Qianliexin capsule exerts anti-inflammatory activity in chronic non-bacterial prostatitis and benign prostatic hyperplasia via NF-κB and inflammasome.

Qianliexin capsule (QLX) is a standardized traditional Chinese herbal preparation that has long been used to treat chronic non-bacterial prostatitis (CNP) and benign prostatic hyperplasia (BPH). This study investigated the anti-inflammatory activity of QLX in improving lower urinary tract symptoms (LUTS) associated with CNP and BPH. Rat models of CNP and BPH were induced by oestradiol or testosterone (hormonal imbalance) or chemical inflammation (carrageenan). QLX significantly relieved LUTS in CNP and BPH rat model by reducing prostate enlargement, epithelial thickness, pain response time, urine volume and bleeding time, and by improving prostatic blood flow. The expression of the pro-inflammatory cytokines interleukin (IL)-1ß and tumour necrosis factor (TNF)-α, the pro-inflammatory transcription factor nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), and inflammasome components (NLRP3, caspase-1 and ASC) in CNP and BPH tissues was reduced by QLX addition. QLX treatment was followed by reduced cellular malondialdehyde and increased superoxide dismutase, catalase and glutathione peroxidase activity, consistent with antioxidant activity. Increases in Beclin-1 expression and the LC3II/I ratio following QLX treatment indicated that autophagy had been induced. QLX relieved LUTS in CNP and BPH rat models by inhibiting inflammation. The underlying mechanisms included inhibition of inflammasome activation, NF-κB activation, oxidant stress and autophagy.

Does Pollen Trigger Urological Chronic Pelvic Pain Syndrome Flares? A Case-Crossover Analysis in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network.

PURPOSE: We sought to determine whether pollen triggers urological chronic pelvic pain syndrome flares. MATERIALS AND METHODS: We assessed flare status every 2 weeks for 1 year as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain case-crossover analysis of flare triggers (NCT01098279). Flare symptoms, flare start date and exposures in the 3 days before a flare were queried for the first 3 flares and at 3 randomly selected nonflare times. These data were linked to daily pollen count by date and the first 3 digits of participants' zip codes. Pollen count in the 3 days before and day of a flare, as well as pollen rises past established thresholds, were compared to nonflare values by conditional logistic regression. Poisson regression was used to estimate flare rates in the 3 weeks following pollen rises past established thresholds in the full longitudinal study. Analyses were performed in all participants and separately in those who reported allergies or respiratory tract disorders. RESULTS: Although no associations were observed for daily pollen count and flare onset, positive associations were observed for pollen count rises past medium or higher thresholds in participants with allergies or respiratory tract disorders in the case-crossover (OR 1.31, 95% CI 1.04-1.66) and full longitudinal (RR 1.23, 95% CI 1.03-1.46) samples. CONCLUSIONS: We found some evidence to suggest that rising pollen count may trigger flares of urological chronic pelvic pain syndrome. If confirmed in future studies, these findings may help to inform flare pathophysiology, prevention and treatment, and control over the unpredictability of flares.

MicroRNA-155 deficiency attenuates inflammation and oxidative stress in experimental autoimmune prostatitis in a TLR4-dependent manner.

