Chronic prostatitis/chronic pelvic pain syndrome in adolescents compared with that in young adults

The characteristics of brain function alterations in patients with chronic prostatitis/chronic pelvic pain syndrome across varying symptom severities evaluated by NIH-CPSI

Background

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent condition in urology characterized by chronic pain. The pathogenesis of CP/CPPS remains unclear.

Methods

We enrolled 45 eligible CP/CPPS patients and 45 healthy volunteers. We evaluated their resting-state fMRI data using a comprehensive set of parameters, such as Regional Homogeneity (ReHo) and Degree Centrality (DC), to detect brain abnormalities and identify potential correlates with the clinical manifestations of CP/CPPS. We further categorized the patients into subgroups according to their scores of NIH-CPSI to elucidate the brain changes associated with differing symptom severities.

Results

Profound alterations in brain function were observed in patients with CP/CPPS. These changes involved multiple brain regions identified by DC analysis, including the right anterior cingulate cortex (ACC), left inferior frontal opercular cortex, left amygdala, right middle frontal cortex, and bilateral insula. ReHo analysis revealed significant changes in the right thalamus, left inferior frontal triangular cortex, right superior temporal pole, left ACC, and right superior frontal cortex (cluster >20 voxels, GRF correction, p < 0.05). Analysis using ReHo and DC revealed that brain alterations associated with varying symptom severities were localized in pain perception and modulation regions. Specifically, the DC values in the right ACC showed a linear correlation with the severity of symptoms measured by the NIH-CPSI (AUC = 0.9654, p < 0.0001).

Conclusion

In CP/CPPS, we first discovered differences in brain function among patients with varying degrees of severity. The brain alterations of DC in the right ACC might be a potential biomarker for diagnosing and assessing disease severity.

The "prostate-pelvic syndrome" theory used in patients with type-III prostatitis and its correlation with prostate volume

BACKGROUND

Type-III prostatitis is the most common prostate disease in adult males below 40 years old. The actual operation of its diagnosis process is cumbersome. Recently, a group of top Chinese urologists have proposed the theory of "prostate-pelvic syndrome (PPS)" and suggested using it to replace the traditional term for type-III prostatitis. However, the practical application effectiveness of PPS theory in clinical practice is still unclear.

OBJECTIVE

The aims of this study were to verify the clinical outcome of PPS theory in diagnosing the adult patients with type-III prostatitis below 40 years old and analyze the related factors for the main symptoms of PPS in adult males below 40 years old, providing references for the prevention and treatment of PPS in young adult males.

METHODS

The clinical medical records of 548 adult outpatients with type-III prostatitis under 40 years old between August 2018 and May 2023 were retrospectively analyzed. The patients were diagnosed retrospectively again by using PPS diagnostic criteria in this retrospective cohort study. Subsequently, the age, disease duration, prostate volume (PV), PV ≥ 20 mL detection rate and other related indicators among different symptom groups were analyzed by univariate analysis. The correlation between different symptoms of PPS patients and PV as well as disease duration was analyzed by correlation analysis. Additionally, the related factors for different main symptoms of PPS patients were analyzed by multivariate analysis.

RESULTS

Of the 548 patients, 229 patients had lower urinary tract symptoms, 159 patients had pelvic pain symptoms, and 160 patients had lower urinary tract and pelvic pain symptoms, respectively corresponding to those with voiding symptoms (VS), pain symptoms (PS), and voiding + pain symptoms (VS + PS) defined according to the concept of PPS. There were significant differences in PV and disease duration among the three main symptoms groups of PPS. PV in the VS group was larger than that in the PS group. Spearman correlation analysis showed that VS was positively correlated with PV and disease duration, while four secondary symptoms (including sexual dysfunction, psychosocial symptoms, reproductive dysfunction and other symptoms) were not related to PV. The proportion of VS patients in the PV ≥ 20 mL group was higher than that in the PV < 20 mL group. Multivariate logistic analysis showed that PV and disease duration were independent related factors for VS in adult PPS patients below 40 years old.

CONCLUSIONS

Type-III prostatitis in Chinese adult males below 40 years old can be diagnosed and treated with PPS. PV and disease duration were independent related factors for VS in Chinese adult PPS patients below 40 years old. The risk of VS in PPS patients with PV ≥ 20 mL was 5.348 times as long as that in PPS patients with PV < 20 mL.

Associated Factors for Prostate Enlargement in Chinese Adult Men Aged <40 Receiving Checkups

PURPOSE

Prostate enlargement (PE) is an increase in prostate volume in morphology. PE was also observed in some patients aged <40 with chronic prostatitis. This study aimed to explore the associated factors for PE in Chinese adult men aged <40.

METHODS

The medical records of 1851 consecutive Chinese adult men aged <40 in a single center were retrospectively analyzed. The checkup indicator characteristics between the PE and non-PE groups were compared by univariate analysis, and the associated factors were analyzed by multivariate analysis.

RESULTS

The overall prevalence of PE (defined as prostate volume ≥ 20 ml) in adult men aged < 40 was 10.4%. Age and the proportions of subjects with prostate calcification or hypertension were different between the PE and non-PE groups (P < 0.05). Multivariate logistic analysis showed that prostate calcification (odds ratio [OR], 1.831; 95% confidence interval [CI], 1.281-2.619; P=0.001), hypertension (OR, 1.528; 95% CI, 1.125-2.076; P=0.007), and age (OR, 1.117; 95% CI, 1.078-1.159; P < 0.001) were associated factors for PE in adult men aged <40.

CONCLUSIONS

The prevalence of PE in Chinese adult check-up men aged <40 was not rare. In addition to age, prostate calcification and hypertension were associated factors for PE in Chinese adult men aged <40.

Prognostic and Clinic-Pathological Significances of SCF and COX-2 Expression in Inflammatory and Malignant Prostatic Lesions

The initiation of prostatic malignancy has been linked to chronic inflammation. Stem cell factor (SCF) is an inflammatory cytokine that is specific to the c-KIT receptor which is type III receptor tyrosine kinase (RTK). Cyclooxygenases (COXs) are the main enzymes which are responsible for prostaglandins production from arachidonic acid. COX2 is an enzyme which is produced under different pathological conditions. The aim of our study; is to investigate the clinicopathological and the prognostic significance of SCF and COX-2 expression in prostatic adenocarcinoma (PC), chronic prostatitis and nodular prostatic hyperplasia (NPH) in a trial to clarify the role of inflammation as a risk factor for prostatic carcinogenesis and cancer progression. SCF and COX-2 tissue protein expression were evaluated in 50 cases of PC, 20 cases of chronic prostatitis and 10 cases of NPH using immunohistochemistry, patients were followed up for 5 years. The relationship between their levels of expressions, clinicopathological, and prognostic criteria were studied. SCF expression in PC was positively correlated with advanced patient age (p = <0.001), high level of PSA (p = 0.010), higher Gleason score (p = 0.011). COX-2 expression in PC was positively correlated with advanced patient age (p = <0.001), high level of PSA (p = 0.016), advanced D'Amico risk group (p = 0.038). High levels of expression of both SCF& COX-2 are associated with higher incidence of tumor relapse, worse disease overall survival and free survival (p < 0.001). SCF and COX-2 are associated with PC progression and associated with poor prognosis in PC patients.