Effects of low-intensity pulsed ultrasound on the microorganisms of expressed prostatic secretion in patients with IIIB prostatitis.

To detect and analyze the changes of microorganisms in expressed prostatic secretion (EPS) of patients with IIIB prostatitis before and after low-intensity pulsed ultrasound (LIPUS) treatment, and to explore the mechanism of LIPUS in the treatment of chronic prostatitis (CP). 25 patients (study power was estimated using a Dirichlet-multinomial approach and reached 96.5% at α = 0.05 using a sample size of 25) with IIIB prostatitis who were effective in LIPUS treatment were divided into two groups before and after LIPUS treatment. High throughput second-generation sequencing technique was used to detect and analyze the relative abundance of bacterial 16 s ribosomal variable regions in EPS before and after treatment. The data were analyzed by bioinformatics software and database, and differences with P < 0.05 were considered statistically significant. Beta diversity analysis showed that there was a significant difference between groups (P = 0.046). LEfSe detected four kinds of characteristic microorganisms in the EPS of patients with IIIB prostatitis before and after LIPUS treatment. After multiple comparisons among groups by DESeq2 method, six different microorganisms were found. LIPUS may improve patients' clinical symptoms by changing the flora structure of EPS, stabilizing and affecting resident bacteria or opportunistic pathogens.

Is type III prostatitis also associated with bacterial infection?

Objective: To explore whether type III prostatitis is related to bacterial infection by detecting the composition and function of microorganisms in expressed prostatic secretion (EPS) of patients with chronic prostatitis (CP) and healthy people. Methods: According to the inclusion and exclusion criteria, 57 subjects were included in our study, divided into the healthy group, type II prostatitis group, and type III prostatitis group. 16s rRNA sequencing technique was used to detect and analyze the microbial composition of EPS in each group. Additionally, the metagenomics sequencing technique was used to further explore the function of different bacteria in the type III prostatitis group. Data analysis was performed by bioinformatics software, and the results were statistically significant when P<0.05. Results: Many microorganisms exist in EPS in both CP patients and healthy populations. However, the relative abundance of Pseudomonas, Haemophilus, Sneathia, Allobaculum, and Enterococcus in CP patients (including type II and III) were significantly different. Still, the relative abundance of different bacteria in type II prostatitis patients was much higher than in type III. The metagenomics sequencing results for the type III prostatitis group showed that the different bacteria had certain biological functions. Conclusion: Based on our sequencing results and previous studies, we suggest that type III prostatitis may also be caused by bacterial infection.

No detection of SARS-CoV-2 from urine, expressed prostatic secretions, and semen in 74 recovered COVID-19 male patients: A perspective and urogenital evaluation.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been spreading all over the world since December 2019. However, medical information regarding the urogenital involvement in recovered COVID-19 patients is limited or unknown. OBJECTIVES: To comprehensively evaluate urogenital involvement in recovered COVID-19 patients. MATERIALS AND METHODS: Men aged between 20 years and 50 years who were diagnosed with SARS-CoV-2 infection and recovered when the study was conducted were enrolled in our study. Demographic and clinical characteristics, and history of hospitalization were collected and analyzed. Urine, expressed prostatic secretions (EPSs), and semen samples were collected for SARS-CoV-2 RNA detection. Semen quality and hormonal profiles were analyzed. RESULTS: Among 74 male recovered COVID-19 patients, 11 (14.9%) were asymptomatic, classified into mild type, and 31 (41.9%) were classified into moderate type. The remaining patients (32/74, 43.2%) had severe pneumonia. No critically ill recovered COVID-19 patient was recruited in our cohort. The median interval between last positive pharyngeal swab RT-PCR test and semen samples collection was 80 days (IQR, 64-93). The median age was 31 years (IQR, 27-36; range, 21-49), and the median body mass index (BMI) was 24.40 (IQR, 22.55-27.30). Forty-five (61.6%) men were married, and 28 (38.4%) were unmarried. Fifty-three (72.6%) patients denied cigarette smoking, 18 (24.7%) were active smokers, and 2 of them were past smokers. The majority of our participants (53/74, 72.6%) did not consume alcohol. Fever occurred in most of the patients (75.3%), and 63 of them had abnormal chest CT images. Only one patient complained of scrotal discomfort during the course of COVID-19, which was ruled out orchitis by MRI (data not shown). A total of 205 samples were collected for SARS-CoV-2 detection (74 urine samples, 70 semen samples, and 61 EPS samples). However, viral nucleic acid was not detected in body fluids from the urogenital system. In terms of hormonal profiles, the levels of FSH, LH, testosterone, and estradiol were 5.20 [4.23] mIU/mL, 3.95 [1.63] mIU/mL, 3.65 [1.19] ng/mL, and 39.48 [12.51] pg/mL, respectively. And these values were within the normal limits. The overall semen quality of recovered COVID-19 patients was above the lower reference limit released by the WHO. While compared with healthy control, sperm concentration, total sperm count, and total motility were significantly declined. In addition, different clinical types of COVID-19 have no significant difference in semen parameters, but total sperm count showed a descending trend. Interestingly, subjects with a longer recovery time showed worse data for sperm quality. Small sample size and lacking semen parameters before the infection are the major limitations of our study. DISCUSSION AND CONCLUSIONS: To the best of our knowledge, it is the largest cohort study with longest follow-up for urogenital evaluation comprehensively so far. Direct urogenital involvement was not found in the recovered COVID-19 male patients. SARS-CoV-2 RNA was undetectable in the urogenital secretions, and semen quality declined slightly, while hormonal profiles remained normal. Moreover, patients with a long time (≥90 days) since recovery had lower total sperm count. Great attention and further study should be conducted and follow-up on the reproductive function in the following months.