To explore the mechanism of microRNA-155 (miR-155) deficiency, protecting against experimental autoimmune prostatitis (EAP) in a toll-like receptor 4 (TLR4)-dependent manner. After wild-type (WT) and miR-155-/- mice were injected with complete Freund's adjuvant and prostate antigen to establish EAP model, half were randomly selected for injection with lipopolysaccharide (LPS, a TLR4 ligand). The following experiments were then performed: von Frey filaments, hematoxylin-eosin (HE) staining, real time quantitative polymerase chain reaction (qRT-PCR), Western blotting, and enzyme-linked immunosorbent assay (ELISA). And the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) and the level of Malondialdehyde (MDA) were detected by corresponding kits.miR-155-/- mice with prostatitis exhibited the attenuated pelvic tactile allodynia/hyperalgesia and the suppressed TLR4/nuclear factor-kappa B (NF-κB) pathway as compared with the WT mice with prostatitis. In addition, LPS enhanced the upregulation of miR-155 and the activation of the TLR4/NF-κB pathway in the prostatic tissues of WT mice with EAP. Furthermore, prostatitis mice had aggravated inflammation scores accompanying the increased interleukin (IL)-1ß, tumor necrosis factor-α, IL-6, interferon-γ, IL-12, and MDA in prostatic tissues with the decreased IL-10, SOD and GSH-Px, and the unaltered IL-4. Compared with the mice from the WT + EAP group and the miR-155-/- + EAP + LPS group, mice from the miR-155-/- + EAP group had decreased inflammation and oxidative stress. miR-155 deficiency ameliorated pelvic tactile allodynia/hyperalgesia in EAP mice and improved inflammation and oxidative stress in prostatic tissues in a TLR4-dependent manner involving NF-κB activation, thereby exerting a therapeutic effect in chronic prostatitis treatment.

Brazilian berry extract (Myrciaria jaboticaba): A promising therapy to minimize prostatic inflammation and oxidative stress.

BACKGROUND: Brazilian berry is a fruit popularly known as "Jaboticaba," rich in bioactive compounds with antioxidant and anti-inflammatory properties. Senescence and overweight are increasing worldwide and are considered risk factors to prostatic pathogenesis mainly due to oxidative and inflammatory processes induction. Thus, this study aimed to evaluate the effect of two increasing doses of the patented jaboticaba peel extract (PJE) on oxidative-stress and inflammation in the prostate of aging or high-fat-fed aging mice. METHODS: PJE and/or high-fat diet (HFD) treatments started with 11-month-old mice and lasted 60 days. The levels or the immunoexpression of different inflammatory (nuclear factor κB [NFκB], CD3+, cyclooxygenase 2 [COX-2], toll-like receptor 4 [TLR4], phosphorylated signal transducers and activators of transcription 3 [pSTAT-3], tumor necrosis factor α [TNF-α], interleukin 6 [IL-6], and IL-1ß) and oxidative-stress (catalase, superoxide dismutase 2 [SOD2], glutathione reductase [GSR], reduced glutathione, and glutathione peroxidase 3 [GPx3]) related molecules were analyzed by western-blotting, immunohistochemistry, and enzyme-linked immunosorbent assays. RESULTS: Both PJE doses reduced the levels of oxidative-stress-related molecules (GPx3, GSR, catalase), lipid peroxidation (4-hydroxynonenal), inflammatory mediators (COX-2, TNF-α, and pSTAT-3) and CD3+ T cells number, which were associated with the maintenance of the glandular morphological integrity in aging and HFD-fed-aging mice. Nevertheless, only the high PJE dose reduced the NFκB and TLR4 levels in aging mice; and SOD2, IL-6, and IL-1ß levels in HFD-aging mice. Aging itself promoted an oxidative inflammation in the prostate, interfering in the levels of the different oxidative-stress, lipid peroxidation, and inflammatory mediators evaluated, in association with high incidence of prostate epithelial and stromal damages. The HFD intake intensified aging alterations, showing an unfavorable prostatic microenvironment prone to oxidative and inflammatory damages. CONCLUSIONS: PJE exerted a dose-dependent effect controlling inflammation and oxidative-stress in aging and HFD-fed aging mice prostate. This fact contributed to prostate microenvironment balance recovery, preserving the tissue architecture of this gland. Thus, the PJE emerges as a potential therapy to prevent inflammation and oxidative stress in the prostate.

New therapy with XLQ® to suppress chronic prostatitis through its anti-inflammatory and antioxidative activities.

