Asymptomatic inflammatory prostatitis: prevalence, etiological factors, diagnostic tools
Date
2008-07-07T05:56:03Z
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Abstract
Asymptomatic inflammatory prostatitis is defined as the presence of significant amounts of leukocytes and/or bacteria in prostate-specific material (expressed prostatic secretions, semen or prostate tissue
sample) and the absence of subjective symptoms. Very few studies are available on the prevalence and etiology of this form of prostatitis.
The primary aims of this research were to 1) determine the prevalence of asymptomatic inflammatory prostatitis in young Estonian men, 2) investigate the etiologic factors of asymptomatic prostatitis by means of quantitative full-microflora analysis of semen, and 3) establish and validate the use of the most acknowledged diagnostic tool available for symptomatic prostatitis – National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) – in Estonian for use in further epidemiological studies and clinical work alike.
As a result we found that a remarkable proportion (6-19% depending on the diagnostic criteria used) of young Estonian men has asymptomatic inflammatory (NIH category IV) prostatitis, whereby symptomatic forms of prostatitis are almost absent in this age group. Asymptomatic inflammatory prostatitis most probably has an important infectious component since these patients harbor abundant polymicrobial microbiocenosis in their semen containing both aerobic and anaerobic bacteria, which resembles the microbiota seen also in symptomatic forms of prostatitis. PSA levels in serum and IL-6 concentration in seminal plasma are significantly higher in NIH IV category prostatitis patients than in the controls. Analogous tendencies have been found in symptomatic prostatitis, thus further supporting the similarities between asymptomatic inflammatory prostatitis and symptomatic forms of prostatitis.
Moderate leukocytospermia appears to increase sperm concentration and total sperm count regardless of age, while severe leukocytospermia tends to have negative effect on the semen quality only in mid-twenties but not in younger men. Moreover, younger study subjects tend to have better semen
quality than their older counterparts regardless of their leukocytospermia status. That may indicate age-dependent differences in functional reserve of accessory sex glands.
Description
Asymptomatic inflammatory prostatitis is defined as the presence of significant amounts of leukocytes and/or bacteria in prostate-specific material (expressed prostatic secretions, semen or prostate tissue
sample) and the absence of subjective symptoms. Very few studies are available on the prevalence and etiology of this form of prostatitis.
The primary aims of this research were to 1) determine the prevalence of asymptomatic inflammatory prostatitis in young Estonian men, 2) investigate the etiologic factors of asymptomatic prostatitis by means of quantitative full-microflora analysis of semen, and 3) establish and validate the use of the most acknowledged diagnostic tool available for symptomatic prostatitis – National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) – in Estonian for use in further epidemiological studies and clinical work alike.
As a result we found that a remarkable proportion (6-19% depending on the diagnostic criteria used) of young Estonian men has asymptomatic inflammatory (NIH category IV) prostatitis, whereby symptomatic forms of prostatitis are almost absent in this age group. Asymptomatic inflammatory prostatitis most probably has an important infectious component since these patients harbor abundant polymicrobial microbiocenosis in their semen containing both aerobic and anaerobic bacteria, which resembles the microbiota seen also in symptomatic forms of prostatitis. PSA levels in serum and IL-6 concentration in seminal plasma are significantly higher in NIH IV category prostatitis patients than in the controls. Analogous tendencies have been found in symptomatic prostatitis, thus further supporting the similarities between asymptomatic inflammatory prostatitis and symptomatic forms of prostatitis.
Moderate leukocytospermia appears to increase sperm concentration and total sperm count regardless of age, while severe leukocytospermia tends to have negative effect on the semen quality only in mid-twenties but not in younger men. Moreover, younger study subjects tend to have better semen
quality than their older counterparts regardless of their leukocytospermia status. That may indicate age-dependent differences in functional reserve of accessory sex glands.
Asümptomaatilise põletikulise prostatiidi puhul leitakse eesnäärmespetsiifilises materjalis (eesnäärme sekreet, sperma või eesnäärmekude) olulisel määral leukotsüüte ja/või baktereid, samas kui subjektiivsed kaebused patsiendil puuduvad. Selle prostatiidivormi levimuse ja etioloogia kohta on siiani avaldatud vaid üksikuid teadusuuringuid.
Uurimuse eesmärgiks oli kindlaks teha asümptomaatilise prostatiidi levimus Eestis, etioloogilised tegurid ning mõju diagnostilistele markeritele, samuti välja töötada ning valideerida NIH-CPSI (National Institutes of Health Chronic Prostatitis Symptom Index) eestikeelne versioon edaspidiste epidemioloogiliste uuringute ja kliinilise töö tarbeks.
Asümptomaatilise põletikulise prostatiidi levimus Eesti noortel meestel on 6,0% (WHO standardite järgi, s.o >1 milj PMN/ml sperma kohta), samas on madalama läviväärtuse (0,2 milj PMN/l) rakendamisel sama põletiku levimuseks 19,0%. Asümptomaatilise põletikuvormi sage esinemine ja sümptomaatilise vormi harvaesinemine selles vanuserühmas viitab vajadusele selgitada edasiste uuringute käigus prostatiidikaebuste tekkedünaamikat sõltuvalt patsiendi vanusest ning teha kindlaks võimalikud
patogeneetilised seosed prostatiidi sümptomaatiliste ja asümptomaatiliste vormide vahel.
Asümptomaatilise põletikulise prostatiidi etioloogias on tõenäoliselt oluline roll infektsioossel komponendil, kuna nende patsientide spermaproovides esineb kõrge kontsentratsiooniga polümikroobne mikrobiotsönoos, mis koosneb nii aeroobsetest kui ka anaeroobsetest bakteritest. Sarnane leid on
iseloomulik ka kroonilisele mittebakteriaalsele prostatiidile (CP/CPPS), viidates nende kahe vormi etiopatogeneetilisele sarnasusele.
Asümptomaatilise põletikulise prostatiidiga patsientidel on PSA tase seerumis ja IL-6 kontsentratsioon spermaplasmas oluliselt kõrgemad kui kontrolluuritavatel. Analoogseid tendentse on täheldatud varasemates uuringutes sümptomaatilise prostatiidiga patsientidel, mis samuti viitab sarnasustele asümptomaatilise ja sümptomaatilise prostatiidi vahel.
Mõõdukas leukotsütospermia (0,2–1,0 milj PMN/ml) mõjutab asümptomaatilise põletikulise prostatiidi tingimustes positiivselt sperma kontsentratsiooni ja spermatosoidide koguhulka sõltumata uuritava vanusest (võrreldud keskmised vanused 18,9 ja 26,4 eluaastat), samas kui tugev leukotsütospermia
(>1,0 milj PMN/ml) mõjutab sperma kvaliteeti negatiivselt vaid vanemal vanuserühmal. Samuti täheldasime, et noorematel uuritavatel oli sperma kvaliteet parem kui vanematel uuritavatel, seda sõltumata leukotsütospermia tasemest. Eelmainitu põhjal võib oletada, et genitaaltrakti lisasugunäärmete funktsionaalne reserv on noorematel meestel põletiku olemasolul suurem.