Low WBC counts may be misleading in differentiation of CP

[consuli]

Low white blood cell counts may be misleading in the differentiation of chronic prostatitis, according to Feliciano and Hennenfent.

The standard criterion to classify chronic prostatitis as inflammatory or non-inflammatory is the white blood cell (WBC) count. The WBC count is measured by the number of white blood cells within the oil immersion field (OIF) , which is a standardized volume between the two examination glasses of a microscope. Usually white blood cell counts < 10x1000 per OIF are considered non-inflammatory and WBC counts > 10x1000 / OIF are considered inflammatory.

Two authors of the following survey studied 35 male patients with typical chronic prostatitis symptoms. These patients were treated with prostatic massages three times a week. The samples of expressed prostatic secretions (EPS) by prostatic massage were intensively evaluated, in average 9 times per patient.

After first massage 74% of the patients (26 of the 35) had WBC counts < 10e3 and though had to be considered non-inflammatory by the classical marginal value of 10e3 WBC/OIF.

In 97% of the patients (34 of 35 ) the WBC count rose to > or = 10e3 as prostatic massage continued on a thrice-weekly schedule. So nearly all 74% before assumed non-inflammatory switched to inflammatory after massage!!!

The authors theorize that this is explained by obstructions in the prostatic ducts, which are cleared by prostatic massage/drainage.

Hennenfent et Feliciano. Changes in white blood cell count in men undergoing thrice-weekly prostatic massage. British Journal of Urology 81 (3): p 370-376

I think it is quite well known, that in chronic prostatitis the prostate often senses like a little blown balloon, sometimes together with stronger aches. I did myself prostatic massage after the Manila protocol a few times. It released a itching/burning fluid into the urethra.

The study is not latest one any more, I know. But what they state seems from my experiences to be one of the more plausible things I have heard in prostatitis discussion. And as far as I know there have not been done any validations yet, which can prove, that the measured WBC count in EPS is a true and unbiased reading of hidden (inflammatory) processes in the rear ducts of the prostate.....

Bye
Consuli

[carld]

Consuli,

Welcome....Here we go again....I don't know where to start here on this one, so here I go. I hope this thread is filed away under "old school/ thinking" Non the less I know you are only trying to help, but you need to read the many posts here regarding this condition. It is true, an EPS can be misleading. For my self, it wasn't. There was a direct connection for the most part on my at the time, boggy prostate and my EPS and inflammation.

Men can have and EPS of 10 or less and have no symptoms. Men can have and EPS of 10 or more and have no symptoms. Men can have and EPS of 10 or less and have symptoms and men can have and EPS of 10 or more and have symptoms. My point is an EPS is only a marker for inflammation for certain types of men say like myself. That's why 95 % of cultures from and EPS come back negative!! I had more then 10 when I was at my worst. I brought it down to a 1, but still have symptoms. So my point is I don't think we can really tie an EPS to symptoms any more. Pelvic Myoneuropathy, neurogenic inflammation, muscle tension can lead to an irritated prostate and CP/CPPS associated symptoms or LUTS.

That link to a 1998 article sighting the dreaded words "Manila" only makes me feel bad for the many men that spent lots of money only to get finger's in their asses from some how should I say this....Suspect people. A prostate massage in my opinion can be helpful to some men and can also be harmful. I wouldn't have my prostate squeezed 3 times a week or ever again because I believe that the problem here is muscles around the prostate and sphincter muscles that can cause irratation/pain and those muscles need to be cared for through our protocol. I sure would not trust information from 10 years ago regarding CP/CPPS. We have come a long way since then....I'm not a doctor...

Regards

[webslave]

Manila Protocol? It is not discussed in the English-speaking countries anymore. I am disappointed to see it still has any credibility in Europe, and specifically Germany. The guys who run the German prostatitis website used to be very much impressed by the old school of thinking, and I suspect this is still a factor there.

I'll summarize why we do not discuss it anymore.

• WBC are not correlated to pain, as many studies have shown. Better markers are cytokines, and in 2006, Chinese researchers found that men with categories IIIa and IIIb both had significantly and similarly raised levels of anti-inflammatory cytokine TGFß1 and pro-inflammatory cytokine IFN-γ in their expressed prostatic secretions when compared with controls; therefore measurement of these cytokines could be used to diagnose category III prostatitis.
• Most men with chronic prostatitis / chronic pelvic pain syndrome actually have small, firm, tender prostates, not big boggy prostates.
• Rubbing on the prostate usually also means you are massaging the levator ani insertions, so there is a confounding factor at work if any improvement is seen.
• Many modern post-2000 studies (high quality, high powered, using PCR etc) have refuted the theory of sequestered (hidden) prostatic infections.
• A high WBC count, if indeed present, signifies inflammation, not the infection Hennenfent and Feliciano try to suggest.
• Etc ... many more points, but I do not want to re-cover all this. Please read this forum extensively.