Chronic prostatitis is a common urological disease. The etiology of this disease and effective therapy for its treatment are yet to be elucidated. We investigated the functions of XLQ® in chronic nonbacterial prostatitis using a complete Freund's adjuvant-induced rat model. Prostates and blood samples were collected for further evaluation after oral gavage with XLQ ® or a vehicle for 4 weeks. The results showed that XLQ ® significantly decreased the prostate index, ameliorated the histopathologic changes, and reduced CD3+ and CD45+ cell infiltration in the prostate stroma. Further study showed that XLQ ® suppressed the expression of proinflammatory cytokines, such as interleukin (IL)-1ß, IL-2, IL-6, IL-17A, monocyte chemoattractant protein-1, and tumor necrosis factor-α. XLQ ® showed a strong antioxidant capacity by enhancing the activities of antioxidative enzymes (e.g., total superoxide dismutase, catalase, and glutathione peroxidase) and decreasing the level of lipid peroxidation products (malondialdehyde). Moreover, XLQ ® can suppress the activation of nuclear factor-κB and P38-mitogen-activated protein kinase signaling pathways. In summary, XLQ ® has affirmative effects on chronic prostatitis, which could be attributed to its anti-inflammatory and antioxidative capacities. On the basis of these results, XLQ ® can be developed as an effective and safe therapy for chronic prostatitis.

The effect of hexanic extract of Serenoa repens on prostatic inflammation: results from a randomized biopsy study.

PURPOSE: To evaluate the effect of hexanic extract of Serenoa repens (HESr) on prostatic inflammation in patients with diagnosed prostatic inflammation. METHODS: Patients with prostatic inflammation histologically confirmed by TRUS prostatic biopsy were randomized either to receive HESr (320 mg/day) or no treatment. A second biopsy was performed 6 months later according to standard clinical practice. Inflammation was assessed by the Irani's score and immunohistochemical staining using the CD3, CD4 and CD8 (for T-leucocytes), CD20 (for B-leucocytes) and CD163 (for macrophages) antibodies. RESULTS: Overall 97 patients were eligible for analysis. In the HESr group the mean inflammation grading and aggressiveness grading score significantly decreased from 1.55 and 1.55 at baseline to 0.79 (p = 0.001) and 0.87 (p = 0.001) at the second biopsy, respectively. In the control group the mean inflammation grading score was 1.44 at first biopsy and 1.23 at the second biopsy. The mean aggressiveness gradings core was 1.09 and 0.89, respectively. No statistical significance was found (p = 0.09 and p = 0.74).The mean decrease in all inflammation scores was statistically higher in the HESr patients compared to controls. The immunohistochemical staining showed a significant change in the expression of the analyzed antibodies for the HESr patients compared to the first biopsy. In the nontreatment group, no significant difference was found at the second biopsy. The change in expression of each antibody in the HESr group was statistical significant compared to control. CONCLUSIONS: HESr seems to reduce prostatic inflammation in terms of histological and immunohistochemical parameters in this specific patients population.

Anti-inflammatory effects of a traditional Korean medicine: Ojayeonjonghwan.

OBJECTIVE: To study the anti-inflammatory properties of OJ. CONTEXT: Ojayeonjonghwan (OJ) is a traditional Korean prescription, which has been widely used for the treatment of prostatitis. However, no scientific study has been performed of the anti-inflammatory effects of OJ. MATERIALS AND METHODS: Peritoneal macrophages were isolated 3-4 days after injecting a C57BL/6J mouse with thioglycollate. They were then treated with OJ water extract (0.01, 0.1, and 1 mg/mL) for 1 h and stimulated with lipopolysaccharide (LPS) for different times. Nitric oxide (NO), inducible nitric oxide synthase (iNOS) and cyclooxygenase (COX)-2, and proinflammatory cytokine levels were determined by NO assay, Western blotting, RT-PCR and ELISA. RESULTS: NO generation and iNOS induction were increased in the LPS-activated mouse peritoneal macrophages. However, NO generation and iNOS induction by LPS were suppressed by treatment with OJ for the first time. The IC50 value of OJ with respect to NO production was 0.09 mg/mL. OJ did not influence LPS-stimulated COX-2 induction, but did significantly decrease LPS-stimulated secretions and mRNA expressions of tumour necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1ß. Inhibition rates of TNF-α, IL-6, and IL-1ß at an OJ concentration of 1 mg/mL were 77%, 88%, and 50%, respectively. OJ also suppressed the LPS-induced nuclear translocation of NF-κB. High-performance liquid chromatography showed schizandrin and gomisin A are major components of OJ. CONCLUSIONS: OJ reduces inflammatory response, and this probably explains its positive impact on the prostatitis associated inflammation.

