UPDATE - Issue 23 - Autumn 2005
Inflammation of the Prostate
by Roger Kirby
Prostatitis, literally inflammation of the prostate, has long been a Cinderella subject. Compared with its two ugly sisters, prostate cancer and benign prostatic hyperplasia (BPH), very little serious research attention has been paid to the inflammatory disorder, the third most prevalent condition to affect the prostate gland. Now at last, things are beginning to change.
Prostatitis may be present without symptoms, or may result in discomfort in the perineum and groin areas together with frequency of urination and pain on ejaculation. In some cases the condition is due to a bacterial infection with an organism such as E coli, in which case it will usually respond to a prolonged course (often 6 weeks) of antibiotics, the most commonly used of which is ciprofloxacin. If an infecting organism is present it should be possible to confirm this by sending a urine specimen to the laboratory for culture immediately after performing a massage of the prostate. If the cultures come back negative, as is often the case, a diagnosis of abacterial (literally 'no bacteria') prostatitis is made and treatment is started with an anti-inflammatory medicine such as Brufen or Voltarol, although many urologists add in ciprofloxacin for good measure whatever the cultures reveal.
chronic inflammation leads to cancer
So what is the cause of this mysterious inflammatory condition from which it is so difficult to identify an infecting organism? Some years ago we performed some experiments to show that in some patients urine has a tendency to pass backwards up the prostatic ducts into the prostate at the time of urination. This phenomenon may account for the high prevalence of inflammation in the gland and also for the marked tendency for stones to form within the gland. These so-called calculi are in their own right a source of further inflammation and infection.
Recent studies suggest that the presence of inflammation within the prostate may not be such an innocent finding after all. This year Dr Claus Roehrborn reported that a subset of 1197 patients from the (MTOPS) study, 544, almost half, were found to have evidence of inflammation on biopsy. Those with inflammation present were four times more likely (2.4% vs 0.6%) to develop acute urinary retention (complete inability to urinate) than those without inflammation and also seemed to have a greater tendency to suffer deterioration of their BPH symptoms.
Chronic inflammation in various parts of the body has also long been been known to result in the development of cancer. Sir Percival Potts famously linked the development of scrotal cancer to the occupation of chimney sweep. This was back in the days when young men had to actually clamber up the chimney with the result that a great deal of soot found its way into their underpants! This summer the American Urological Association held a symposium on inflammation of the prostate chaired by Dr William Nelson and Robert Getzenberg. One of the conclusions from this meeting was that some of the molecules released by the inflammatory cells within the prostate clearly have the potential to stimulate the development of cancer. This of course raises the intriguing possibility that therapy with an anti-inflammatory agent, particularly one of the new COX 2 inhibitors, might be preventative against prostate cancer. Long-term studies will be needed to confirm or refute this.
At last the mysteries of prostatic inflammation are beginning to be unravelled, but much more needs to be done before we have a clearer understanding of the causes and effects of prostatitis, and before we can effectively treat it. In the meantime much research work, supported by the Prostate Research Campaign UK and other funding bodies, continues to be focussed on stopping prostate diseases ruining so many peoples' lives.