Can expressed prostatic secretions affect prostate biopsy decision of urologist?

ABSTRACT Objectives: To evaluate the frequency of NIH category IV prostatitis, and the use of expressed prostatic secretions tests in an effort to improve the reliability of prostate specific antigen as an indicator, to avoid unnecessary prostate biopsy. Materials and Methods: 178 expressed prostatic secretion positive patients with serum prostate specific antigen levels of ≥ 2.5 ng / mL were included in present prospective study. The diagnostic evaluation included detailed history and physical examination, digital rectal examination, urine analysis, urine culture, and expressed prostatic secretions tests. Transrectal ultrasonography was used both to measure prostate volume and conduct 12 core prostate biopsy. Results: The prevalence of NIH category IV prostatitis was 36.9% (178 / 482) in our population of men. In our study patients (n: 178) prostate biopsy results were classified as; 66 prostatitis, 81 BPH, and 31 Pca. In asymptomatic prostatitis group, expressed prostatic secretion mean leucocyte ratio was higher compared to other two groups (p < 0.0001). The relation between number of expressed prostatic secretion leucocytes and prostatitis, benign prostate hyperplasia, and prostate cancer is analyzed. If 16 is taken as the cut of number for leucocyte presence, its sensitivity is 0.92 (AUC = 0.78 p = 0.01). Conclusions: The number of leucocytes in expressed prostatic secretion is higher in the chronic prostatitis group. If the leukocyte presence of 16 and above is taken as the cut off point, the sensitivity becomes 0.92 (AUC = 0.78). We firmly believe that our new cut off value may be used as to aid prostate specific antigen and derivates while giving biopsy decision.

Prostatitis: ¿infección, alteración neuromuscular o síndrome doloroso? La adecuada clasificación del paciente es clave / Prostatitis: infection, altered or neuromuscular pain syndrome? The proper classification of the patient is key

La prostatitis en un término muy amplio utilizado para describir la inflamación de la próstata con una variedad de síntoma urinarios bajos, molestias en la actividad sexual y disfunción. Es una condición que afecta entre el 5 y 10 por cien de la población masculina y es el diagnostico urológico más común en menores de 50 años. La prostatitis se clasifica en cuatro categorías, incluyendo sus formas aguda y crónica bacterianas, una crónica abacteriana y una asintomática. Las formas bacterianas son más fáciles de diagnosticar y tratar, pero no es usual que los síntomas del paciente estén claramente relacionados con una condición infecciosa, tanto así que la prostatitis crónica abacteriana (también conocida como síndrome de dolor pélvico crónico), es la forma más prevalente y menos entendida, así como también es la que implica un mayor reto diagnóstico y terapéutico. Esta forma de prostatitis puede responder a terapias no centradas en la próstata como terapia física, liberación de puntos gatillo miofasciales y terapias de relajación. Teniendo en cuenta que hay múltiples formas de prostatitis, es necesario tener presentes las múltiples modalidades terapéuticas, hacer un enfoque diagnostico apropiado y hacer un diagnóstico diferencial adecuado , con miras a tener un manejo efectivo.

Premalignant lesions of prostate and their association with nodular hyperplasia and carcinoma prostate.

BACKGROUND: A relatively new development in the arena of prostatic histopathological study is the premalignant proliferative changes in the glandular epithelium, possibly relating to carcinoma. Two major categories have come up, namely prostatic intraepithelial neoplasia (PIN) and atypical adenomatous hyperplasia (AAH). AIMS: The aims of present study were to identify foci of the two putative premalignant conditions viz. PIN and AAH in ducto-acinar lining epithelia of 200 prostatectomy specimens and their association with nodular hyperplasia and adenocarcinoma prostate. MATERIAL AND METHODS: Micro sections from 200 prostatectomy specimens, received in the Department of Pathology, PGIMS, Rohtak, were extensively studied for the presence and association of premalignant conditions. Significant values were obtained by employing Chi-square (chi2) test, with P value < 0.05 as significant. RESULTS: Out of 177 cases of nodular hyperplasia, 53 (29.9%) showed PIN and 38 (20.3%) showed presence of AAH. All 6 cases (100%) of pure carcinoma revealed foci of PIN. Out of the remaining 23 cases of carcinoma with nodular hyperplasia, foci of PIN were observed in 16 cases (94.1%) and AAH in 2 cases (11.7%). High-grade PIN was observed in 20 cases (86.9%) of the total 23 cases of carcinoma, with/without nodular hyperplasia and 20 cases (11.2%) of nodular hyperplasia. Low-grade PIN was observed in 33 cases (18.6%) of nodular hyperplasia and in only 1 case (5.8%) of carcinoma prostate with nodular hyperplasia. CONCLUSION: PIN, especially high-grade type was the most commonly observed premalignant lesion, in cases of adenocarcinoma, thereby suggesting it to be the likely precursor of carcinoma prostate. AAH showed a weaker association with carcinoma.

Prostatitis: Diagnostic criteria and classification

Our aim from this prospective study is to determine the prevalence and classification of maj types of prostatitis, also determining the commonest etiological agents. Materials and We analyzed 54 patients with symptoms suggestive of prostatitis, the patients were presented to the family clinic at Princess Haya Hospital/ Aqaba between January - June 2000, and underwent prostatic localization [diagnostic] studies. 54 consecutive patients were analyzed, and according to the currently accepted criteria for the diagnosis of prostatitis; 4 patients were given a diagnosis of acute bacterial postatitis which account for [7%] of all cases, 10 patients diagnosed as chronic bacterial prostatitis with [18%] prevalence, 25 had chronic non-bacterial prostatitis [46%] and 15 given a diagnosis of chronic pelvic pain syndrome [28%]. Bacterial growth was obtained from 14 patients [26%], of which Escherichia coli was grown from 5 [36%], Staphylococcus aureus from 4 [29%], Proteus from 3 [21%], Serratia from one [7%] and Klebsiella from one patient [7%]. The dilemma of diagnosing prostatitis is discussed. Conclusions: prostatitis is an important diagnosis in urological and primary care practice, this study emphasizes the need for improved diagnosis of prostatitis, also the higher prevalence of Staphylococcus aureus in our patients should prompt researchers to study their patient since cultural, social habits and evolusion of microbial world may have an impact on the etiology of the disease