[Advances in the studies of special biomarkers for the experimental diagnosis of CP/CPPS].

At present, there are no widely accepted specific biomarkers for the experimental diagnosis of chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS). Recent studies show that many related biomarkers exist in expressed prostatic secretions (EPS) or semen, urine and blood or serum. The monocyte chemotactic protein-1 (MCP-1/CCL-2), macrophage-inflammatory-protein-1 alpha (MIP-1α/CCL-3), interleukin-6 (IL-6), interleukin-8 (IL-8), nerve growth factor (NGF) and B7-H3 in EPS, prostatic exosomal protein (PSEP) in the urine, and prostate-specific antigen (PSA), mean platelet volume (MPV) and macrophage migration inhibitory factor (MIF) in the serum are believed to be of significant clinical and research value, and expected to become important laboratory biomarkers for the diagnosis of CP/CPPS.

The absence of coronavirus in expressed prostatic secretion in COVID-19 patients in Wuhan city.

Due to the cellular entry of the novel coronavirus (SARS-CoV-2) modulated by angiotensin converting enzyme 2 (ACE2), the ACE2 bearing prostate is therefore hypothesized as a susceptible organ to COVID-19. To delineate whether the pathogenic SARS-CoV-2 of the coronavirus disease (COVID-19) could be detected in the expressed prostatic secretion (EPS), a total of ten male patients with confirmed COVID-19 were recruited. All patients were stratified into two groups: one group with positive nasopharyngeal swabbing SARS-CoV-2 within 3 days of the EPS taken day (PNS group, n = 3) and the other group with previously positive nasopharyngeal swabbing SARS-CoV-2 but turned negative before the taken day (PNNS group, n = 7). The COVID-19 patients showed elevated inflammatory indictors, i.e. C-reaction protein (3.28 (1.14, 33.33) mg/L), erythrocyte sedimentation rate (22.50 (8.00, 78.50) mm/h), and interleukin-6 (6.49 (4.96, 21.09) pg/ml). Serum IgM against SARS-CoV-2 was only positive in the PNS group, whereas serum IgG was positive for all patients. Furthermore, our data showed for the first time that none of the COVID-19 patients had positive SARS-CoV-2 RNA in EPS. To this end, this study found the negativity of SARS-CoV-2 in EPS and possibly exclude the sexual transmission of COVID-19.

[One-glass test for diagnosis and classification of chronic prostatitis: A randomized double-blind controlled multicentered clinical trial].

OBJECTIVE: To compare a new method "one-glass test" with the international gold standard "four-glass test" for the classification of chronic prostatitis (CP). METHODS: Totally, 360 CP patients were randomly assigned to receive "one-glass test" (n = 240) and "four-glass test" (n = 120) for the classification of the disease. Urine and expressed prostatic secretion (EPS) samples were collected from all the patients for microscopic and bacteriological examination and the results were subjected to statistical analysis, followed by comparison of the safety, procedures and costs of the two strategies. RESULTS: Compared with the "four-glass test", the urethal membrane "one-glass test" showed a significantly higher accuracy in the classification of types Ⅱ (8.6%), ⅢA (50.0%) and ⅢB prostatitis (41.4%) (P < 0.05), simpler procedures and lower costs, reducing RMB ¥412 (61.24%) per case. CONCLUSIONS: The "one-glass test" has a high accuracy in the diagnosis and classification of chronic prostatitis and the advantages of simple operation and low cost, and therefore can be used in place of the "four-glass test" and widely promoted clinically.

