Home | Contact Us | FAQ | Search & Site Map | Link to Us
Sign In | Join | Other 45 Sites in Network
Home
Discussion Groups
General
GeneralCardiologyVisionDentistryPharmacyLaboratoryNutritionAlternative
Diseases and Disorders
AIDSAlzheimer'sArthritisAsthmaCancerBreast CancerDiabetesEpilepsyGlaucomaHepatitisHerpesLupusProstate BPHProstate CancerProstatitisSinusitisTinnitus

Medical Forum / Diseases and Disorders / Prostatitis / October 2003

Tip: Looking for answers? Try searching our database.

Andrologia Part 2

Thread view: 
Enable EMail Alerts  Start New Thread
Thread rating: 
Mr. Pubmed - 12 Oct 2003 16:21 GMT
Here are 2 abstracts with actual data. Conclusion:

More evidence for an autoimmune cause in CPPS
Lack of evidence of the role of chlamydia

Andrologia. 2003 Oct;35(5):294-9.

Immunological alterations in the ejaculate of chronic prostatitis
patients: clues for autoimmunity.

John H, Maake C, Barghorn A, Zbinden R, Hauri D, Joller-Jemelka HI.

Clinic of Urology Institutes of Anatomy Clinical Pathology Medical
Microbiology Clinical Immunology, University Hospital and University
of Zurich, Zurich, Switzerland.

The aim of this prospective study was to observe immunophenotypic
patterns in the ejaculate of patients with noninflammatory chronic
pelvic pain syndrome (Cat IIIB CPPS) and to test for a possible
autoimmune aetiology. Thirty-five patients of a total of 88 patients
with chronic prostatitis Cat IIIB were consecutively selected. Monthly
ejaculate testing was carried out for IgG, IgA, IgM, IL-1alpha, sIL-2R
and IL-6. The control group for ejaculate analysis was composed of 96
normal ejaculates (according to the WHO criteria). Immunohistochemical
detection of CD3 cells (T lymphocytes) and CD20 cells (B lymphocytes)
was performed in 71 biopsy cylinders of Cat IIIB CPPS patients and in
25 prostate biopsy cylinders of subjects without symptoms or
obstruction. Intra-acinar T-lymphocytic infiltrates were dominated by
T-cytotoxic cells (P = 0.05). Ejaculate IL-6 and ejaculate IgA
increased significantly and dropped again, correlating with a release
of clinical symptoms. Inflammatory ejaculate interleukin
concentrations correlated with the immunohistochemical findings with
presence of large numbers of T cells (all P-values </= 0.01).
Immunomodulation was performed in a pilot series of three patients by
five monthly cycles of IgG (Sandoglobulin(R)), 1 g kg-1 body weight.
Immunomodulation with IgG decreased pain moderately and did not change
ejaculate interleukin and immunoglobulin concentrations. In summary,
interleukin and immunoglobulin determinations in the ejaculate
revealed an inflammatory process even in Cat IIIB CPPS. The findings
of intra-acinar T-cell rich infiltrates and the associated
inflammatory reaction may indicate a possible autoimmune component in
the aetiology of CPPS. Exact origin and role of interleukin changes in
the ejaculate of CPPS patients need to be further evaluated.
Unfortunately, pilot series with immunomodulation with IgG do not seem
to provide clear clinical benefit.

2: Andrologia. 2003 Oct;35(5):263-5.

Chlamydial and ureaplasmal infections in patients with nonbacterial
chronic prostatitis.

Badalyan RR, Fanarjyan SV, Aghajanyan IG.

Department of Urology, NIH, Yerevan, Armenia.

