JC Lee,1 CH Muller,1 I Rothman,1 D Eshenbach,3 C Agnew,3, JN Krieger,1 J Turner,2 M Ciol,4 MS Frest,1 RE Berger1
Departments of Urology, 2Psychiatry and Behavioral
Sciences, 30bstetrics and Gynecology, and 4Health Services, University of Washington, Seattle, WA
Introduction The presence of white blood cells (WBCs) in the expressed prostatic secretions (EPS) of men
with category Illa Chronic Pelvic Pain syndrome (CPPS) has led investigators to seek an infectious etiology for this syndrome. Previous reports have identified bacteria in the prostate of men with idiopathic prostatic
inflammation. It is unknown whether bacteria exist in prostates of men without CPPS.
Methods Study methods and design were approved by the University's internal review board. Men with CPPS types Illa and Illb
(N=84) and controls (N=49) underwent standard four glass urine and transperineal, digitally guided prostate biopsies. Tissue was cultured for aerobes, anaerobes, trichomonas, chlamydia, and herpes simplex virus (HSV).
Results Positive prostate biopsy cultures were obtained in both patients and controls. Bacteria were found in 39/84 (46%) pain patients and 14/49 (29%) controls (p=0.04). One prostate biopsy culture from a
patient with pain grew HSV, while one culture from a control grew chlamydia trachomatis. CPPS men and controls did not differ significantly in the number of WBCs in their EPS (p=0.74 Mann-Whitney U). Pain patients with
>500 WBC/mm3 in EPS were more likely than those with <500 to have positive cultures (65% vs. 25%; p<O.01). No association between WBC in EPS and positive cultures was seen in the controls. WBCs in EPS were also
associated with positive coagulase negative staphylococcus (p=0.03) and positive anaerobic cultures (p=0.04) in pain patients but not controls. The type of bacteria grown in post-prostate massage urine was not related
to that found in prostatic biopsy cultures.
Conclusions Bacteria are more common in the prostate biopsies of men with CPPS than controls. The types of bacteria found in post-massage urine did not correspond to
that cultured from prostate biopsy cultures. Patients with category Illa CPPS were more likely to have bacteria in prostate biopsy cultures than those with category Illb. No relationship was found between inflammation
of EPS and bacteria in the prostate biopsy cultures of controls.
(Supported by the Paul G Allen Foundation for Medical Research)