Granulomatous prostatitis after bacille Calmette-Guérin instillation resembles prostate carcinoma:A case report and review of the literature

BACKGROUND Bacille Calmette-Guérin(BCG)instillation is recommended in patients with nonmuscle-invasive bladder cancer who have intermediate-risk and high-risk tumors.However,granulomatous prostatitis is a rare complication induced by BCG instillation,which can easily be misdiagnosed as prostate cancer.Here,we report a case of granulomatous prostatitis that resembled prostate cancer.CASE SUMMARY A 64-year-old Chinese man with bladder cancer received BCG instillation.Three days later,he stopped BCG instillation and received anti-infective therapy due to the urinary tract infection.Three months after BCG restart,he had rising total prostate-specific antigen(PSA)(9.14 ng/mL)and decreasing free PSA/total PSA(0.09).T2-weighted images of magnetic resonance imaging(MRI)showed a 28 mm×20 mm diffuse low signal abnormality in the right peripheral zone,which was markedly hyperintense on high b-value diffusion-weighted MRI and hypointense on apparent diffusion coefficient map images.Considering Prostate Imaging Reporting and Data System score of 5 and possibility of prostate cancer,a prostate biopsy was conducted.Histopathology showed typical features of granulomatous prostatitis.The nucleic acid test for tuberculosis was positive.He was finally diagnosed with BCG-induced granulomatous prostatitis.Thereafter,he stopped BCG instillation and received anti-tuberculosis treatment.During 10 mo follow-up,he had no evidence of tumor recurrence or symptoms of tuberculosis.CONCLUSION Temporarily elevated PSA and high followed by low signal abnormality on diffusion-weighted MRI are important indicators of BCG-induced granulomatous prostatitis.

Research progress of miRNA and chronic nonbacterial prostatitis

Chronic nonbacterial prostatitis(CNP),also the typeⅢprostatitis account for more than 90%of all patients with prostatitis.It has a long course of disease,easy to repeat,unknown pathogenesis and poor clinical efficacy.At present,some scholars at home and abroad have found that there is differential expression of microRNA(miRNA)in prostatic fluid of CNP patients or prostate tissue of CNP rat model.Intervention of miRNA expression can alleviate the symptoms and pharmacodynamics of CNP to a certain extent,which opens up a new way and direction for the pathogenesis and diagnosis and treatment of CNP.Therefore,this paper reviews the research progress of miRNA and CNP in recent years.

A comparative study of two methods for establishing a chronic non‑bacterial prostatitis model in rats‑

Objective:To compare the biological characteristics and stability of the chronic non-bacterial prostatitis(CNP)model in rats induced by the depot combined with estrogen induction method and the autoimmune response induction method.Methods:The CNP rat model was prepared using the depot combined with 17β-estradiol induction method in the depot hormone group and three concentrations of prostate protein homogenate at 40 mg/mL,20 mg/mL and 10 mg/mL in the autoimmune group,respectively.The degree of prostate tissue damage was evaluated by pathology(HE staining),and the immunoturbidimetric method was used to evaluate the contents of immunoglobulins IgA,IgM and IgG.ELISA was used to evaluate interleukin-1β(IL-1β),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)and high-sensitivity-C-reactive protein(hs-CRP),and electrochemiluminescence was used to evaluate the expression level of testosterone(T),and the two model methods were compared.Results:Compared with the sham-operated group,the body mass of rats in both models was significantly lower in the depot hormone group and autoimmune group before extraction(P<0.01,P<0.01),and histopathology of the prostate in both models showed destruction of glandular structure and a significant increase in inflammatory cells.Compared with the depot hormone group and the autoimmune group,the histopathological changes and inflammatory pathological scores of prostate and the contents of immune indexes IgA,IgM and IgG were significantly different in the depot hormone group(P<0.05,P<0.05,P<0.05),and the levels of IL-1β,IL-10,TNF-α,hs-CRP and T were significantly changed in the autoimmune group(P<0.01).The comparison between the high,medium and low dose groups of the autoimmune group,in which the pathological changes in the medium dose of the autoimmune group were slightly better than the other two groups between the groups,but the changes in IL-1β,IL-10,TNF-α,hs-CRP,and T in the low dose of the autoimmune group were the most significant(P<0.05).Conclusion:The pathological tissues of the chronic non-bacterial prostatitis model established by the depot combined with estrogen induction method and the autoimmune response induction method both showed significant changes,and the comprehensive indexes indicated that the depot combined with estrogen induction method was a more appropriate modeling choice.