Our study was designed to establish the necessity of routine
evaluation of patients with inflammatory (IIIA) and noninflammatory
(IIIB) types of nonbacterial prostatitis (NBP) for chlamydial and
ureaplasmal infections. From 1999 to 2001, 165 patients with a mean
age of 35 years (range 20-54 years) were evaluated for the syndrome of
chronic prostatitis. The evaluation included scoring with Prostate
Symptom Score Index (PSSI) and NIH Chronic Prostatitis Symptom Index
(CPSI), Meares-Stamey test and culturing of post-massage urine portion
(fourth glass). In all cases, polymerase chain reaction (PCR)-testing
of the semen was performed to establish the persistence of Chlamydia
trachomatis (ChT) and Ureaplasma urealyticum (UU). Based on laboratory
findings (four glass test and post-massage urine culture), in 69 (42%)
of 165 cases, NBP was diagnosed, which includes 30 patients with type
IIIA and 39 with type IIIB of NBP. According to semen PCR tests, in 11
(36.6%) of 30 cases with IIIA type of NBP, chlamydial (six cases),
ureaplasmal (four cases) and a mixture of both (one case) infections
were described. Among 39 patients with IIIB type of NBP test was
positive in 14 cases (36%), where UU was presented in eight and ChT in
six cases. In patients with previously diagnosed inflammatory as also
noninflammatory NBP, according to four glass test, chlamydial and/or
ureaplasmal infections can be presented. Although their role in
pathogenesis of prostatitis remains speculative, however, testing for
infections is highly recommended.
Webmaster Chronicprostatitis.com - 12 Oct 2003 17:19 GMT
> 2: Andrologia. 2003 Oct;35(5):263-5.
>
> Chlamydial and ureaplasmal infections in patients with nonbacterial
> chronic prostatitis. Department of Urology, NIH, Yerevan, Armenia.

This study recommends testing for ureaplasma and chlamydia with
gusto based on their findings that a minority men with pelvic pain are
positive for these bugs by PCR. Why are there no controls in this study,
and why was it even published since it doesn't seem to meet the
requirements for evidence-based medicine? Why do they recommend
expensive testing for these bugs when there is no evidence that treating
these bugs cures CPPS? Why are they still using the 4-glass test when
anyone familiar with recent research would know it is useless? Why did
they only find "NBP" in a minority (44%)of the patients with chronic
prostatitis? Does this mean they found bacteria in ~60% of the men with
chronic prostatitis? (an astonishing result, but typical of the
continental Europeans, sadly). Is this another example of the third rate
"research" men with CPPS have endured for all these years?
Mr. Pubmed - 13 Oct 2003 01:00 GMT
> Is this another example of the third rate
> "research" men with CPPS have endured for all these years?

As I mentioned, this looks like an issue devoted to review articles,
so it was probably not peer reviewed to the same extent as a standard
research submission would have been.
Idea Man - 13 Oct 2003 04:47 GMT
"Mr. Pubmed" <mrpubmed@hotmail.com> wrote in message

> "Webmaster Chronicprostatitis.com" <webmaster@chronicprostatitis.com> wrote in message

> > Is this another example of the third rate
> > "research" men with CPPS have endured for all these years?
>
>  As I mentioned, this looks like an issue devoted to review articles,
> so it was probably not peer reviewed to the same extent as a standard
> research submission would have been.

We deserve more studies using PCR and controls.
Webmaster Chronicprostatitis.com - 14 Oct 2003 18:28 GMT
> We deserve more studies using PCR and controls.

I couldn't disagree more. We've had a plethora of such studies, and the
conclusion is in: microbes are not involved in male chronic pelvic pain
(CP/CPPS), or "pelvic myoneuropathy", except (perhaps) as one of many
triggers.

The precious research dollars deserve to be spent in other ways.
Fortunately for us, the NIH agrees with me.
Idea Man - 15 Oct 2003 01:42 GMT
"Webmaster Chronicprostatitis.com" < wrote..

> I couldn't disagree more.

I know :-) That's the beauty of this newsgroup and other's like C.P.com. We
can agree to disagree.

> We've had a plethora of such studies, and the
> conclusion is in: microbes are not involved in male chronic pelvic pain
> (CP/CPPS), or "pelvic myoneuropathy", except (perhaps) as one of many
> triggers.