[carld]

You go mark!!! You should of read my 1st version of my response before I edited it. I was very harsh, but backed off...I want to be helpful and not attack, but every now and then you have to say what the f***...


Regards...

[consuli]

Hello carld and webslave!

Thank you for your fast answers.

I don't understand the buzz.
You both say WBC count is inadequate and I say the same. I do not recommend the manila protocol for therapy purposes. I just mentioned it for diagnostic reasons. Last but not least Nickels EPS extraction in 4-glass test is exactly the same.

• WBC are not correlated to pain, as many studies have shown. Better markers are cytokines, and in 2006, Chinese researchers found that men with categories IIIa and IIIb both had significantly and similarly raised levels of anti-inflammatory cytokine TGFß1 and pro-inflammatory cytokine IFN-γ in their expressed prostatic secretions when compared with controls; therefore measurement of these cytokines could be used to diagnose category III prostatitis.

Most of these methods are still in research. For clinical diagnostics you may be right. The point is, that most of the usual urologist do not use these advanced methods and (maybe falsly) diagnose NIH 3b non-inflammatory CP by the standard WBC count!! Sometimes still by seminal fluid test, which is even worse than EPS test.

I think patients should know that. I am sorry if I bored you prostatitis experts.

The cytokine interleukine-8 has high correlation to prostatitis symptom score.

Penna G, Mondaini N, Amuchastegui S, Degli Innocenti S, Carini M, Giubilei G, Fibbi B, Colli E, Maggi M, Adorini L; "Seminal plasma cytokines and chemokines in prostate inflammation: interleukin 8 as a predictive biomarker in chronic prostatitis/chronic pelvic pain syndrome and benign prostatic hyperplasia". Eur Urol. 2007 Feb;51(2):524-33. ( http://www.ncbi.nlm.nih.gov/entrez/quer ... dopt=Books)

Penna et al showed that even patients with low WBC counts had significant elevated Interleukin-8 values. Of course there has to be done more research. But maybe there is no noninflammatory chronic prostatitis. I do not say anything about bacteria and it is surely not necessary to discuss Hennenfents speculations about it (he did not research it).

• Many modern post-2000 studies (high quality, high powered, using PCR etc) have refuted the theory of sequestered (hidden) prostatic infections.

Can you give the link?

Ciao
Consuli

[carld]

Consuli,

I'm not in any way a "prostatitis expert". My response is only based on your comments on the "Manila" protocol and as you state for diagnostic purposes is a statement that is a poor example on what I feel that this forum is dedicated to cutting edge information. Reading your post was confusing because it seemed you were in support of not against or as an example To bring up "old school" diagnostic tools is not cutting edge and not worth discussion in my view.

You're right. Most urologist do not use a more advanced research type method of looking at inflammatory markers in EPS. I think IL-8 is a good marker for some symptoms related to CP/CPPS. Particularly in my case of LUTS and irritation that I experience, but I don't know how it effects pain. To further this I look at the study of BIOXELL with elocalcitol and how it did not help CP/CPPS symptoms of pain but lowered inflammation of IL-8 if I'm not mistaken. So this tells me that you can lower inflammation and not help with pain, but maybe for LUTS and irritation and discomfort

Regards.

[webslave]

I do not recommend the manila protocol for therapy purposes.

Good. You had me worried there. :)

The point is, that most of the usual urologist do not use these advanced methods and (maybe falsely) diagnose NIH 3b non-inflammatory CP by the standard WBC count!! Sometimes still by seminal fluid test, which is even worse than EPS test.

I agree, and it is a situation that will take another decade to change. That is why many uros are not much use to us as a patient group, other than to rule out other pathology.

I think patients should know that.

This site does inform people of those facts.

The cytokine interleukine-8 has high correlation to prostatitis symptom score.

But also is raised in BPH: Is benign prostatic hyperplasia (BPH) an immune inflammatory disease? Kramer G, Mitteregger D, Marberger M. Eur Urol. 2007 May;51(5):1202-16.

Penna et al showed that even patients with low WBC counts had significant elevated Interleukin-8 values.

The study you cite also shows that IL-8 is raised in BPH, and therefore cannot be used to distinguish BPH from CP/CPPS, so it is probably useless as a test. IL-8 is also supposed to be able to distinguish between IIIa and IIIb, and I don't happen to believe that there is any substantive difference between these groups.

But maybe there is no noninflammatory chronic prostatitis.

Exactly.

Many modern post-2000 studies (high quality, high powered, using PCR etc) have refuted the theory of sequestered (hidden) prostatic infections.

Can you give the link?

Please look at the home page and research news pages, were the main studies are cited:
https://ucpps.men/
https://ucpps.men