[Correlation of the prostatic exosomal protein content with conventional indicators of EPS and NIH-CPSI].

OBJECTIVE: To study the relationship of the content of prostatic exosomal protein (PSEP) in the urine with the counts of WBCs and small particles of lecithin (SPL) in the EPS and NIH-CPSI in patients with chronic prostatitis. METHODS: We collected mid-stream urine samples from 367 chronic prostatitis patients in the Department of Andrology of the General Hospital of Eastern Theater Command from November 2017 to August 2018. We measured the content of PSEP in the urine, counted WBCs and SPLs in the EPS of the patients, obtained their NIH-CPSI scores, and analyzed the correlation of the PSEP level with the WBC and SPL counts and NIH-CPSI scores of the patients. RESULTS: The PSEP level in the urine was elevated with the increase of the WBC count in the EPS of the patients (r = 0.19, P = 0.047) but not significantly correlated with the SPL count in the EPS (r = 0.02, P = 0.48). A significant correlation was observed between the PSEP level and the NIH-CPSI scores of the patients (r = 0.31, P = 0.02). CONCLUSIONS: The PSEP content in the urine can be used as an indicator in the clinical diagnosis and assessment of the inflammation degree of chronic prostatitis.

[Reduced zinc concentration in expressed prostatic secretion relates to the pain symptoms of types â ¢ and â £ prostatitis].

OBJECTIVE: To determine the zinc levels in the expressed prostatic secretion (EPS) of the patients with different types of chronic nonbacterial prostatitis, and explore the reference value of zinc concentration in EPS in the diagnosis and treatment of prostatitis. METHODS: We collected EPS samples from 35 healthy men and 173 patients with chronic nonbacterial prostatitis, including 65 cases of type ⅢA, 69 cases of type ⅢB, and 39 cases of type Ⅳ, according to the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). We compared the zinc levels in the EPS samples among different groups and analyzed the correlations of zinc concentration with the NIH-CPSI scores, WBC count, pH value, and age of the subjects. RESULTS: The participants were aged 17－65 (32.5±8.5) years. The zinc concentrations in the EPS were significantly lower in the ⅢA (ï¼»162.2±10.8ï¼½ µg/ml) and ⅢB (ï¼»171.2±12.0ï¼½ µg/ml) than in the Ⅳ (ï¼»234.6±17.9ï¼½ µg/ml) (P<0.05 ) and the control group (ï¼»259.5±14.6ï¼½ µg/ml) (P<0.05 ). The zinc level was correlated negatively with the NIH-CPSI pain score (r=－0.248, P<0.01), quality of life score (r=－0.232, P<0.01), severity score (r=－0.270, P<0.01), total NIH-CPSI score (r=－0.281, P<0.01), and the pH value in EPS (r=－0.208, P<0.01), but showed no correlation with the WBC count and age of the subjects. CONCLUSIONS: The reduced zinc concentration in the EPS of the patients with chronic nonbacterial prostatitis may be associated with the pain symptoms of the disease, which suggests the potential reference value of measuring the zinc concentration in EPS in the diagnosis and treatment of prostatitis.

Reduced zinc concentration in expressed prostatic secretion relates to the pain symptoms of types Ⅲ and Ⅳ prostatitis / 中华男科学杂志

<p><b>Objective</b>To determine the zinc levels in the expressed prostatic secretion (EPS) of the patients with different types of chronic nonbacterial prostatitis, and explore the reference value of zinc concentration in EPS in the diagnosis and treatment of prostatitis.</p><p><b>METHODS</b>We collected EPS samples from 35 healthy men and 173 patients with chronic nonbacterial prostatitis, including 65 cases of type ⅢA, 69 cases of type ⅢB, and 39 cases of type Ⅳ, according to the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). We compared the zinc levels in the EPS samples among different groups and analyzed the correlations of zinc concentration with the NIH-CPSI scores, WBC count, pH value, and age of the subjects.</p><p><b>RESULTS</b>The participants were aged 17－65 (32.5±8.5) years. The zinc concentrations in the EPS were significantly lower in the ⅢA (［162.2±10.8］ μg/ml) and ⅢB (［171.2±12.0］ μg/ml) than in the Ⅳ (［234.6±17.9］ μg/ml) (P<0.05 ) and the control group (［259.5±14.6］ μg/ml) (P<0.05 ). The zinc level was correlated negatively with the NIH-CPSI pain score (r=－0.248, P<0.01), quality of life score (r=－0.232, P<0.01), severity score (r=－0.270, P<0.01), total NIH-CPSI score (r=－0.281, P<0.01), and the pH value in EPS (r=－0.208, P<0.01), but showed no correlation with the WBC count and age of the subjects.</p><p><b>CONCLUSIONS</b>The reduced zinc concentration in the EPS of the patients with chronic nonbacterial prostatitis may be associated with the pain symptoms of the disease, which suggests the potential reference value of measuring the zinc concentration in EPS in the diagnosis and treatment of prostatitis.</p>

Intraprostatic injection of botulinum toxin-A in patients with refractory chronic pelvic pain syndrome: The transurethral vs. transrectal approach.