[Immune mechanisms of the active ingredients of Chinese medicinal herbs for chronic prostatitis].

Chronic prostatitis is a common male disease, and its pathogenesis is not yet clear. Most scholars believe that oxidative stress and immune imbalance are the keys to the occurrence and progression of chronic prostatitis. Currently immunotherapy of chronic prostatitis remains in the exploratory stage. This article relates the active ingredients of 5 Chinese medicinal herbs (total glucosides of paeony, tripterigium wilfordii polglycosidium, curcumin, geniposide, and quercetin) for the treatment of chronic prostatitis and their possible action mechanisms as follows: 1) inhibiting the immune response and activation and proliferation of T-cells, and adjusting the proportion of Th1/Th2 cells; 2) upregulating the expression of Treg and enhancing the patient's tolerability; 3) suppressing the activation of the NF-kB factor, reducing the release of iNOS, and further decreasing the release of NO, IL-2 and other inflammatory cytokines, which contribute to the suppression of the immune response; 4) inhibiting the production of such chemokines as MCP-1 and MIP-1α in order to reduce their induction of inflammatory response. Studies on the immune mechanisms of Chinese medicinal herbs in the treatment of chronic prostatitis are clinically valuable for the development of new drugs for this disease.

Effects of different Chinese herbal prescriptions on cytokines in au- toimmune prostatitis rats.

OBJECTIVE: To observe and compare the effects of Chinese herbal prescriptions for promoting blood circulation, clearing heat, removing toxicity, and dispersing stagnated liver-Qi on cytokines in mode rats with experimental autoimmune prostatitis (EAP) to provide an experimental basis for the use of Chinese herbal prescriptions in the treatment of chronic prostatitis. METHODS: One-hundred and ten male Wistar rats were randomly divided into 11 groups: blank group; model group; Huoxuehuayu (promoting blood circulation to remove blood stasis) high, middle, and low dose groups; Qingrejiedu (clearing heat and removing toxicity) high, middle, and low dose groups; and Shuganliqi (dispersing stagnated liver-Qi) high, middle, and low dose groups. Except the blank group, rats in all groups were injected subcutaneously in multiple points on days 0 and 30 with prostatic protein extractive solution (60 mg/ mL), and intraperitoneally injected with diphtheria-pertussis and tetanus vaccine (DPT vaccine) to establish the EAP model. Model rats were adminis- trated high, middle, and low doses of Chinese herb- al prescriptions and were sacrificed after 4 weeks. Pathological changes in the prostate gland were observed with HE staining and changes in serum interleukin-6 (IL-6), interleukin-8 (IL-8), and prostaglandin E2 (PGE2) levels were detected with enzyme-linked immunosorbent assay. RESULTS: Compared with the blank group, serum PGE2, IL-6, and IL-8 levels in the model group were significantly higher (P < 0.05). Compared with the model group, serum PGE2, IL-6, and IL-8 levels in the Qingrejiedu low dose and middle dose groups were significantly lower (P < 0.05), with the lower dose having a more obvious effect. Serum PGE2, IL-6, and IL-8 levels in the Huoxuehuayu high dose group (P < 0.05), IL-6 and IL-8 levels in the Huoxue- huayu middle dose group (P < 0.05), and the IL-8 level in the Huoxuehuavu low dose group were significantly lower than those in the model group (p < 0.05). There were significant differences in PGE2 and IL-6 levels among the different dose groups of Shuganliqi drugs (P < 0.05). Compared with the model group, serum PGE2, IL-6, and IL-8 levels in the Shuganliqi high dose group (P < 0.05) and IL-8 level in the Shugangliqi low dose group were significantly lower (P < 0.05), while the Shuganliqi middle dose group did not change significantly. CONCLUSION: Therefore, in TCM treatment of autoimmune prostatitis, different treatment methods should select different doses. For prescriptions that clear heat and remove toxicity, low doses should be used. For prescriptions that promote blood circulation to remove blood stasis and for prescriptions that disperse stagnated liver-Qi, high doses should be used.

