Question on Abstract @ www.ucpps.men

[prostateproblem]

Hi,


Can someone explain to me what this really indicates....I found this @ https://ucpps.men, its a clinical trial on leukocytes...

CONCLUSIONS Men with CP/CPPS have significantly higher leukocyte counts in all segmented urine samples and EPS but not in semen as compared to controls. There is no difference in rates of localization of bacterial cultures for men with CP/CPPS compared to control men. The high prevalence of WBCs and positive bacterial cultures in the asymptomatic control population raises questions about the clinical usefulness of the standard 4-glass test as a diagnostic tool in men with CP/CPPS.

How can one have more leukocyes in the EPS but not in semen, when EPS is part of the semen? Am I missing something?

[webslave]

Semen contains a lot of fluid from the seminal vesicles and testicles, as well as the fluids you get from EPS. But prostatic secretions, as a % of semen, is not high enough to make semen look abnormal simply by adding a few more leukocytes.

The point of that study is that bacteria and pus cells alone do not distinguish men with CP/CPPS from controls, since many controls have pus cells and bacteria. It implies that testing segmented urine is pointless (tell your uro that and watch him scowl!)

It means you should stop worrying about bacteria, pus cells and EPS. They are all, essentially, yesterday's concepts.

[prostateproblem]

Mark,


Great, I am totally with you on that. Bacteria is also in the prostate of asymptotic men.

Can you explain what this study means?

Oxidative stress in prostatic fluid of patients with chronic pelvic pain syndrome: correlation with gram positive bacterial growth and treatment response.

Shahed AR, Shoskes DA.

Division of Urology, Harbor-UCLA Medical Center, Torrance, California, USA.

The etiology of chronic pelvic pain syndrome (CPPS)/chronic prostatitis category III remains unknown. Whereas a subset of men respond to antimicrobial therapy, gram positive bacteria isolated from expressed prostatic secretions (EPS) are often considered to be commensal rather than pathogenic. We wished to study oxidative stress as a marker of tissue injury and response in EPS of men with chronic prostatitis / chronic pelvic pain syndrome to determine whether infection with gram positive bacteria is associated with increased oxidative stress. A total of 300 EPS specimens from 100 men with chronic prostatitis / chronic pelvic pain syndrome were collected for microscopy, culture, and biochemical and molecular assays. Oxidant injury was measured by 8-isoprostane F2alpha (IsoP) levels and total antioxidant capacity as Trolox equivalents. Total RNA from EPS was used for gene expression of heme oxygenase-1 (HO-1) and granzyme B. The only bacteria found in EPS were gram positive. For our analysis, these men were classified as having chronic bacterial prostatitis (category II). IsoP levels (pg/mL) were highest in men with category II prostatitis (7315 +/- 1428) followed by nonbacterial prostatitis (category IIIa, 2043 +/- 561), prostatodynia (category IIIb, 319 +/- 81), and asymptomatic controls (298 +/- 99). IsoP levels decreased significantly after successful treatment with antibiotics or an antioxidant supplement (Quercetin). Antioxidant capacity was detected in 11 out of 18, 4 out of 16, and 1 out of 16 men tested with category II, IIIa, and IIIb prostatitis, respectively. No correlation was observed between IsoP levels and the number of white blood cells in EPS. HO-1 and granzyme B expression was highest in men with category II prostatitis than in men with either category III prostatitis or asymptomatic controls. On the basis of elevated oxidative stress, clinical response to antibiotics, and post-treatment reduction in oxidative stress, we conclude that gram positive bacteria in some men with chronic prostatitis / chronic pelvic pain syndrome may be pathogens. It is speculated that oxidative stress may be a key pathway in some men with chronic prostatitis / chronic pelvic pain syndrome that can be targeted with antioxidant therapy.

PMID: 10975414 [PubMed - indexed for MEDLINE]


What is oxidative stress?

[prostateproblem]

Tech Urol. 2000 Sep;6(3):240-2. Related Articles, Links


Detection of bacterial signal by 16S rRNA polymerase chain reaction in expressed prostatic secretions predicts response to antibiotic therapy in men with chronic pelvic pain syndrome.

Shoskes DA, Shahed AR.

Division of Urology, Harbor-UCLA Medical Center, Torrance, California 90509, USA.

PURPOSE: Some men with chronic pelvic pain syndrome (CPPS) have evidence of bacteria in their prostatic fluid (expressed prostatic secretions [EPS]) detected by 16S rRNA techniques. In this study, we correlate presence of bacterial signal with response to therapy. MATERIALS AND METHODS: EPS and first voided urine (VB1) from 47 men with chronic prostatitis / chronic pelvic pain syndrome were analyzed by polymerase chain reaction (PCR) for bacterial signal using universal primers specific for bacterial 16S rRNA. Signal was considered positive if found only in the EPS sample, or if at least 10x stronger in the EPS than in VB1. All patients were treated with antibiotic therapy. RESULTS: Thirty-three patients were category IIIa (nonbacterial prostatitis) and 14 were category IIIb (prostatodynia). Seventeen of the 33 category IIIa patients had positive localizing cultures for gram-positive bacteria. However, a positive bacterial signal was detected in 23 EPS samples by 16S rRNA PCR. This signal was found in 14 of 17 culture-positive patients, 7 of 16 of the remaining category IIIa patients, and 2 of 14 of category IIIb patients. No patient with negative bacterial signal improved with antibiotic therapy (negative predictive value 100%). Thirteen patients with positive bacterial signal improved with antibiotic therapy. CONCLUSIONS: In men with category III chronic prostatitis/CPPS, bacterial signal detected by PCR can help predict response to antimicrobial therapy.

PMID: 10963501 [PubMed - indexed for MEDLINE]


This one too Mark, what does this one mean????

[webslave]

The first study simply underlines that any accredited quercetin product is effective at reducing inflammation, and the second study, to my mind, has been superceded by more recent studies using evidence-based medicine and proper controlled, randomised design to show that bacteria cannot be used as a measure in this disease/disorder to distinguish controls from patient cohort. So, in effect, the second study probably only shows the temporary analgesic effects of antibiotics.

Put simply: take Quercetin, not antibiotics, and stop worrying about bacteria.