Concretions / calculi / calcifications

These are hardened grains that can form in the bladder, prostate or ductus deferens and ejaculatorius. The composition of prostatic calculi indicates that they too are caused by reflux.(1) Small concretions occur in healthy men, but men with many or larger ones have shown improvement upon elimination of those.(2-3)

CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, miktionsfysiologi, miktion, urodynamic findings,calculi, prostate, ductus deferens.
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(1) http://www.prostatitis.org/stones.html
(2) Geramoutsos I, Gyftopoulos K, Perimenis P, Thanou V, Liagka D, Siamblis D et al. Clinical correlation of prostatic lithiasis with Chronic Pelvic Pain Syndromes in Young Adults. Eur Urol 45(3):333-338, 2004.
(3) Shoskes DA, Lee CT, Murphy D, Kefer J, Wood HM. Incidence and significance of prostatic stones in men with chronic prostatitis/chronic pelvic pain syndrome. Urology 70(2):235-238, 2007.

Does testosterone cause prostate cancer?

A very good question and not likely related to CPPS, but there is a dicussion if there is a correlation. The association between testosterone and cancer is currently in doubt due to the following. Men dying from prostate cancer are all castrated (zero testosterone) due to treatment. Huggins assertion that testosterone causes cancer is based on equivocal results from one patient!! No modern studies during the last 25 years have managed to prove that prostate cancer cells grow with extra testosterone.(1) Prostate cancer increases with age, while testosterone decrease with age. Aggressive cancer is correlated with low testosterone.(2) As is recurrence. Morgentaler calls the high testosterone cancer connection a myth.(3) Recent research indicates that vitamin D deficiency may increase the risk of developing prostate cancer.(4)

Andra bloggar om kronisk prostatit, kroniskt bäckenbottensmärtsyndrom, testosteron, prostatacancer
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(1) Endogenous Hormones and Prostate Cancer Collaborative Group, Roddam AW, Allen NE, Appleby P, Key TJ. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. JNCI 100(3):170-183, 2008.
(2) C Schulman, Testosteron treatment and and prostate risk, EUA Congress 2009
(3) Morgentaler A. Testosterone and prostate cancer: an historical perspective on a modern myth. Eur Urol 50(5):935-939, 2006.
(4) Schwartz GG. Vitamin D and intervention trials in prostate cancer: from theory to therapy. Ann Epidemiol. 19(2):96-102, 2009.

Magnesium and zinc in the prostate

CP/CPPS is currently not connected with magnesium or zinc insufficiency, but the prostate is the most zinc and magnesium-rich organ in the body (up to 20 times higher concentration than in other organs). Magnesium is essential for seminal fluid quality and sperm "survival" and uro-genital health. A study (1) has shown that magnesium levels were significantly decreased in the seminal plasma of normozoospermic chronic prostatitis sufferers. But other studies have shown no such correlation(2). Zinc is essential for sperm quality, prostate and uro-genital health in general (3,4) and also for health in general.

Plasma zinc levels are below normal in patients with malignancies (decreased about 60-70%), but above normal in patients with benign hyperplasia and chronic prostatitis(5). Levels in controls is 94.5±10.38 µg/100 ml; with benign diseases of the prostate between 145 and 173 µg/100 ml (highest in BPH) and patients with malignancy 59.6±3.08 µg/100 ml(6).

It is unclear if the raised zinc levels are causing the illness or are an effect thereof(7). Anecdotal data suggest zinc supplementation may improve semen abnormalities.
Both minerals are tightly regulated in the body and not stored (if one does not include the skeleton).

(Curiously MgCl was suggested in France before WWII as an effective diuretic and uro-prostatic function "corrector" [J. Favier, "Equilibre mineral et sante", Librairie Le François, 1951]. Which is popular to mention on self-help and altmed sites.)

Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, prostata
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(1) Edorh AP, Tachev K, Hadou T, Gbeassor M, Sanni A, Creppy EE, Le Faou A, Rihn BH. Magnesium content in seminal fluid as an indicator of chronic prostatitis. Cell Mol Biol (Noisy-le-grand). 2003;49 Online Pub:OL419-23.
(2) Colleen S, Mårdh PA, Schytz A. Magnesium and zinc in seminal fluid of healthy males and patients with non-acute prostatitis with and without gonorrhoea. Scand J Urol Nephrol 9:192-197, 1975.
(3) "Zinc: a key urological element" by IM Bush et al., presentation at the 1974 AMA annual meeting, Chicago, USA
(4) Yan M, Song Y, Wong CP, Hardin K, Ho E. Zinc deficiency alters DNA damage response genes in normal human prostate epithelial cells. J Nutr 138:667-673, 2008.
(5) Goel and Sankwhar, Comparative study of zinc levels in benign and malignant lesions of the prostate, Scand J Urol Nephrol, 108-12, 2006
(6) Goel T, Sankhwar S. Comparative study of zinc levels in benign and malignant lesions of the prostate. Scand J of Urology and Nephrology, 40(2):108-112, 2006.
(7) Antibacterial effect of intraprostatic zinc injection in a rat model of chronic bacterial prostatitis by YH Cho et al., Int J Antimicrob Agents 19:576-582, 2002

Prostate related findings

Inflammation in bacterial prostatitis is characterized by the "presence of polymorphonuclear leukocytes and macrophages in the glandular ducts, epithelium and/or adjacent stroma" around the acini or ducts. Stromal involvement depends on intraluminal inflammation (1, 2). Other findings are: abnormal glandular ducts, epithelial atrophy, metaplasia and dysplasia, and hyperchromasia ("with polymorphism of the epithelial cell nuclei and cytoplasmic basophilia"). Changes that may be misinterpreted as cancerous. If palpated the prostate is often enlarged and "soft" in bacterial prostatitis while never in CPPS.

