Chronic prostatitis/chronic pelvic pain pyndrome): seminal markers of inflammation

Effects of leukocyte elastase in semen on sperm quality

The study analyzed the effect of leukocyte elastase (LE) in 460 semen on sperm quality, and explore the reference interval of normal level of LE in semen. The differences of LE levels between normal semen and few, weak and abnormal semen were analyzed. Referring to domestic standards, the samples were divided into normal group (LE ≤ 250 ng/mL), occult infection (250 < LE ≤ 1000 ng/mL), and infection group (LE > 1000 ng/mL), and the differences in semen quality among the groups were compared. According to European standards, the samples were divided into normal group (≤600 ng/mL) and abnormal group (>600 ng/mL), and the differences in semen quality between the 2 groups were compared. The correlation between LE levels in semen and semen quality were analyzed. The positive rates of LE in the normal semen group and abnormal semen groups were 30.7% versus 34.7%, and there was no significant difference between the two groups (P > .05). When the semen divided into 3 groups, there was no significant difference between the physicochemical parameters, kinetic parameters, movement trajectory parameters, morphological parameters, and sperm DNA fragmentation index (DFI) (P > .05). There were significant differences in sperm morphology and sperm DFI between the two groups at 600 ng/mL (P < .05). Spearman correlation analysis showed that there was no significant difference between the level of LE in semen and physicochemical parameters, sperm kinetic parameters, sperm movement trajectory parameters, sperm morphological parameters, and sperm DFI (P > .05). It is appropriate to use 600 ng/mL as the threshold for the concentration of LE in semen; the correlation between the level of LE and sperm quality is not significant.

Overview of seminal fluid biomarkers for the evaluation of chronic prostatitis: a scoping review

BACKGROUND

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a very common and difficult condition to evaluate, as it is a clinical diagnosis, without a measurable diagnostic "gold standard". The aim of this scoping review is to synthesize all the available data for seminal fluid biomarkers used to assess patients with CP/CPPS.

METHODS

A systematic search to identify all relevant publications was conducted on October 22, 2020 across five databases: Ovid Medline, Ovid EMBASE, PubMed, CCRT, and the CINAHL. Two independent authors screened all articles and extracted relevant data.

RESULTS

A total of 27 articles met the eligibility criteria. A majority of studies were case-control (15), with 6 observational cohorts and 6 comparative interventional studies. The total number of pooled patients included 585 patients with CP/CPPS (unspecified subtype), 371 patients with inflammatory CP/CPPS, 387 patients with non-inflammatory CP/CPPS, 354 patients with chronic bacterial prostatitis, and 432 healthy controls. Inflammatory seminal biomarkers were the most frequently studied, with IL6, IL8, TNFα and IL1β being the most promising candidates.

CONCLUSIONS

There are a number of very promising seminal biomarkers to help categorize and monitor therapies in CP/CPPS. Large multicentre studies using a shared protocol for measuring seminal biomarkers with the primary intention of biomarker validation are needed prior to clinical implementation. Identification of biomarker(s) will facilitate the etiological categorization of patients with chronic prostatitis and provide an objective framework to tailor specific therapies according to the biomarker family.

The relationship between genitourinary microorganisms and oxidative stress, sperm DNA fragmentation and semen parameters in infertile men

An imbalance in the genitourinary microbiome is emerging as a contributing factor to male infertility. The purpose of this study was to determine whether there is an association between genitourinary microorganisms and seminal oxidative stress, sperm DNA fragmentation and semen parameters. It included 770 men attending for diagnostic testing for subfertility. Genitourinary microorganisms were identified in 43.0% men; 20.1% had microorganisms in semen; 18.7% in urine; and 5.8% had microorganisms in urine and semen. Enterococcus faecalis was the most prevalent organism in semen (22.0% samples; 61.5% organisms) with Ureaplasma spp. (16.9% samples; 53.3% organisms) and Gardnerella vaginalis (11.4% samples; 37.4% organisms) most prevalent in urine. Semen parameters were unaffected by microorganisms (p > 0.05). Seminal ROS were significantly higher in men with microorganisms compared to those without (p < 0.001), particularly when present in both urine and semen (p < 0.01). Microorganisms were associated with significantly higher DNA fragmentation, irrespective of whether they were in semen or urine (p < 0.001). An imbalance in the genitourinary microbiome is associated with DNA damage and oxidative stress which may have considerable consequences for achieving an ongoing pregnancy. This highlights the need for incorporating genitourinary microorganism screening for all men as part of diagnostic evaluation prior to undergoing treatment for infertility.