Acupuncture and immune function in chronic prostatitis/chronic pelvic pain syndrome: a randomized, controlled study.

OBJECTIVE: The immune system has been implicated as one mechanism underlying the benefits of acupuncture therapy. Evidence suggests that acupuncture can ameliorate symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), but the association between clinical response and the immune system has not been investigated. DESIGN/SETTING: We investigated 12 CP/CPPS patients participating in a prospective randomized clinical trial comparing acupuncture versus sham acupuncture for effects on cellular immunity. Blood samples were taken before the first needling and after the last of 20 treatment sessions (week 10). Patients also completed questionnaires examining their CP/CPPS symptoms and mood status at the baseline and end of study visits. RESULTS: At the end of study 8 of 12 participants (67%) were classified as treatment responders, four participants each from the acupuncture and sham groups. The acupuncture group averaged a 5% increase in natural killer cell levels compared to corresponding sham (-13%; p=0.03). Similarly, patients randomized to acupuncture reported a reduction in other white blood cell parameters examined, supporting the possibility that immunity might be important in the pathophysiology of CP/CPPS. CONCLUSIONS: The specific effect of acupuncture on CP/CPPS remains unclear. Further research is warranted to examine the mechanisms by which acupuncture therapy may improve clinical symptoms in patients with CP/CPPS. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT00260637).

[Effect of electroacupuncture at "Sanyin" acupoints on cellular immune function in rats with chronic abacterial prostatitis].

OBJECTIVE: To observe the effect of electroacupuncture (EA) at "Sanyin" acupoints (bilateral "Jiayin" and "Zhongyin") on the cellular immune function of rats with chronic abacterial prostatitis (CAP), so as to explore its mechanism underlying relieving CAP. METHODS: Forty male Wistar rats were randomly divided into four groups: control, model, medication (Cernilton) and EA (n = 10 rats/group). The CAP model was made by injection of allogeneic prostatein purification liquid + Freund's complete adjuvant (1:1) and diphtheria, pertussis, tetanus (DPT) vaccine (0.5 mL). EA was applied to bilateral "Jiayin" acupoints (located at the bilateral groins at the horizontal level of the upper border of the pubic symphysis) and "Zhongyin" [the midpoint between the "Huiyin" (CV 1) and the scrotum root, punctured with filiform needle] for 20 min, once daily for two therapeutic courses (15 days/course, one day break between the two courses). Rats of the medication group were given with oral administration of Cernilton (13 mg/kg) once daily for 15 days. Following killing the rats under deep anesthesia, the prostate wet weight, and prostate index (prostate weight/body weight) were determined. Pathological changes of the prostate tissue were examined by light microscope after sectioning and haematoxylin (HE) staining. Plasma levels of CD4+ Th- and CD8+ T-lymphocytes were assayed with flow cytometry. RESULTS: Compared with the control group, the morphological structure of prostate tissues of rats in the model group was severely damaged (proliferation of the prostate epithelium and inflammatory cell infilitration), which was relatively milder in the EA group. The plasma CD4+ level and CD4+/CD8+ ratio were significantly lower in the model group than in the control group (P < 0.01, P < 0.05). Compared with the model group, plasma CD4+ levels were significantly increased in both medication and EA groups (P < 0.05, P < 0.01), and the CD4+ level of the EA group was considerably higher than that of the medication group (P < 0.05). The ratio of CD4+/CD8+ in the EA group was remarkably higher than that in the model group (P < 0.05). No significant differences were found among the four groups in the prostate weight, prostate index and plasma CD8+ levels (P > 0.05). CONCLUSION: EA stimulation of "Sanyin" points is beneficial to relieve chronic abacterial prostatitis, which may contribute to its effect in strengthening the cellular immune function via upregulation of plasma CD4+ and CD4+/ CD8+ levels.