Clinical Study on Treatment of Chronic Prostatitis with Lingze Tablets Combined with TCM Herbal Acupoint Plasters

Objective:To study the therapeutic effect of Lingze tablets combined with traditional Chinese medicine herbal acupoint plasters on chronic prostatitis.Methods:A total of 64 patients with chronic prostatitis who were admitted to the Andrology Clinic of Shuyang County Hospital of Traditional Chinese Medicine from March 2021 to March 2023 were randomly divided into a treatment group and a control group,with 32 cases in each group.The control group took Lingze tablets orally,4 tablets/time,3 times/d;the treatment group took the same medication along with traditional Chinese medicine acupoint herbal plasters.The two groups of patients were treated continuously for 6 weeks,and the differences in the relevant indexes of the curative effect were observed.Results:The NIH-Chronic Prostatitis Symptom Index(NIH-CPSI)scores of the two groups significantly reduced after treatment(P<0.05),and the scores of the patients in the treatment group were lower than those in the control group(P<0.05).The treatment received in the treatment group achieved and efficacy of 96.88%,which was significantly higher than that of the group,which was 81.25%(P<0.05).The maximum flow rate(MFR),average flow rate AFR,and urine output of the patients of both groups improved significantly after treatment(P<0.05).However,the experimental group showed better improvements in these indicators(P<0.05).Conclusion:Lingze tablets combined with traditional Chinese medicine acupoint herbal plasters can significantly improve the symptoms and urodynamic function of patients with chronic prostatitis.

Treatment of chronic prostatitis in Chinese men

The aim of this study is to assess the status of treatment of chronic prostatitis(CP)in Chinese men.A population-based cross-sectional survey was performed,in which 15000 men aged between 15 and 60 years were randomly selected to receive a questionnaire designed to assess National Institutes of Health Chronic Prostatitis Symptoms Index(NIH-CPSI)status,therapeutic efficacy and 28 other items.A total of 12743 men(84.95%)completed the questionnaire,of whom 1071(8.4%)were identified as having prostatitis-like symptoms and 517(4.5%)were diagnosed with CP according to NIH-CPSI criteria and prostatitis-like symptomatology.Of the CP patients,372(65%)underwent long-term routine treatment 12 times per year.Additionally,217(72.8%)patients received antibiotic therapy and 215(79.3%)men showed therapeutic effects.The treatment cost USD 1151(8059 yuan)per person per year on average.Most CP patients received routine treatment,in most cases with antibiotics.Treatment was costly and most CP patients were not satisfied with its effectiveness.Antibacterial treatment might have been effective primarily in patients with bacterial disease.

The influence of asymptomatic inflammatory prostatitis on the onset and progression of lower urinary tract symptoms in men with histologic benign prostatic hyperplasia

Benign prostatic hyperplasia(BPH)is a condition that greatly affects the quality of life of middle-aged and elderly men.Histopathologically,hyperplastic changes frequently occur in the prostate tissue of elderly men,the incidence of which has been reported to reach approximately 80% in men in their 70s.In clinical practice,approximately 25% of men with histologic BPH are assumed to experience lower urinary tract symptoms(LUTS)and receive some kind of treatment.In other words,there are some men with histologic BPH who do not exhibit LUTS.For that reason,many factors,such as the change in hormonal environment,the immune or autoimmune response,the alteration of gene expression,and so on,are thought to affect the onset and progression of LUTS in men with histologic BPH.One such factor that has long drawn attention is the presence of asymptomatic histological inflammation,which very often accompanies symptomatic BPH.Recent studies have suggested that asymptomatic histological inflammation causes repeated destruction,healing,and regeneration of the prostate tissue,leading to the enlargement of prostatic nodules,while at the same time causing stromal tissuepredominant remodeling of the prostate tissue,which can increase urination resistance and result in the condition changing from asymptomatic BPH to symptomatic BPH.In future,the biomolecular clarification of the significance of asymptomatic histological inflammation in the prostate tissue could help develop new treatment strategies for BPH accompanied by LUTS.