The role of infections and leukocytes in male infertility

Declining birth rates are one of the problems facing society today. Male counterparts are responsible for about half of the infertility cases, and genitourinary tract infections may play a contributing role in approximately 15% of male infertility cases. Leukocytospermia is an established indicator of infection in the male urogenital tract, although other microorganisms such as bacteria and virus may also be contributors to the etiology of male infertility. The pathophysiology of these infectious agents may be initiated by a local inflammatory reaction resulting in an increase in reactive oxygen species (ROS). This results in testicular injury, thereby affecting sperm morphology, sperm motility, sperm viability and elevation of the seminal leukocyte as a result of the genital tract infection. The infectious and inflammatory changes can result in male infertility. It is proposed that high concentrations of seminal leukocyte and infectious agents may affect sperm function resulting in clumping of motile spermatozoa, decreasing acrosomal functionality and also causing alterations in sperm morphology. However, the literature has poorly clarified the role of infection in male infertility, provoking further debate and research on this topic.

Shedding Light on the Nature of Seminal Round Cells

INTRODUCTION

In this investigation we assess the incidence of round cells (RCs) in semen samples in our infertile patient population and their significance on intracytoplasmic sperm injection (ICSI) cycle outcomes. We also evaluate the usefulness of RCs as indicators of bacterial infection and highlight the origin of this cell-type, as well as its role in the human ejaculate.

PATIENTS AND METHODS

In a prospective fashion, a total of 4,810 ejaculated samples were included in the study during a period of 24 months. RCs were characterized for white blood cell (WBC) components versus exfoliated germ cells by testing for multiple markers of ploidy as well as protamine assays. Cases displaying ≥ 2 x 106/ml RCs were screened for bacteria. Raw specimens containing RC were processed by peroxidase and other leukocyte assays, specific stains for protamines were used to identify spermiogenic stage, aneuploidy (FISH) assessment was carried out, and the presence of various Sertoli-cell cytoplasmic remnants was analyzed to identify and characterize immature germ cells. The effect of RC on clinical outcome was assessed in specimens used for ICSI.

RESULTS

The average age of the men involved was 39.2 ± 7 years. Semen samples had a mean concentration of 40.7 ± 31 x 106/ml, motility of 42.6 ± 35%, and morphology of 2.3 ± 2%. RCs were identified in 261 specimens, representing a proportion of 5.4%. Men with RCs had comparable age but lower sperm concentration and morphology than the control group (P<0.001). The aneuploidy rate of 4.3% in RCs group was remarkably higher than the control group (2.3%; P<0.001). Sperm aneuploidy rate positively correlated with the number of RCs (P<0.001). Of 44 men, 17 of them in 18 cycles had up to 1.9 x 106/ml RCs without affecting fertilization and clinical pregnancy rates when compared to controls (n = 365 cycles). In 27 men undergoing 33 ICSI cycles with ≥ 2 x 106/ml RCs, the fertilization rate trended lower and the miscarriage rate was significantly increased (P = 0.05). There was lack of correlation between RC and bacteriological growth. Specific markers indicated that seminal RCs are mostly immature germ cells encased in the remnants of Sertoli cell cytoplasm. Moreover, their modest protamine content and their haploid status confirm that they are post-meiotic. Sequential observation in the same man showed that RC episodes were followed by an amelioration of semen parameters, and interestingly, the episodic occurrence of RCs often coincides with flu season peaks.

CONCLUSIONS

Seminal RCs are not a marker of infectiousness but rather a transient indicator of spermatogenic insult that possibly occurs in most men following a mild and transient ailment such as the flu.

Orchialgia and the chronic pelvic pain syndrome

This review paper highlights the important health issue of orchialgia and the chronic pelvic pain syndrome. There are a number of specific and non-specific etiologies and different treatment options based on the sub-categorization of orchialgia. The focus of this article is on the specific etiologies of chronic orchialgia as well as non-specific scrotal pain, and the diagnostic evaluation and optimal management of these men. The clinician must be cautious about assuming that orchialgia is constitutive in the chronic pelvic pain syndrome, and must be diligent in ruling out specific etiologies for scrotal pain prior to managing orchialgia as a non-specific chronic pain syndrome.

