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Third International Chronic Prostatitis Network

A histopathological framework for prostatitis


J.W. Polacheck and L.E. Vega,
Carondelet St. Joseph’s Hospital and The Prostatitis Center, Tucson, Arizona
Since prostate tissue from patients with prostatitis is rarely available for histopathologic examination, we decided to study surgically removed tissue, total prostatectomy specimens, as a model to study prostatitis. In all cases, the prostate gland was removed for carcinoma. We also have studied tissue derived from transurethral resections of the prostate (TURPs) from patients with benign prostatic hyper-trophy/ hyperplasia (BPH). However, in general, that tissue was less satisfactory because of the small amount of prostate tissue available. Also, tissue samples obtained from TURPs are generally peri-urethral, and only rarely is more peripheral tissue obtained, and the anatomical relationships can not be easily reconstructed.
In our study of total prostatectomies, we found areas of prostatitis in the great majority of cases. The relationship between the prostatitis and the carcinoma needs to be studied further. We observe two distinct patterns:
  1. Chronic inflammation of the interstitium/ stroma, consisting of small foci of inflammatory cells, predominately lymphocytes. This chronic interstitial inflammation is common and appears to be diffusely distributed.
  2. Acute inflammation within glands and ducts, consisting predominately of polymorphonuclear leukocytes (PMNs). This acute inflammation is less common than the chronic interstitial inflammation. It is focal, and usually found in the peripheral regions of the prostate gland. Frequently, acute inflammatory changes are also seen within the epithelium of glands. Only rarely is acute inflammation seen within the interstitium. Then, it is always associated with inflamed glands. We note that the PMNs within glands appear to be "organized": cohesive aggregates of PMNs with a protein matrix, at times admixed with corpora amylacea. The glands may be dilated and the aggregates of PMNs are generally larger in size than the diameter of the ducts which lead to the urethra. As we have previously reported, we find remarkably similar cohesive aggregates of PMNsin expressed prostatic secretions (EPS) from patients with prostatitis. We call these "prostatic inflammatory aggregates" (PIAs). At times PIAs are admixed with corpora amylacea supporting our premise that they are derived from inflamed glands within the prostate.
Further studies are needed to study the etiology of the inflammation, the interaction between the chronic and acute inflammation, and also the relationship to patients’ symptoms.
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