Application of Distress Thermometer in Patients with Prostatic Cancer and Prostatitis

Objective: To discuss the application of distress thermometer (DT) on psychological pain in primary hospital patients with prostatic cancer (Pca) and prostatitis;and to analyze the present status and related factors of psychological pain in these patients. Methods: Questionnaire survey of DT and related problem lists were carried out in 168 patients with Pca and 226 patients with prostatitis. The data were input to EXCEL and analyzed with SPSS 18.0. The statistical description was used to analyze the graded of psychological pain. Square test and Logistic regression were used to analyze influence factors of significant psychological distress. Pearson correlation analysis was used to assess the correlation between psychological distress and related problems. Results: Psychological pain score of Pca patients and prostatitis patients were 3.42 ± 1.86 and 3.02 ± 1.75, respectively. Moderate to severe degree of pain accounted for 69.6% in Pca patients, compared to 49.1% in prostatitis patients. In Pca and prostatitis patients, marital status, age, educational backgrounds and income were associated. Physical and emotional problems were the top two items having the highest score. Psychological distress score was positively correlated with physical problems, emotional problems, practical problems and communication problems in both Pcar and prostatitis patients. Conclusion: The Distress Thermometer can be used to assess the severity and explore the causes of psychological distress in Pca patients and prostatitis patients. Our study could help detecting the degree and reason of psychological distress, and provide evidence for the possibility of future personalized intervention to treat medical mental problems in primary hospital.

Boswellia resin extract and propolis derived polyphenols in patients with type III chronic prostatitis/chronic pelvic pain syndrome:An Italian prospective multicenter study

Objective:To assess the efficacy and safety of a treatment regimen based on rectal administration of Boswellia resin extract and propolis derived polyphenols in patients with type IIIa and type IIIb chronic prostatitis and chronic pelvic pain syndrome(CP/CPPS).Methods:Patients with type IIIa and type IIIb CP/CPPS received one rectal suppository a day for 15 days per month for 3 consecutive months.Participants were evaluated with National Institutes of Health-Chronic Prostatitis Symptom Index(NIH-CPSI),the International Prostate Symptom Scores(IPSS),International Index of Erectile Function(IIEF),four-glass test,uroflowmetry,and prostate-specific antigen assessments at baseline and at Week 4,and Week 12.Primary endpoints were improvement in pain domain of NIH-CPSI and improvement of NIH-CPSI total score.Secondary outcomes included improvement of micturition and quality of life(QoL)domains of NIH-CPSI questionnaire.Results:A total of 61 males were enrolled.No adverse events were reported.Significant improvements from baseline to Day 30 were reported for NIH-CPSI total score(mean difference:-9.2;p<0.01),NIH-CPSI pain domain(mean difference:-5.5;p<0.01),NIH-CPSI micturition domain,NIH-CPSI QoL domain,and IPSS total score(mean difference:-5.6;p<0.01).No significant changes from baseline in terms of IIEF score or maximum flow rate were observed.At final follow-up(Day 90),further significant improvements in terms of NIH-CPSI total score(mean difference:-12.2;p<0.01),NIH-CPSI pain domain(mean difference:-6.6;p<0.01),NIH-CPSI micturition domain,NIH-CPSI QoL domain,and IPSS total score were reported.Conclusion:Rectal administration of Boswellia resin extract and propolis derived polyphenols is well tolerated and delivers a significant symptomatic improvement in most patients with type IIIa and type IIIb CP/CPPS.