Intriguing location of myeloperoxidase in the prostate: a preliminary immunohistochemical study

BACKGROUND

Myeloperoxidase (MPO) is a member of the peroxidase-cyclooxygenase superfamily, which is secreted from stimulated leucocytes at inflammatory sites. It is well known that MPO catalyses oxidation reactions via the release of reactive halogenating and nitrating species and thus induces tissue damage. Several studies have already implicated MPO in the development of neoplasia. Chronic or recurrent prostatic inflammation has long been recognized as having the potential to initiate and promote the development of prostate cancer. The objective was to investigate whether MPO is present in the prostate.

METHODS

Human prostate material was obtained from biopsies, transurethral resections of the prostate (TURP), prostatic adenomectomies, and retropubic radical prostatectomies. Twenty-nine slides of normal prostate tissue, benign prostatic hyperplasia (BPH), and prostate cancer were reviewed by a pathologist. Immunohistochemical analysis using MPO-specific human antibody was performed to detect MPO in the prostate tissue.

RESULTS

Immunocytohistochemistry showed cellular colocalization of MPO in the secretory epithelial cells of the prostate with staining varying from light to strong intensity. Staining in the glandular apical snouts was often reinforced although staining of basal as well as of luminal glandular cells was also present.

CONCLUSIONS

We identified, for the first time, the presence of MPO at the surface of prostatic epithelial cells. In view of the pro-oxidant properties of this enzyme, further research is needed to define whether MPO contributes to the development of prostatic lesions.

Characterization of the seminal plasma proteome in men with prostatitis by mass spectrometry

Background

Prostatitis is an inflammation of the prostate gland which affects approximately 10% of men. Despite its frequency, diagnosing prostatitis and monitoring patient response to treatment remains frustrating. As the prostate contributes a substantial percentage of proteins to seminal plasma, we hypothesized that a protein biomarker of prostatitis might be found by comparing the seminal plasma proteome of patients with and without prostatitis.

Results

Using mass spectrometry, we identified 1708 proteins in the pooled seminal plasma of 5 prostatitis patients. Comparing this list to a previously published list of seminal plasma proteins in the pooled seminal plasma of 5 healthy, fertile controls yielded 1464 proteins in common, 413 found only in the control group, and 254 found only in the prostatitis group. Applying a set of criteria to this dataset, we generated a high-confidence list of 59 candidate prostatitis biomarkers, 33 of which were significantly increased in prostatitis as compared to control, and 26 of which were decreased. The candidates were analyzed using Gene Ontology and Ingenuity Pathway analysis to delineate their subcellular localizations and functions.

Conclusions

Thus, in this study, we identified 59 putative biomarkers in seminal plasma that need further validation for diagnosis and monitoring of prostatitis.

A review of the epidemiology, diagnosis and evidence-based management of Mycoplasma genitalium

Mycoplasma genitalium is attracting increasing recognition as an important sexually transmitted pathogen. Presented is a review of the epidemiology, detection, presentation and management of M. genitalium infection. Accumulating evidence suggests that M. genitalium is an important cause of non-gonococcal, non-chlamydial urethritis and cervicitis, and is linked with pelvic inflammatory disease and, possibly, obstetric complications. Although there is no standard detection assay, several nucleic acid amplification tests have >95% sensitivity and specificity for M. genitalium. To date, there is a general lack of established protocols for screening in public health clinics. Patients with urethritis or cervicitis should be screened for M. genitalium and some asymptomatic sub-groups should be screened depending on individual factors and local prevalence. Investigations estimating M. genitalium geographic prevalence document generally low incidence, but some communities exhibit infection frequencies comparable to that of Chlamydia trachomatis. Accumulating evidence supports an extended regimen of azithromycin for treatment of M. genitalium infection, as data suggest that stat 1 g azithromycin may be less effective. Although data are limited, azithromycin-resistant cases documented to date respond to an appropriate fluoroquinolone (e.g. moxifloxacin). Inconsistent clinical recognition of M. genitalium may result in treatment failure and subsequent persistence due to ineffective antibiotics. The contrasting nature of existing literature regarding risks of M. genitalium infection emphasises the need for further carefully controlled studies of this emerging pathogen.