OBJECTIVE: To evaluate the outcome of an intraprostatic injection of botulinum toxin-A (BTX-A) in men with refractory chronic prostatitis-associated chronic pelvic-pain syndrome (CP/CPPS) and to compare the efficacy of the transurethral and transrectal routes. PATIENTS AND METHODS: In an uncontrolled randomised clinical trial conducted in men with refractory CP/CPPS, the patients were classified into two groups according to the route of BTX-A injection; transurethral (group 1, 28 patients) and transrectal ultrasonography-guided (group 2, 35 patients). The chronic prostatitis symptom index (CPSI), maximum urinary flow rate (Q max) and white blood cell (WBC) count in expressed prostatic secretion (EPS) were measured before and at 3, 6 and 12 months after the injection. A significant clinical improvement (SCI, defined as a reduction of 4 points or a 25% decrease in total CPSI score) was correlated with patient age, prostate volume and symptom duration. RESULTS: In group 1, the pain and quality-of-life domain scores improved, but statistically significantly only at 6 months. The voiding score improved at all follow-up visits. In group 2 there was a significant improvement in all the CPSI domain scores at all follow-up visits, except for pain, which was insignificantly improved by 12 months. The SCI ratings in groups 1 and 2 were 36%, 79% and 57%, and 49%, 89% and 74% in group 2 at the three follow-up visits, respectively. The Q max was significantly improved in both groups during the follow-up (except at 12 months in group 1). There was a significant reduction in the mean WBC count in the EPS in patients with inflammatory prostatitis. Both prostate volume and symptom duration were significantly associated with a lower SCI rating. CONCLUSION: BTX-A is an available treatment option for patients with refractory CP/CPPS. It is more effective in patients with a small prostate and short symptom duration. The transrectal route provided better results than the transurethral route. More prospective longer term studies are needed.

Expressed prostatic secretion biomarkers improve stratification of NCCN active surveillance candidates: performance of secretion capacity and TMPRSS2:ERG models.

PURPOSE: Active surveillance is a viable patient option for prostate cancer provided that a clinical determination of low risk and presumably organ confined disease can be made. To standardize risk stratification schemes the NCCN (National Comprehensive Cancer Network®) provides guidelines for the active surveillance option. We determined the effectiveness of expressed prostatic secretion biomarkers for detecting occult risk factors in NCCN active surveillance candidates. MATERIALS AND METHODS: Expressed prostatic secretion specimens were obtained before robot-assisted radical prostatectomy. Secretion capacity biomarkers, including total RNA and expressed prostatic secretion specimen volume, were measured by standard techniques. RNA expression biomarkers, including TXNRD1 mRNA, prostate specific antigen mRNA, TMPRSS2:ERG fusion mRNA and PCA3 mRNA, were measured by quantitative reverse-transcription polymerase chain reaction. RESULTS: Of the 528 patients from whom expressed prostatic secretions were collected 216 were eligible for active surveillance under NCCN guidelines. Variable selection on logistic regression identified 2 models, including one featuring types III and VI TMPRSS2:ERG variants, and one featuring 2 secretion capacity biomarkers. Of the 2 high performing models the secretion capacity model was most effective for detecting cases in this group that were up-staged or up-staged plus upgraded. It decreased the risk of up-staging in patients with a negative test almost eightfold and decreased the risk of up-staging plus upgrading about fivefold while doubling the prevalence of up-staging in the positive test group. CONCLUSIONS: Noninvasive expressed prostatic secretion testing may improve patient acceptance of active surveillance by dramatically reducing the presence of occult risk factors among those eligible for active surveillance under NCCN guidelines.

Increased bisecting N-acetylglucosamine and decreased branched chain glycans of N-linked glycoproteins in expressed prostatic secretions associated with prostate cancer progression.

