AUA 2004 - Bacteria in 20% of Pelvic Pain Patients

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Presentation Title:
HIGH BACTERIAL DNA LEVELS IN A SUBSET OF CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME PATIENTS

Presentation Time: 5/8/2004 3:40:00 PM

Author Block: Donald E. Riley, John N. Krieger, David Miner, Sue Ross. University of Washington, Seattle, WA

Introduction and Objective: CP/CPPS patient prostate biopsies often have bacterial DNA detectable by the polymerase chain reaction, but these studies lack discrimination of patients more likely to respond to antibiotic therapy. Our objective was to determine whether the quantity of DNA in PCR positive CP/CPPS patients was consistent with ongoing infection in some patients who were more likely to respond to therapy, or more consistent with a low level of bacterial DNA.

Methods: Biopsies were obtained by a perineal, double needle procedure that limits contamination. Controls consisted of organ donor prostate tissue, or prostate cancer tissue. For CP/CPPS patients, a skin biopsy and a skin swab at the site were obtained and processed in parallel with the prostate biopsy. Contaminating DNA from previous amplifications were eliminated using heat-labile uracil DNA glycosylase. CP/CPPS prostate biopsies and control biopsies were digested with proteinase K and 16S rDNA amplified in the presence of SYBR Green I. PCR was carried out in a LightCycler (Roche, Molecular).

Results: Comparing 111 CP/CPPS patients and 71 CaP patients, CP/CPPS patients had significantly higher levels of bacterial DNA (Chi-square = 9.759, df = 1, p = 0.02). Among the 111 CP/CPPS patients, 22 (20%) had bacterial colony forming unit equivalents (CFUE) > 10,000. Among the 71 CaP patients, 4 (6%) had CFUE > 10,000 (Chi-square = 7.239, df =1, p = 0.01). Compared with CaP paitients, CP/CPPS patients had mean CFUE values 3 times higher due in part to a sub-population with high CFUE.

Conclusions: Many CP/CPPS patients and CaP patients had low levels of bacterial DNA although a subset consisting of 20% of CP/CPPS patients had extremely high levels of bacterial DNA potentially consistent with active infection. There were significantly more CP/CPPS patients than CaP patients with CFUE > 10,000. These observations may help define a sub-population of CP/CPPS more likely to respond to antibiotic therapy. Our findings may have implications for population size needed to demonstrate efficacy of antibiotic therapy.

(Question: could the differences in bacterial counts between CP/CPPS patients and Prostate Cancer patients have anything to do with the fact that most men with CP/CPPS are young and sexually active [average age around mid-thirties], while CaP patients are usually old [65+] and far less sexually active? Questions like these can invalidate studies completely.)

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(Question: could the differences in bacterial counts between CP/CPPS patients and Prostate Cancer patients have anything to do with the fact that most men with CP/CPPS are young and sexually active [average age around mid-thirties], while CaP patients are usually old [65+] and far less sexually active? Questions like these can invalidate studies completely.)

Just to illustrate this point, the median age at diagnosis of prostate cancer is 72 years, and only 1 in 100,000 men will get prostate cancer under the age of 40 (when CP/CPPS is at its peak incidence).

What you get when you compare apples and oranges is junk science.