A review of the literature on randomized controlled trials of acupuncture and moxibustion in the treatment of chronic prostatitis/chronic pelvic-pain syndrome within 2016-2021

Chronic prostatitis(CP)/chronic pelvic-pain syndrome(CPPS)is a common urinary-system disease with a high incidence in young and middle-aged men,seriously affecting patients'ability to work and their quality of life(Qo L).Western medicine(WM)has some limitations in treating CP/CPPS.Acupuncture is an ancient Chinese medical method that is commonly used to treat this condition and has a relatively good effect on it.Many randomized controlled trials(RCTs)on this subject have been published.For this study,we searched the China National Knowledge Infrastructure(CNKI),Chinese Science and Technology Periodical(VIP),Wanfang,Sino Med,and Pub Med databases for RCTs on acupuncture treatment of CP/CPPS in the last 5 years(2016/01/01-2021/12/01).In addition,we conducted analysis and research,aiming to summarize acupuncture treatment in CP/CPPS RCTs and the clinical efficacy,with the goal of providing clinical reference.A total of 466 related documents were retrieved in the search,and 62 articles were retained after screening.We obtained RCT information on acupuncture treatment of CP/CPPS.The results showed that several relevant clinical studies have been performed over the last 5 years and that acupuncture and moxibustion have better curative effect on CP/CPPS than WM.Due to the small number of included studies,more experimental evidence is needed to verify the clinical efficacy of acupuncture.

Treatment of Nonspecific Chronic Prostatitis with Qian Lie Xian Yan Suppository in 104 Cases

Qian Lie Xian Yan Suppository (前列腺炎栓) was rectally applied to treat 104 patients with nonspecific chronic prostatitis ( damp-heat syndrome with blood stasis) in contrast to 30 patients treated with traditional Chinese drug Ye Ju Hua Shuan (野菊花栓Suppository of Flos Chrysanthemi Indici). The results show that chronic prostatitis is markedly improved by using Qian Lie Xian Yan suppository, with a short-term cure rate of 23.1% and a total effective rate of 84.6%, superior to that of the control group. The animal experiment indicates that Qian Lie Xian Yan suppository has better anti-inflammatory and analgesic effects, with an action of promoting blood circulation.

Experimental studying of the drug efficiency Prostamax in the therapy of chronic aseptic prostatitis and its complications

The treatment of one of the most common urological diseases, a chronic aseptic prostatitis, is an exigeant problem. Used methods of pharmacotherapy are insufficiently effective and after treatment, as a rule, there comes a recrudescence. The efficiency of new prostatotropic agent Prostamax is studied in the present work, this drug is related to bioregulator peptides at experimental chronic aseptic inflammation of prostate gland. It is established that Prostamax reduces intensity of signs of a chronic inflammation (swelling, hyperemia of vessels, lymphoid infiltration), prevents development of sclerotic and atrophic processes. It is shown that the agent intensifies sexual activity of animals. Efficiency of the preparation Prostamax surpasses that among widespread prostatotropic agents derived from the extract of Serenoa repens and prostate of animals.

TREATMENT OF 133 CASES OF CHRONIC PROSTATITIS BY SEMINAL CONSOLIDATION AND TURBIDITY EXCRETION

The authors adopted the method of seminal con-solidation and turbidity excretion in a specific pre-scription with modifications according to symptomsfor the treatment of 133 cases of chronic prostatitis.The average therapeutic course was 95 days with acure rate of 69.1% and a total effective rate of 96.2%.This prescription relieved obstruction in the prostaticducts and promoted excretion of stagnant secretions,thus alleviating the clinical symptoms.Tests of serumand prostatic fluid,and prostatic fluid culture sug-gested that,besides direct bacteriostatic andbacteriocidal effects,the prescription also strengthen-ed or regulated local immunological functions.

TREATMENT OF CHRONIC PROSTATITIS WITH LASER ACUPUNCTURE

A new model of He--Ne laseracupuncture therapeutic instrument wasused in the treatment of 122 cases of chronicprostatitis. A specially designed laserphotofiber needle conducted laser energy tothe appropriate depth of the acupoints fordirect stimulation. The combined effects

CLINICAL RESEARCH ON TREATMENT OF CHRONIC PROSTATITIS WITH ACUPUNCTURE

In the present study, the authors put forward that Zhibian(BL 54) and Sanyin-jiao(SP 6) are the effective acupoints for treatment of chronic prostatitis and possess an unique cura-tive effect in treatment of this disease with the type of deficiency of both the spleen and the kidney. Atotal effective rate was 92% in group of 1OO cases treated with acupuncture and comparison betweenpre- and post-treatment in examinations of prostatic fluid and other 6 items showed, significantly bet-ter than that of oral compound Sinohan(P【0. 01 ).