In CP/CPPS "glandular atrophy with stromal fibrosis, accompanied by a mild residual inflammatory reaction" is commonly observed(3). But only 5% of biopsies show significant inflammation(4). Although variation between studies is high up to 100% (5) prevalence has been found. The variation is obviously due to the varying (read: poor!) selection criteria of the studies. There is minimal correlation between histopathology and visible/clinical symptoms, but histological findings increase with age and are more commin in infertile men.

It is unclear whether some minimal inflammation of the prostate is normal or not, so if this is of any clinical use remains to be seen.

The recent REDUCE trial involving 5597 subjects has shown that no "clinically meaningful" difference is present between healthy subjects and CP/CPPS sufferers.(6) PSA levels are insignificantly elevated in CPPS (NIH III) and slightly to highly elevated in NIH IV. CPPS sufferers with elevated levels should be screened for cancer and BPH.(7)

Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, prostata
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(1) Mehik A, Leskinen MJ, Hellström P Mechanisms of pain in CPPS: influence of prostatic inflammation. World J urol 21:90-94, 2003
(2) Dellabella M, Milanese G, Sigala S, d’Anzeo G, Arrighi N, Bodei S, Muzzonigro G. The role of prostatic stroma in CP/CPPS. Inflamm Res. 2009 Sep 11 Epub ahead of print.
(3) Mehik A, Leskinen MJ, Hellström P Mechanisms of pain in CPPS: influence of prostatic inflammation. World J urol 21:90-94, 2003
(4) True LD, Berger RE, Rothman I, Ross SO, Krieger JN. Prostate histopathology and CP/CPPS: a prospective biopsy study. J Urol 162:2014-2018, 1999.
(5) PHF Schatteman, L Hoekx, J J Wyndaele, W Jeuris, E van Marck. Inflammation in prostate biopsies of men without prostatic malignancy or clinical prostatitis. Eur Urol 37:404-412, 2000
(6) Nickel JC, Roehrborn CG, O'Leary MP, Bostwick DG, Somerville MC, Rittmaster RS. Examination of the Relationship Between Symptoms of Prostatitis and Histological Inflammation: Baseline Data From the REDUCE Chemoprevention Trial. J Urol. Jul 13 2007.
(7) Nadler RB, McNaughton Collins M, Propert KJ, Mikolajczyk SD, Knauss JS, Landis JR, Fowler JE jr, Schaeffer AJ, Alexander RB. PSA test in diagnostic evaluation of CP/CPPS. Urology 67:337-342, 2006.

Prostate findings

Bacterial prostatitis
Inflammation in bacterial prostatitis is characterized by the "presence of polymorphonuclear leukocytes and macrophages in the glandular ducts, epithelium and/or adjacent stroma" around the acini or ducts. Stromal involvement depends on intraluminal inflammation(1). Other findings are: abnormal glandular ducts, epithelial atrophy, metaplasia and dysplasia, and hyperchromasia ("with polymorphism of the epithelial cell nuclei and cytoplasmic basophilia"). Changes that may be misinterpreted as cancerous. If palpated the prostate is often enlarged and "soft" in bacterial prostatitis.

CP/CPPS
In CP/CPPS "glandular atrophy with stromal fibrosis, accompanied by a mild residual inflammatory reaction" is commonly observed(2). But only 5% of biopsies show significant inflammation(3). Although variation between studies is high up to 100% (4) prevalence has been found. The variation is obviously due to the varying (read: poor!) selection criteria of the studies. There is minimal correlation between histopathology and visible/clinical symptoms, but histological findings increase with age and are more common in infertile men. If palpated the prostate is never abnormal in CPPS.

It is unclear whether some minimal inflammation of the prostate is normal or not, so if this is of any clinical use remains to be seen. The recent REDUCE trial involving 5597 subjects has shown that no "clinically meaningful" difference is present between healthy subjects and CP/CPPS sufferers.(5)

PSA levels are insignificantly elevated in CPPS (NIH III) and slightly to highly elevated in NIH IV. CPPS sufferers with elevated levels should be screened for cancer and BPH.(6)

Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, prostata
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(1) Mehik A, Leskinen MJ, Hellström P Mechanisms of pain in CPPS: influence of prostatic inflammation. World J urol 21:90-94, 2003
(2) Mehik A, Leskinen MJ, Hellström P Mechanisms of pain in CPPS: influence of prostatic inflammation. World J urol 21:90-94, 2003
(3) True LD, Berger RE, Rothman I, Ross SO, Krieger JN. Prostate histopathology and CP/CPPS: a prospective biopsy study. J Urol 162:2014-2018, 1999.
(4) PHF Schatteman, L Hoekx, J J Wyndaele, W Jeuris, E van Marck. Inflammation in prostate biopsies of men without prostatic malignancy or clinical prostatitis. Eur Urol 37:404-412, 2000
(5) Nickel JC, Roehrborn CG , O'Leary MP, Bostwick DG, Somerville MC, Rittmaster RS. Examination of the Relationship Between Symptoms of Prostatitis and Histological Inflammation: Baseline Data From the REDUCE Chemoprevention Trial. J Urol. Jul 13 2007.
(6) Nadler RB, McNaughton Collins M, Propert KJ, Mikolajczyk SD, Knauss JS, Landis JR, Fowler JE jr, Schaeffer AJ, Alexander RB. PSA test in diagnostic evaluation of CP/CPPS. Urology 67:337-342, 2006.