Effect of a phytotherapeutic agent, Eviprostat®, on prostatic and urinary cytokines/chemokines in a rat model of nonbacterial prostatitis.

BACKGROUND: Chronic inflammation in the prostate has recently been recognized as an important component of the symptom progression of benign prostatic hyperplasia. The objective of this study was to evaluate a range of cytokines/chemokines in prostate tissue and urine to identify markers of prostate inflammation in a prostatitis model and to investigate the effect of a phytotherapeutic agent, Eviprostat®, on these markers. METHODS: Ten-month-old male Wistar rats were divided into four groups. Nonbacterial prostatitis (NBP) was experimentally induced in groups 2-4 by castration followed by daily subcutaneous injection of 17ß-estradiol for 30 days. Control rats were fed a standard diet, while animals in the Eviprostat groups were fed a diet containing 0.05 or 0.1% Eviprostat for 30 days. The levels of cytokines/chemokines in prostate tissue on the 31st day and in urine collected the day before castration and the day before removal of the prostate were determined. RESULTS: Experimentally induced NBP increased the prostatic levels of the cytokines interleukin-1ß (IL-1ß) and tumor necrosis factor-α (TNF-α). The levels of the chemokines CCL2/monocyte chemoattractant protein-1 (MCP-1), CCL3/macrophage inflammatory protein-1α (MIP-1α), CXCL1/CINC-1, CXCL3/CINC-2, and CXCL5/LIX were elevated in both prostate and urine. Eviprostat significantly suppressed the increases in prostate IL-1ß, TNF-α and CCL3/MIP-1α and prostatic and urinary CCL2/MCP-1 and CXCL1/CINC-1. CONCLUSIONS: Chemokines, including CCL2/MCP-1 and CXCL1/CINC-1, were elevated in the prostate and urine of NBP rats, and Eviprostat potently suppressed the increases in CCL2/MCP-1 and CXCL1/CINC-1. These chemokines are therefore candidate diagnostic biomarkers for nonbacterial chronic prostatic inflammation.

[Immunocorrecting therapy of chronic bacterial prostatitis].

A total of 55 patients aged 20-59 years with recurrent chronic bacterial prostatitis (RCBP) entered a trial of immunomodulator panavir. The study group consisted of 40 patients. They were given standard treatment and panavir. The control group (n = 15) matched by all the studied characteristics received standard treatment only. Blood count, bacteriological characteristics of prostatic secretion, immunological status, subjective parameters were studied. RCBP patients were diagnosed to have marked disorders of interferon status. The addition of panavir to standard treatment of RCBP patients significantly improved treatment results. Therefore, panavir is recommended as an adjuvant in combined RCBP treatment.

[Application of physiobalneotherapeutic factors in the combined rehabilitative treatment of patients with chronic bacterial prostatitis complicated by erectile dysfunction].

Patients with chronic bacterial prostatitis complicated by erectile dysfunction received combined rehabilitative treatment based on the use of various combinations of physiobalneotherapeutic factors, such as ultrasound, local negative pressure, white and yellow turpentine or sodium chloride baths, supplemented by basal medicamentous therapy in the form of rectal suppositories. Efficiency of therapy involving sodium chloride, white and yellow turpentine baths was estimated at 85, 60, and 75% respectively.

[Study of effects and mechanism of phytosterols on chronic abacterial prostatitis].

