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1999 Selected Abstracts from American Urological Association annual meeting

Oxidant Stress in Prostate Fluid Correlates with Diagnosis and Treatment Response in Chronic Prostatitis

A Shahed and DA Shoskes; Torrance, CA (Presented by Dr. Shoskes)
Chronic prostatitis syndromes are diagnosed on the basis of white count in expressed prostatic secretions (EPS) and culture, but these are seldom predictive of treatment response. White cells may not indicate infection, while commonly seen Gram positive bacteria may not be true pathogens. We wished to study oxidative stress in the EPS of patients with chronic prostatitis as a potential diagnostic and therapeutic marker.
EPS was collected from 71 patients at their first clinic and serially in 15 patients. There were 10 WBC/hpf in 25 patients and greater in 37. Oxidative stress was measured by adding the EPS to 2',7'-dichlorofluorescin (DCF) and measuring the induced fluorescence. Results were expressed as % change in fluorescence over background and correlated with the WBC count and culture results.
Thirty five patients had positive EPS cultures, but all had counts 100,000 cfu per ml. If these cultures were considered negative, 25 patients with prostatodynia had a median DCF increase of 51% and 37 with nonbacterial prostatitis (NBP) had a median DCF increase of 64% (p=0.85). If all positive cultures were considered to be pathogens, the DCF increase in 15 patients with prostatodynia was 18%, in 21 patients with NBP was 53.4% and in 35 patients with chronic bacterial prostatitis (CBP) was 179% (p=0.001). In patients treated with antibiotics and serial massages, all who responded to treatment had lower terminal than initial DCF values while those that did not respond to treatment had no decrease in DCF value. In vitro addition of antioxidants to the DCF reaction demonstrated partial inhibition with superoxide dismutase, thiol and calcium ion chelators but profound inhibition with bioflavonoids and L-NAME.
Oxidant stress in EPS as measured by DCF fluorescence is significantly higher in patients with CBP than those with prostatodynia or NBP and correlates with treatment response independently of WBC count or EPS culture. The mechanism of this oxidant reaction involves superoxide anion and nitric oxide and is significantly inhibited by bioflavonoids.
Source: 1999 AUA Meeting

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