Male accessory gland infection and sperm parameters (review)

Male accessory gland infection (MAGI) has been identified among those diagnostic categories which have a negative impact on the reproductive function and fertility in males (Rowe et al., World Health Organization Manual for the Standardised Investigation and Diagnosis of the Infertile Couple, Cambridge University Press, Cambridge, 1993). MAGI is a hypernym which groups the following different clinical categories: prostatitis, prostate-vesiculitis and prostate-vesiculo-epididymitis. Some of the characteristics they share are: common diseases, mainly have a chronic course, rarely cause obstruction of the seminal pathways, can have an unpredictable intracanicular spread to one or more sexual accessory glands of the reproductive tract, as well as to one or both sides. In this review, we show that all components involving the inflammatory response (from the agents which first trigger it to each component of the inflammatory response dynamic) can deteriorate conventional and/or non-conventional sperm parameters arising from one or more of the following mechanisms: altered secretory function of the epididymis, seminal vesicles, and prostate which reduce the antioxidant properties or scavenging role of the seminal plasma; deterioration of spermatogenesis; and (unilateral or bilateral) organic or functional sub-obstruction of the seminal tract.

[Symptomatic approach to chronic prostatitis/chronic pelvic pain syndrome]

OBJECTIVE

To review the diagnosis and pathogenesis of chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS).

MATERIAL AND METHODS

A review of the literature was performed by searching the Medline database (National Library of Medicine). Search terms were either medical subject heading (MeSH) keywords (microbiology, pelvic pain, prostatitis) or terms derived from the title or abstract. Search terms were used alone or in combinations by using the "AND" operator. The literature search was conducted from 1990 to the present time.

RESULTS

Chronic bacterial prostatitis is a chronic, recurrent bacterial infection of the prostate, accounting for about 5 to 10% of all cases of chronic prostatitis (CP). CPPS is nonbacterial genitourinary pelvic pain present for at least 3 months, sometimes associated with sexual and voiding disorders. Although the prostate does not appear to be involved in all cases of chronic pelvic pain in men, the term CP usually remains associated with CPPS (CP/CPPS). CP/CPPS has a negative impact on quality of life. The precise pathogenesis of CP/CPPS has not been elucidated, but prostatic infection and inflammation could be involved, not as direct causes, but as initiating factors of a neurological hypersensitization phenomenon. Evaluation of CP/CPPS comprises clinical interview completed by the National Institutes of Health-Chronic Prostatitis Symptom Index questionnaire (NIH-CPSI), physical examination, urine culture and uroflowmetry combined with determination of the post-voiding residual volume. The other investigations are optional and are designed to exclude other urological diagnoses. The Meares-Stamey four-glass test should be abandoned in favour of a simplified test comprising urine analysis before and after prostatic massage. However, the indications for this test are limited to patients in whom chronic bacterial prostatitis is suspected or with bacteriuria on urine culture.

CONCLUSION

Chronic bacterial prostatitis represents only about 5 to 10% of all cases of CP. The usual terminology of chronic non-bacterial prostatitis has been replaced by the term CPPS or CP/CPPS in men, in order to situate this disease in a broader context not exclusively related to the prostate. Despite its prevalence and its impact on quality of life and sexuality, CP/CPPS remains poorly known and continues to raise diagnostic problems.

Prostatitis and male pelvic pain syndrome: diagnosis and treatment

BACKGROUND

The prostatitis syndrome is a multifactorial condition of largely unknown etiology. The new NIH classification divides the prostatitis syndrome into a number of subtypes: acute bacterial prostatitis, chronic bacterial prostatitis, inflammatory and noninflammatory chronic pelvic pain syndrome, and asymptomatic prostatitis.

METHODS

This article is based on a selective review of the literature regarding the assessment and management of the prostatitis syndrome and on a recently published consensus statement of the International Prostatitis Collaboration Network.

RESULTS

Pathogenic organisms can be cultured only in acute and chronic bacterial prostatitis. These conditions should be treated with antibiotics, usually fluoroquinolones, for an adequate period of time. 90% of patients with prostatitis syndrome, however, suffer not from bacterial prostatitis but from chronic (abacterial) prostatitis / chronic pelvic pain syndrome (CP/CPPS). It remains unclear whether CP/CPPS is of infectious origin, and therefore the utility of a trial of antimicrobial treatment is debatable. Treatment with alpha receptor blockers is recommended if functional subvesical obstruction is documented or suspected. Symptomatic therapy for pelvic pain should be given as well.