OBJECTIVE: To investigate the inhibitory effects of phytosterols on abacterial prostatitis and discuss the possible mechanism. METHOD: Xiaozhiling-induced chronic prostatitis model were used to observe the inhibitory effect of phytosterols on abacterial prostatitis. The changes of serum IL-2, IL-1beta and TNF-alpha were evaluated by enzyme-linked immunosorbent assay (ELISA). The expression of COX-2 and 5-LOX were evaluated by Western blot and immunohistochemistry. RESULT: Treated by phytosterols (150 mg x kg(-1)), the number of white blood cells in xiaozhiling-induced chronic abacterial prostatitis rats was obviously decreased, the density of lecithin corpuscle in prostatic secretion increased and closed to control group. The edema, inflammatory infiltration of prostate were partly recovered compared with model group. The proliferation of chronic prostatitis were obviously decreased in phytosterols groups compared with model group in histological sections. Phytosterols could obviously reduce the serum IL-1beta, TNF-alpha, prostate COX-2 and 5-LOX expression and improve IL-2 level. CONCLUSION: These results demonstrated that phytosterols had good therapeutic effects on chronic abacterial prostatitis. Participation of immune regulation and inhibiting COX-2 and 5-LOX expression may be the mechanisms of action.

Cytomegalovirus prostatitis: a series of 4 cases.

Cytomegalovirus (CMV) prostatitis is very rare with only 1 report of biopsy-proven CMV prostatitis in the literature. The authors report 4 cases, 3 detected on needle biopsy and 1 detected on transurethral resection. Patients were 36, 41, 48, and 71 years old. All patients were immunosuppressed, including 1 with AIDS and 3 undergoing immunosuppressive therapy following organ transplantation. CMV inclusions were seen in secretory cells of the prostatic glands, endothelial cells of small vessels, and prostatic stromal cells associated with a dense lymphoid inflammation. Only very rarely is CMV prostatitis detected on clinical specimens, typically in immunosuppressed hosts undergoing immunosuppressive therapy following organ transplantation. Patients with CMV prostatitis may harbor multiple infections or have other serious medical conditions adversely affecting their prognosis.

Chronic prostatitis/chronic pelvic pain syndrome in males may be an autoimmune disease, potentially responsive to corticosteroid therapy.

UNLABELLED: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) represents the most common form of prostatitis. No known etiology factor in most cases can be found. It is possible that at least in some cases autoimmune response could be causative factor. Common treatment options include antibiotics, alpha blockers, myorelaxants, phytotherapeuticals, non steroidal anti-inflammatory drugs, hormonal treatment and surgery but corticosteroids have not been investigated. HYPOTHESIS: Chronic pelvic pain syndrome is in some cases autoimmune disease and this could have repercussions on treatment using low dose corticosteroids. RATIONALE: Currently corticosteroids are not a standard treatment option in CP/CPPS. Theoretical, experimental and scarce clinical evidence suggest that treatment with low dose corticosteroids could be beneficial in some patients with chronic prostatitis. If our hypothesis could be supported with well designed, randomized clinical trials this could change the approach of the medical treatment of CP/CPPS.

[Effect of danpu capsule on inflammatory factors in rat model of autoimmune prostatitis].