Comment on“Treatment of chronic prostatitis in Chinese men”by Liang CZ et al.in Asian Journal of Andrology

The manuscript by Liang et al.[1]entitled Treatment of chronic prostatitis in Chinese men appears to be an important and comprehensive analysis of the issue of chronic prostatitis(CP)as well as treatment avenues that are pursued within a Chinese population.The analyses of more than 12000 men confirm other studies[2]which demonstrate that CP represents a large problem in adult male populations.Even the numbers that are seen in urology clinics may under represent the true magnitude of these symptom profiles that are observed.This study also confirms the fact that antibiotics,as commonly used,do not seem to have much efficacy within this group.

Prediction of the mechanism of prostate prescription Ⅰ in the treatment of chronic prostatitis based on integrative pharmacology of traditional Chinese medicine

Objective:To investigate potential mechanism of Prostate prescriptionⅠin the treatment of chronic prostatitis based on integrated pharmacology.Methods:with the help of TCMIP,the effective compounds of Prostate prescriptionⅠwere screened,and the potential target database of Prostate prescriptionⅠwas established by using the target prediction function of TCMIP.Based on the Human Phenotype Ontology database and protein interaction network(PPI)database,the disease target of CP was identified and the target interaction network was constructed;Through the GO function analysis and KEGG pathway enrichment analysis of the candidate targets,combined with Chinese and foreign literature studies to predict the potential Signaling pathway of Prostate prescriptionⅠin the treatment of CP.Results:79 effective compounds of Prostate prescriptionⅠexerted its effect on 33 targets through 11 pathways.Conclusion:Clinical efficacy of Prostate prescriptionⅠon CP may be reflected in antiinflammation and anti-tumor,cell metabolism,immune regulation,neuroregulation and so on.

Midline Prostatic Cysts Presenting with Chronic Prostatitis or Secondary Infertility and Minimally Invasive Treatment: Endoscopic or Laparoscopic Approach?

Backgrounds: Surgical interventions especially minimally invasive treatments are recommended for symptomatic midline prostatic cysts. The endoscopic unroofing of cysts close to urethra is easy and simple, but it has little effect on the large cysts and cysts lying deeply, in contrast with the laparoscopic approach. Therefore, the selection of minimally invasive therapeutic approaches is important. The aim of this study is to describe our experience in the diagnosis and selection of minimally invasive treatment for midline prostatic cyst. Methods: 15 cases of midline prostatic cyst were studied.10 cases presented with prostatitis-like symptoms, 1 with dysuria and acute urinary retention, 3 with secondary infertility and the rest 1 with hemospermia. 6 patients presented with small cysts (≤2 cm × 2 cm) close to urethra and underwent transurethral unroofing. The other 9 patients with large cysts (>2 cm × 2 cm) or cysts lying closely behind the prostate received the laparoscopic excision. Results: The average duration of transurethral unroofing and laparoscopic excision was 39 mins and 118 mins respectively, whereas the average time of hospitalization was 2.7 days and 4.5 days respectively. After a follow-up of 21 months, all cases were treated successfully without complications and recurrence. Their prostatitis-like symptoms disappeared, and the three patients presented with secondary infertility achieved conception within one year after the operation. Conclusions: A midline prostatic cyst can present with chronic prostatitis-like symptoms and secondary infertility. It can be cured by minimally invasive treatments, but these procedures should be carefully selected according to the size and location of the cyst.