CONCLUSIONS

The prostatitis syndrome is a complex condition with a tendency toward chronification. It is important, therefore, that the patient be fully informed about the diagnostic uncertainties and the possibility that treatment may meet with less than complete success.

Increased concentration of neutrophil elastase in urine from patients with interstitial cystitis

OBJECTIVE

To identify proteins associated with interstitial cystitis (IC), protein profiles were analyzed using a proteomics-based approach. The study tested whether neutrophil elastase in urine correlates with the symptomatic condition of IC.

MATERIAL AND METHODS

Proteins in urine from IC patients and healthy subjects were analyzed through a comparative proteomics approach using two-dimensional difference in-gel electrophoresis and nano-liquid chromatography-tandem mass spectrometry. Neutrophil elastase activity was measured by the digestion of peptide substrate.

RESULTS

The urinary neutrophil elastase concentration was significantly higher in IC patients with pain than in healthy subjects. It was significantly increased in patients with small bladder capacity (median 6.31 ng/ml in IC with a bladder capacity < 200 ml vs 1.15 ng/ml in IC with a bladder capacity > or = 200 ml and 0.18 ng/ml in healthy bladders, p < 0.01). The concentration of neutrophil elastase did not correlate with the neutrophil count in the urine of IC patients.

CONCLUSION

The concentration of neutrophil elastase increased in the urine of the IC patient subset with bladder pain and small bladder capacity.

The evaluation of markers of prostatic inflammation and function of the prostate gland in patients with chronic prostatitis

Introduction:

The aim of the study was to determine the numbers of polymorphonuclear (PMN) leukocytes and PMN elastase and citric acid concentrations in chronic prostatitis patients regardless of etiology and in those with Chlamydia trachomatis infection of the prostate gland.

Materials and Methods:

The study involved 46 patients with chronic prostatitis. Expressed prostatitc secretions (EPS) were obtained to determine the leukocyte count, PMN elastase (ELISA) and citric acid concentrations (UV method), and the occurrence of C. trachomatis infection (ligase chain reaction).

Results:

Increased PMN cell counts (≥10 per high-power field) were found in 73.9% of patients and increased PMN elastase concentration (<250 ng/ml) in 78.3%. In 44.4% of the patients the elastase concentration indicated moderate (250–1000 ng/ml) and in 55.6% acute infection (≥1000 ng/ml). Decreased citric acid concentration (<18.12 mg/ml) in the EPS was found in 65.2% of the men. C. trachomatis prostate infection was detected in 17.4% of the patients and all of these men had higher inflammation parameters and lower citric acid concentrations.

Conclusions:

C. trachomatis prostate inflammation was accompanied by an increase in inflammation markers and a decrease in citric acid concentration.

Prostatitis: updates on diagnostic evaluation

Prostatitis accounts for almost 2 million office visits to urologists and primary care physicians. The label "prostatitis" refers to a diverse constellation of symptoms and disease processes. The diagnosis and treatment of this disorder present numerous challenges for the physician, including a lack of abnormal findings on physical examination, laboratory tests, and radiographic images. In this article, we offer a review of the current literature and recommendations for the evaluation and diagnosis of the patient presenting with prostatitis.

Prostatitissyndrom

Prostatitis syndrome is a multifactorial disease with a largely unknown etiology. Quite different therapeutic options are therefore recommended. According to the new NIH classification, pathogens can be cultured only in acute and chronic bacterial prostatitis. A long-term antimicrobial therapy, mainly with fluoroquinolones, is then recommended. Most patients suffer from chronic pelvic pain syndrome (CP/CPPS) which can be subdivided into inflammatory and non-inflammatory types. Whether the inflammatory CP/CPPS is an infectious disease remains uncertain. The effect of an antibiotic therapy therefore remains debatable. In case of proven or suspected functional infravesical obstruction, treatment with a-receptor blockers is recommended. Accompanying symptomatic therapy is also recommended. It is important, however, to keep the patient fully informed about the diagnostic and therapeutic limitations.

Chronic prostatitis during puberty

OBJECTIVE

To investigate the features of chronic prostatitis (CP) during puberty and the effects of biofeedback on young males with this disease.