In all fairness, and particularly to the subject of research studies, quite
often reaching conclusion's regarding studies often stems from what we
decide to rule in and rule out as relevant. Each & every one of us is guilty
of this to some degree. No? Anyhooooooo, I'm not pointing fingers. I'm
actually pleased to see your comment about microbes acting as a trigger, (
along with many other triggers of course ).

> The precious research dollars deserve to be spent in other ways.
> Fortunately for us, the NIH agrees with me.

I don't want all the research $$'s to go directly towards answering the role
of microbes and it's relationship to inflammation either, nor all the money
to be spent on PCR studies. Yes, that would be a mistake because there are
some dedicated people out there doing fine work, and they make a strong case
for the research dollars to be used in a variety of ways as "you say", but
this polymerase chain reaction opportunity should not be ignored, and PCR
research does indeed deserve some serious consideration and subsequent
funding. There are many reason's to go forward on this, but offering one
persuasion is that those physician's that oppose it, haven't considered that
PCR conclusion's may actually aid them in their own protocol's. Consider
this: if the results from future PCR studies are at all distinguishable, an
advantage for the specialist is that it potentially makes inhibiting actual
patients with a bacterial etiology from entering their office's for
treatment an option. You ask why would specialist's want to see only a
certain type of patient? I hypothesis that a physician who specializes in
say pelvic floor dysfunction and/or physiotherapy, may experience more
frustration and failure rates in men who actually have microbes instigating
inflammation and pain, as opposed to a more receptive patient in terms of
treatment who does not have microbes spurring on the inflammatory response
and pain cycle. In order for the specialist to be as effective as he can be,
he needs accurate information. PCR is not only a tool for the sufferer, but
for the doctor as well.

Admittedly the man who takes on the task of organizing a PCR research study,
has his work cut out for him. There needs to be a different approach to
these studies.

1.) Most can be learnt from PCR investigation if the emphasis focused on
CPPS patients with EPS inflammation.
2.) Compare PCR results between CPPS patients with an inflammatory response
to those of controls.
3.) Supply medical treatment based on PCR results.
4.) Follow-up == measure inflammatory response after treatment.
5.) Follow-up == following treatment, PCR examination of fluids "not
immediately", but 1 month after treatment.

It's true that many of us who are living our lives with symptoms want to see
this research begin. Targeting this group would prove invaluable in terms of
results and information

IMPORTANT ==== the success of this study should NOT be measured on whether
or not these patients improve, but rather what is being identified in the
EPS and semen of men who suffer from CPPS as compared to controls by using
PCR. Subsequent studies can address what can be done with the found data,
and the best strategy of treatment.

From my experience, I have come across dozens who have had conflicting
bacterial growth results when they compare their standard and dismal, 2-3
day culture approach and a PCR procedure. But, two men in particular come to
mind at this point. Like many, they both have had the regular culture, and
indeed microbes grew, but those microbes, ( enterococcus, staph. coag. neg.
etc. ) were always considered commensuals by their local doctors. This may
or not be the case. But, it was only until they had the polymerase chain
reaction examination of the same prostatic and seminal fluid that E.Coli and
and a certain species of fungus was properly identified. During and after
treatment, ( massage, antibiotic's, antifungals ),one man had significant
improvement in pain and symptoms,but the other man noticed a negligable
change in pain and symptoms, although at one point the characteristic's of
his seminal fluid improved. Why treatment fails or is not fully effective,
is EXtremely perplexing and a for a different day of debate, discussion, and
research. I hear what your saying, but, there is a case to be made for
funding PCR research studies, along side the other learning.

Sorry for taking so much of your time, guys. Honestly, I don't want to
debate. I just want everyone to improve, and I respect all of your
opinion's.

Regards.
 
Sign In
Join
My Latest Posts
My Monitored Threads
My Blog
My Photo Gallery
My Profile
My Homepage

Start New Thread
Enable EMail Alerts
Rate this Thread



©2008 Advenet LLC   Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.