Study on the Mechanism of Angelica sinensis-Phellodendri Chinensis Cortex in the Treatment of Chronic Prostatitis Based on Network Pharmacology

[Objectives]To explore the mechanism of Angelica sinensis-Phellodendri Chinensis Cortex in the treatment of chronic prostatitis(CP)based on the method of network pharmacology.[Methods]The active components and action targets of Angelica sinensis-Phellodendri Chinensis Cortex were screened by(TCMSP),a systematic pharmacological analysis platform of traditional Chinese medicine,combined with literature search.The target was corrected by Uniprot database,and the disease CP target was screened by GeneCards and OMIM database.The common targets of drugs and diseases were screened by R language software,and the visual network map of drugs-active components-targets-diseases was constructed by Cytoscape 3.5.1 software.The common target protein-protein interaction(PPI)network was constructed by using STRING platform.The R language software was used to annotate and analyze the gene function and pathway of the core target through geneontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG).[Results]46 active components of Angelica sinensis-Phellodendri Chinensis Cortex were screened,and 212 related targets were predicted,of which 159 were related to disease.These targets were mainly involved in biological processes such as heterologous biological stimulation,oxidation and anti-oxidation,and were mainly concentrated in PI3K-Akt,mitogen-activated protein kinase(MAPK),hypoxia inducible factor-1(HIF-1)and other related signaling pathways.[Conclusions]The multi-component,multi-target and multi-pathway action characteristics of Angelica sinensis-Phellodendri Chinensis Cortex were confirmed by network pharmacology,and the possible mechanism of Angelica sinensis-Phellodendri Chinensis Cortex in the treatment of CP was predicted,which provided a theoretical basis for further experiments to verify its action mechanism.

Urine chemokine levels correlate with treatment response to phosphodiesterase 4 inhibitor in prostatitis

AIM To investigate the association of urinary chemokines with the treatment response in chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS) patients.METHODS Between 2007-2011,18 out of 21 male CP/CPPS patients met the exclusion/inclusion criteria of the 16 wk longitudinal study on twice daily oral treatment with Phosphodiesterase 4 inhibitor called Apremilast for 12 wk. Symptom scores and urine specimen were collected at baseline and every visit at 4 wk interval from CP/CPPS patients who completed at least 8 wk of drug treatment. Urine collected at each visit was frozen and then analyzed together after thawing for chemokines and growth factors using MILLIPLEX? MAP immunoassay. Cross sectional association of Chronic Prostatitis Symptom Index(CPSI) and visual analog scale(VAS) with chemokine levels in urine collected at baseline was assessed in 18 CP/CPPS patients relative to 10 asymptomatic male subjects. Longitudinal association between urine chemokine levels and symptom scores was assessed in 8 treatmentadherent CP/CPPS patients at baseline and at 4,8,12 and 16 wk.RESULTS Urine chemokines levels of CXCL-1(GRO-a),CXCL-8(IL-8),CXCL-10(IP-10) and CCL5(RANTES) in CP/CPPS patients at baseline were significantly elevated relative to asymptomatic subjects,whereas levels of s IL-1RA in CP/CPPS were significantly lower compared to controls(P <0.05). Quantitatively,urine levels of CXCL-10 were higher than other chemokines in CP/CPPS,but its fold change of5 relative to controls was lower than the 20 fold change noted for CXCL-8. The mean age of enrolled patients who completed at least 8 wk of treatment(n = 8) was 46.5± 9.4 years and analysis found that elevation of CXCL-8and CCL5 increased the odds for higher score of CPSI by54% and 25%,respectively(F test,P = 0.00007). Urine levels of CCL2(MCP-1) and CXCL-10 together explained approximately 85% of variance in longitudinal data on multivariate analysis. Bivariate analysis of 5 patients who fully complied and completed the assigned dose regimen,showed strong linear correlation of reduced urine levels of CXCL-10,CXCL-8,CCL5,CCL2 and PDGF with improvement in clinical activity as measured by pain VAS and CPSI(Pearson r = 0.83-0.97; P < 0.05).CONCLUSION Urine levels of CXCL-10,CCL2 and PDGF can be sensitive,objective and non-invasive markers of response to new therapeutic intervention in CP/CPPS patients.

MICROSTRIP APPLICATOR FOR TREATMENT OF PROSTATITIS AND HYPERTROPHY OF PROSTATE VIA RECTUM

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