PATIENTS AND METHODS

In all, 40 patients were divided into two groups; group 1 included 25 pubertal patients with CP (mean age 16.5 years, sd 1.1) and group 2 was a control group including 15 patients (mean age 16.2 years, sd 1.2) with a normal lower urinary tract. National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) scores (three parts) were assessed individually in both groups. Expressed prostatic secretions and urine samples after prostate massage from group 1 were cultured to determine whether patients were infected with bacteria, and group 1 was categorized into various NIH types. Each patients in the two groups underwent urodynamics and group 1 were treated with biofeedback.

RESULTS

In group 1, there were one, three and 21 patients with type II, IIIA and IIIB prostatitis. The incidence of staccato voiding and detrusor-sphincter dyssynergia (DSD), and the maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), maximum detrusor pressure (Pdetmax) and maximum urethral closure pressure (MUCP) between the groups were significantly different (P < 0.05). The total NIH-CPSI scores and all the subdomains between the groups before biofeedback were significantly different (P < 0.001). In group 1 the difference in NIH-CPSI scores and Qmax before and after biofeedback was significant (P < 0.05).

CONCLUSIONS

The main type of CP during puberty is IIIB; the dominating symptom is a voiding disorder. The impact on life and psychological effects are substantial. Pubertal boys with CP have pelvic floor dysfunction and several abnormal urodynamic values, i.e. staccato voiding, DSD, decreasing Qmax, and increasing Pdetmax and MUCP. The effect of biofeedback strategies for treating pubertal CP is satisfactory.

Value of Counting White Blood Cells (WBC) in Semen Samples to Predict the Presence of Bacteria

OBJECTIVES

To investigate the correlation between the presence of white blood cells (WBC) without the use of specific stain to differentiate leukocytes and the presence of bacteria in semen samples of infertile men.

METHODS

A total of 143 semen samples of men who attended an andrologic clinic for the evaluation of fertility were investigated using routine semen analysis (according to WHO laboratory guidelines) and bacterial culture.

RESULTS

WBC were found in 43.4% (62/143). There were no WBC in 56.6% (81/143) of the samples (group I) while WBC were found in 43.4% (62/143) of the samples (group II). Pathogenic bacteria were detected in 48.2% (39/81) in group I and in 54.9% (34/62) in group II, all in all Bacteriospermia was present in 51.1% (73/143). The most common bacteria were Ureaplasma urealyticum, Enterococcus faecalis and Escherichia coli (23.8%, 16.8%, and 7.0% of samples, respectively). The sensitivity/specificity for detecting bacteria was 0.47/0.60 at a cut-off level of 0.25 Mio/mL WBC and 0.16/0.84 at a cut-off level of WBC 1 Mio/mL, representing likelihood ratios of 1.16 and 1.04, respectively. The greatest ratio between sensitivity and specificity (0.37/0.72) was found at a cut-off level of 0.5 Mio/mL WBC, with a likelihood ratio of 1.29.

CONCLUSIONS

Counting WBC instead of a specific stain for the detection of leukocytes has only a poor sensitivity/specificity for the detection of bacteria.

[Sperm biochemical markers of genital tract inflammation: usefulness of elastase determination]

Genital tract inflammation was for a long time suspected of inducing sterility in the male. The role of leukocytes in sperm changes is still debated. The identification of inflammation is based on the presence of activated leukocytes and the elastase measurement. Residual inflammation is evaluated by the reactive oxygen species activity. The true damage caused by inflammation on spermatozoa is reflected in negative changes observed during sperm apoptosis. Increased sperm DNA fragmentation is frequently observed while classical sperm characteristics are not modified automatically. The diagnosis of genital tract inflammation, follow-up after treatment and prognosis in terms of fertility require the use of different and complementary parameters.

