Prostatitis Center
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Tucson, Arizona
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Understanding Diagnosis |
| Diagnosis in prostatitis is difficult for all physicians, especially those who are not backed by microbiologists and pathologists specifically trained for this condition. Fortunately, at The Prostatitis Center, we have developed a great deal of knowledge about diagnosing prostatitis. |
| Many physicians will obtain a sample of "Expressed Prostatic Secretion", the fluid that can (sometimes) be forced out of your prostate gland by the doctor's gloved finger, and send that off to the lab. However, most labs don't know what to look for and don't use proper culture techniques. Or, quite frequently, the doctor cannot extract ANY fluid upon which to do lab work! The result in any case is often a diagnosis of "non-bacterial prostatitis," "Category III CPPS" or "prostatodynia." |
| The following two articles, while somewhat technical, give an idea of how we diagnose prostatitis here in Tucson. (You can find definitions of technical terms in Blue by holding your cursor over the word.) |
Serial Cytopathologic Examinations Of Expressed Prostatic Secretions From Patients With Chronic Prostatitis |
| John W. Polacheck, Tucson, AZ, L. Eduardo Vega, Tucson, AZ |
| Introduction and Objectives: |
| In order to learn more about the patho-physiology of chronic prostatitis, we examined the cytopathology of expressed prostatic secretions (EPS) from patients with chronic prostatitis. |
| Methods: |
| EPS was obtained by digital rectal massage, which was done at each outpatient visit. The EPS fluid was placed onto two microscope slides, air-dried and then stained with a modified Wright's stain and a PAS stain. The slides were then examined microscopically by a pathologist experienced with EPS. We were looking for signs of inflammation. Most commonly, we observed acute inflammatory changes (AIC): an exudate with numerous polymorphonuclear (PMN) leukocytes and also aggregates of PMNs which we call prostatic inflammatory aggregates (PIAs). |
| If such findings of inflammation were not observed, a repeat EPS from a subsequent outpatient visit was similarly examined. |
| Results: |
| We would like to report our findings from 25 consecutive patients: in 12 (48%) patients we observed AIC in the EPS obtained from the first, second or third massage; 7 (28%) patients had AIC in the EPS obtained only later, from the 4th to 13th massage; 6 (24%) patients never showed AIC. |
| Conclusions: |
| We conclude that acute inflammatory changes, PMNs and PIAs, are common (76%) in the EPS from patients with chronic prostatitis. We also note that these signs of inflammation may not be present in the EPS obtained from the first outpatient massage, or even from the first few. Therefore, caution must be taken when classifying patients with symptoms and physical findings of chronic prostatitis. The laboratory findings may be misleading at the initial visit(s). |
A Histopathological Framework For Prostatitis |
| L. E. Vega and J. W. PolacheckCarondelet St. Joseph's Hospital and The Prostatitis Center: Tucson, AZ |
| Since prostate tissue from patients with prostatitis is rarely available for histopathologic examination, we decided to study surgically removed tissue consisting of total prostatectomy specimens, as a model to study prostatitis. In all cases, the prostate gland had been removed for carcinoma. |
| We also have studied tissue derived from transurethral resections of the prostate (TURPs) from patients with benign prostatic hypertrophy/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 periurethral, 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: - 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.
- 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 PMNs in 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. |
Contacts
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- Mail
- 1701 W. St. Mary's Rd.
- Suite 102
- Tucson, Arizona 85754
- USA
- E-mail:
- jpolacheck@attglobal.net
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- Phone :
- 520-622-4599
- Answering Service:
- 520-570-6011
- Fax:
- 520-903-9972
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