OBJECTIVE: To explore the acting mechanism of Danpu Capsule (DPC) in treating chronic prostatitis by observing its effect on inflammatory factors in autoimmune prostatitis rat model. METHODS: The rat model was established by abdominal subcutaneous multiple points injection of rat's prostate tissue antigen. Thirty modeled rats were randamly divided into 3 groups, the DPC group, the Qianlietai Tablet (QLT) group and the model group. They were treated via gastrogavage respectively with DPC, Qianlietai Tablet and normal saline respectively. Besides, a control group was set up with 10 healthy rats. All animals were sacrificed 56 days after treatment. Pathologic change of prostatic tissue was observed by light microscopy, and the levels of interleukin 8 (IL-8), interleukin 10 (IL-10), tumor necrosis factor alpha (TNF-alpha) and prostaglandin E2 (PGE2) in blood serum and prostatic tissue were detected by enzyme linked immunosorbent assay (ELISA). RESULTS: Compared with the normal group, the serum and prostatic levels of IL-8, IL-10 and TNF-alpha, as well as the prostatic level of PGE2 in the model group were higher (P <0.05 or P <0.01). In the DPC group, the serum and prostatic levels of IL-8 was 3.07 +/- 0.61 ng/L and 7.32 +/- 2.44 ng/L respectively, which was lower than those in the model group (4.73 +/- 1.95 ng/L and 10.14 +/- 3.64 ng/L, respectively); that of TNF-alpha in the DPC group (85.34 +/- 19.20 ng/L and 87.01 +/- 15.4 ng/L) was also lower in the model group (111.48 +/- 31.57 ng/L and 119.88 +/- 14.13 ng/L); similar difference between the two groups was also shown in prostatic level of IL-10 (34.05 +/- 7.56 ng/L vs 47.20 +/- 15.97 ng/L), and so was PGE2 (603.97 +/- 114.62 ng/L vs 712.58 +/- 117.10 ng/L), all with statistical significance (P <0.05 or P <0. 01). CONCLUSION: DPC could reduce the prostatic inflammatory response of model rats, and regulate the local immune condition.

Reduction of PSA values by combination pharmacological therapy in patients with chronic prostatitis: implications for prostate cancer detection.

We identified from our clinical database a total of 471 patients affected by cat. II chronic bacterial prostatitis (CBP), cat. III (IIIa and IIIb) chronic pelvic pain syndrome (CP/CPPS), or cat. IV asymptomatic inflammatory prostatitis (AIP), according to NIH criteria. 132 intent-to-treat patients, showing levels of PSA > or =4 ng/mL, were subjected to a 6-week course of combination pharmacological therapy with 500 mg/day ciprofloxacin, 500 mg/day azithromycin (3 days/week), 10 mg/day alfuzosin and 320 mg b.i.d. Serenoa repens extract. At the end of treatment, 111 per-protocol patients belonging to all categories of prostatitis showed a total 32.5% reduction of PSA levels. In the same group, 66 patients (59.4%) showed "normalization" of PSA values under the 4 ng/mL limit. Patients affected by cat. IIIb CP/CPPS showed the highest PSA reduction and normalization rates (40% and 68.4%, respectively). Follow-up data show that, after a marked, significant reduction at completion of therapy, PSA levels, urine peak flow rates and NIH-CPSI symptom scores remained constant or decreased throughout a period of 18 months in patients showing normalization of PSA values. Prostatic biopsy was proposed to 45 patients showing persistently high PSA values (> or = 4 ng/mL) at the end of treatment. Fourteen patients rejected biopsy; of the remaining 31, 10 were diagnosed with prostate cancer. Four months after a first biopsy, a second biopsy was proposed to the 21 patients with a negative first diagnosis and persistently elevated PSA levels. Three patients rejected the procedure; of the remaining 18, four were diagnosed with prostatic carcinoma. In summary, combination pharmacological therapy decreased the number of patients undergoing prostatic biopsy from 111 to 45. Normalization of PSA values in 59.4% of patients--not subjected to biopsy--increased the prostate cancer detection rate from 12.6% (14/111) to 31.1% (14/45). The reduction of PSA after a 6-week course of therapy was calculated in patients affected by cat. II, IIIa, IIIb and IV prostatitis after stratification with respect to the concomitant presence or absence of benign prostatic hyperplasia (BPH). PSA was reduced by 41% in cat. II CBP patients without BPH, compared to a 12.7% reduction in patients affected by BPH. Cat. IIIa CP/CPPS patients without BPH showed a 58.3% reduction of PSA levels, compared to a 20.7% reduction observed in CPPS/BPH patients. These data show that the presence of BPH may prevent the reduction of PSA induced by combination pharmacological therapy, and suggest that care has to be taken in the adoption of PSA as a marker of therapeutic efficacy in the presence of confounding factors like BPH. PSA should in our opinion be used as a significant component of a strategy integrating multiple diagnostic approaches.