Prostate carcinoma and green tea: (-)epigallocatechin-3-gallate inhibits inflammation-triggered MMP-2 activation and invasion in murine TRAMP model

Green tea infusion has been shown to inhibit metastatic spreading of the transgenic adenocarcinoma of mouse prostate (TRAMP). Investigation on the molecular mechanisms triggered by the main green tea flavonoid, (-)epigallocatechin-3-gallate (EGCG), shows that EGCG restrains TRAMP-C1 cell proliferation in a dose-dependent manner, at concentrations (IC(50) < 0.2 microM) equivalent to those measured in the plasma of moderate green-tea drinkers. Up to 10 microM, EGCG does not modify the cell-surface immuno-localization of MMP-2, one of the invasion-instrumental proteinases; but while in default culture conditions these cells secrete mainly pro-MMP-2, in the presence of reconstituted basement membrane (Matrigel) they release almost exclusively pro-MMP-9. In contrast, when stimulated to traverse Matrigel toward a chemo-attractant, in addition to pro-MMP-9, they secrete pro-MMP-2. In the presence of 0.2 microM EGCG, only the level of the latter is markedly lowered in the conditioned medium, in parallel with the invasive behavior (>50%). In vivo, s.c. injection of TRAMP-C1 cells dispersed in Matrigel gives origin to a tumor mass, whose growth is not inhibited by green-tea regimen. This growth is contained greater than two-thirds by LPS-triggered polymorpho-nuclear phagocyte (PMN) recruitment but this effect is abolished by green tea. Nevertheless, while tumor-released pro-MMP-2 is activated by co-incubation of TRAMP-C1 cells with PMNs, in the presence of 10 microM EGCG the activation is almost abolished. These results suggest that inflammatory involvement of prostate carcinoma could be efficaciously prevented by green tea with a concomitant lowering of the invasive potential.

Prostate carcinoma and green tea: PSA-triggered basement membrane degradation and MMP-2 activation are inhibited by (-)epigallocatechin-3-gallate

Prostate-specific antigen (PSA) is a serine-protease that, in addition to cleaving semenogelins in the seminal coagulum, is able to cleave extracellular matrix glycoproteins, thereby affecting cell migration and metastasis. We here report some new activities of PSA that deserve careful consideration in the cancer context: degradation of gelatin, degradation of type IV collagen in reconstituted basement membrane (Matrigel) and activation of progelatinase A (MMP-2), but not pro-MMP-9, in a cell-free system. Since consumption of green tea has been reported to lower the risk of prostate cancer, we investigated the effects of the major flavanol of green tea, (-)epigallocatechin-3-gallate (EGCG), on expression and activity of PSA by prostate carcinoma cells. In addition to restraint of PSA expression, EGCG was found to inhibit in a dose-dependent manner all the above PSA activities, at concentrations lower than the cytotoxic serine-protease inhibitor PMSF and close to levels measured in the serum following ingestion of green tea. The activity of PSA was suppressed also by the elastase released by the inflammatory leukocytes. These results highlight new PSA activities, suggest gelatin zymography as a new convenient assay for PSA, propose EGCG as natural inhibitor of prostate carcinoma aggressiveness, but also stimulate further investigation on the role of prostatic inflammation.

Two-year experience with the german-translated version of the NIH-CPSI in patients with CP/CPPS

OBJECTIVES

To examine, after psychometric evaluation and validation of the translated National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the practical value of this questionnaire in a routine diagnostic prostatitis setup for patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The NIH-CPSI is a well-accepted tool for the symptomatic evaluation of patients with CP/CPPS. The recently translated German version has not yet been validated in detail.

METHODS

A total of 137 consecutive patients attending a prostatitis outpatient department were classified according to the internationally accepted NIH consensus classification into CP/CPPS NIH type IIIA (n = 53; mean age 43.2 years) and IIIB (n = 84; mean age 43.4 years). For psychometric analysis, the overall type III group was evaluated for reliability and validity of the German NIH-CPSI. The psychometric properties of the translated NIH-CPSI were compared with those of the original English version. In addition, the total scores of all men and separately for CP/CPPS NIH types IIIA and IIIB were evaluated.

RESULTS

The German NIH-CPSI was reliable, with an alpha coefficient for the overall index and its subscales of between 0.60 and 0.74. However, the internal consistency of the pain subdomain was lower in our translated version (alpha 0.60) compared with the original English version (alpha 0.86). In this cohort, men with NIH type IIIB CP/CPPS were significantly (P = 0.03) more symptomatic in the total index compared with men with NIH type IIIA CP/CPPS.

CONCLUSIONS

The German version of the NIH-CPSI has a relatively high reliability and face and construct validity overall. A validated translated NIH-CPSI is suggested as a standardized tool to quantify chronic pelvic pain symptoms for different countries and languages.