EPS of prostatitis patients.
EPS was collected from 35 patients and frozen until use. EPS was centrifuged and a 5-10 µ:l sample was used to measure END (Peninsula Labs) and PEG2 (Caymen Chemicals) by EIA and data presented as ng/ml EPS. Samples were stratified according to prostatitis category and samples from patients who had samples before and after successful therapy were compared.
In symptomatic patients, levels of END and PGE-2 were similar regardless of diagnosis. Comparing category II vs IIIa vs IIIb in symptomatic patients yield-ed similar results for END (12.2 vs 9.7 vs 9.1, p=NS) and PGE-2 (6.4 vs 4.9 vs 5.2, p=NS). In aggregate however, successful treatment with antibiotics, phytotherapy (Prosta-Q) or neuromuscular treatments increased END levels (23.8 ± 11 vs 8.7 ±: 4.7 p=0.0001) and reduced PGE 2 levels (6.01 ±: 2.9 vs 3.01 ±: 2.9 p=0.001).
Regardless of etiology, patients with chronic pelvic pain syndrome have high levels of a COX-2 mediated inflammatory marker and low levels of the natural opiod ß-endorphin. Successful treatment of the pain syndrome increases ß-endorphin levels and reduces PGE-2 in the EPS. These findings suggest that agents which inhibit oxidative stress (eg COX-2 inhibitors, Prosta-Q) may reduce pain by increasing local opiod levels.
© 2002 The Prostatitis Foundation
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