PURPOSE: Using prostatic fluids rich in glycoproteins like prostate-specific antigen and prostatic acid phosphatase (PAP), the goal of this study was to identify the structural types and relative abundance of glycans associated with prostate cancer status for subsequent use in emerging MS-based glycopeptide analysis platforms. EXPERIMENTAL DESIGN: A series of pooled samples of expressed prostatic secretions (EPS) and exosomes reflecting different stages of prostate cancer disease were used for N-linked glycan profiling by three complementary methods, MALDI-TOF profiling, normal-phase HPLC separation, and triple quadropole MS analysis of PAP glycopeptides. RESULTS: Glycan profiling of N-linked glycans from different EPS fluids indicated a global decrease in larger branched tri- and tetra-antennary glycans. Differential exoglycosidase treatments indicated a substantial increase in bisecting N-acetylglucosamines correlated with disease severity. A triple quadrupole MS analysis of the N-linked glycopeptides sites from PAP in aggressive prostate cancer pools was done to cross-reference with the glycan profiling data. CONCLUSION AND CLINICAL RELEVANCE: Changes in glycosylation as detected in EPS fluids reflect the clinical status of prostate cancer. Defining these molecular signatures at the glycopeptide level in individual samples could improve current approaches of diagnosis and prognosis.

Measurement and correlation of electrolytes in EPS and urine of patients with chronic prostatitis / 中华泌尿外科杂志

Objective To measure the concentration of electrolytes such as potassium,sodium,chloride,calcium in EPS and urine of patients with chronic prostatitis and to analyze the correlation of the electrolytes in different patient groups. Methods The concentrations of potassium,sodium,chloride and calcium in EPS and urine of 31 controls and 79 patients with prostatitis were measured and analyzed. Results There was no significant difference between the patients and normal controls in electrolytical concentration of potassium,sodium,calcium except chloride (P=0.001).The concentration of chloride in the patients was significantly higher than that in the normal controls.In the treatment effective group, potassium concentrations were decreased from 40.66?17.10 to 33.42?17.27 mmol/L after treatment.In the treatment ineffective group, potassium concentrations were (37.57?16.93)mmol/L before treatment and 50.66?18.77 mmol/L after treatment.Potassium concentrations were 36.02?12.36 and 48.90?16.93 mmol/L in the pain group and painless group,respectively.There were positive correlations between the concentrations of potassium and calcium of EPS,sodium and chloride of urine as well. Conclusions The concentrations of potassium in EPS are obviously different between the effective group and ineffective group or the pain group and painless group.There is a close relationship between the concentration of potassium and calcium of EPS,sodium and chloride of urine; and they are positively correlated.

Anaerobic Bacterial Isolation in Patients with Chronic Prostatitis Syndrome / 대한비뇨기과학회지

In a general way, anaerobic isolation is troublesome and needs competent personnel and fittings. In addition, bacterial isolation from the prostate is disappointing because of difficulty in interpretation of the results. In this experiment, we tried the best way to isolate anaerobes from the prostate in terms of processing of the specimens such as catching, transportation, etc. We performed this antegrade experiment for 12 months in 1992 and got the results from 43 patients with chronic prostatitis syndrome as follows. l. Age distribution was in broad range between 20 and 54 showing peak incidence in 31-40 years(49% ) and the next in 20-30 years( 30%). 2. Subjective symptoms and signs consisted of perineal discomfort, suprapubic discomfort, frequency, urethral discomfort, dysuria, morning drop, testicular discomfort, and hemospermia 3. Majority of the cases( 36 cases. 83.7% ) were normal in the microscopy of VB1 EPS of 31 cases(72%) showed WBC more than 10/HPF. VB3 of 23 cases(53.5% ) showed than l0/HPF 4. A total of 40 cases showed aerobes in EPS and/or VB3 by culture. However, only 8 cases showed aerobes in EPS and/or VB, exclusive of 32 cases in which aerobes also appeared in VB1. 5. Anaerobic bacteria were cultured only from EPS for a total of 8 cases. There were 2 cases with Bacteroides species, 2 cases with Prevotella bivia, 2 cases with Peptostreptococcus anaerobrus,2 cases with Actinomyces meyeri, 1 case with Eubacterium lentum and 1 case with Eubacterium limosum.

The Concentrations of Zinc in Expressed Prostatic Secretion of Chronic Prostatitis Patients / 대한비뇨기과학회지

We have performed assay for zinc on the expressed prostatic secretion in 52 consecutative patients with complaints of chronic prostatitis along with 23 controls. Among 52 patients, 29 are chronic bacterial prostatitis and 23 are chronic non-bacterial prostatitis. The result is as follows: 1. There is a significant difference(p<0.01) of the concentration of zinc in expressed prostatic secretion between the patient and the control. 2. Not remarkable difference of the concentration of zinc between the bacterial prostatitis and the non-bacterial prostatitis is elucidated.