Prostatitis Center | ||
Tucson, Arizona | ||
The role of Fungi in Chronic Active Prostatitis | ||
Study by the Prostatitis Center |
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| Dates of project:August 1998 through July 1999 | John W. Polacheck, M.D. Medical Director Prostatitis Center P.O. Box 85699, Tucson, AZ, 85754 Telephone: 520-620-9909 FAX: 520-624-6888 E-mail:jpolacheck@ibm.net |
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| Long-term objectives:To learn more about the pathogenesis of chronic prostatitis in order that better treatment protocols can be developed. | ||
| Specific aims:The purpose of this study is to determine if fungi COMMONLY play a role in the pathogenesis of chronic prostatitis. The study is not designed to rule out if they can ever be involved, for example in unusual circumstances. | ||
| Background:There are two positions, diametrically opposed, which are held by both providers, who treat prostatitis patients, and by the patients themselves: | ||
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(1). Fungi DO play a major role in chronic prostatitis. |
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There are a great number of anecdotal reports and isolated references in the literature about fungi in patients with chronic prostatitis. However, almost every symptom known to man, at one time or another, has been attributed to yeast !!! Yet, a few of the reports from prostate patients seem quite credible. Moreover, the sheer number of these reports make it difficult to ignore the possibility that fungi could play a role. Unfortunately, there is little actual data. | |
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As examples, several patients have reported to me and/or to theProstatitis News Groupgreat relief in their symptoms when they follow an anti-fungal diet, very low both in sugar and low yeast. Furthermore, a few have reported a marked increase in their symptoms immediately after stopping the diet, or "challenging" themselves for a brief period with a high sugar intake. | |
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Dr. A. E. Feliciano, Jr.,has reported that an increase in white blood cells (WBC's) in expressed prostatic secretions (EPS) late in treatment of prostatitis is associated with yeast. This is usually after a course of antibiotic(s). On a few occasions he has seen yeast in microscopic examinations of EPS. Furthermore, treatment with an anti-fungal medication, most often Sporanox, has been observed to rapidly decrease the WBC's in the EPS of several of these patients along with an associated decrease in their symptoms. | |
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(2). Fungi DO NOT play a major role in chronic prostatitis. |
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There are theoretical reasons to believe that fungi do not play a major role in the pathogenesis of chronic prostatitis. Fungi have specific environments where they can live. In the absence of a severe immune deficiency state (such as AIDS or intensive chemotherapy, etc.), fungi do not live in deep tissues. For example, although yeast is a common component in the vaginal flora in healthy women, it is extremely rare to find it in the uterus, even though there is a "real" connection, the cervical os. Another example is that although fungi are frequently present on the external skin of the genitalia in healthy persons, it is extremely rare to find them in the deeper parts of the urinary system, even though there is a "real" connection, the urethra. | |
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Several series which have reported the frequency of various micro-organisms in patients with prostatits either have reported no fungal isolates, or, at most, a very rare fungal isolate. | |
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Numerous pathology reports fail to report fungi in prostate specimens, and pathologists in the United States examine thousands of prostate specimens each month. It should be noted that prostatitis, pathologically, is common in surgical specimens. Because yeast are not difficult to identify microscopically, if they were indeed present in a significant number of cases, it is quite probable that they would have been reported. | |
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Supporting this, in a preliminary study, we screened for fungi over 50 surgical specimens of the prostate in which pathological evidence of prostatitis was present. Not one fungus was found. However, special fungal stains, which are more sensitive, were not used. | |
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Also, in another preliminary study, a Gram stain of EPS samples from over 100 patients with prostatitis did not reveal any fungi. However, special fungal stains, which are more sensitive than gram stain, were not used. | |
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In still another preliminary study, we have used a more sensitive microscopic cytological examination of the EPS to search for fungi in over 30 samples of EPS. Not one fungus was found. Again, special fungal stains, which are more sensitive, were not used. | |
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Furthermore, we reviewed over 100 EPS cultures from prostatitis patients. The culture methods utilized easily isolates the common fungi, including monilia, if they are present. Not one fungus was isolated. Again, special fungal culture methods, which are more sensitive, were not used. | |
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Finally, in yet another preliminary study, we did use special fungal methods to culture the EPS in about 12 cases. Again, not one fungus was isolated. | |
Research Design and Methods: |
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| We have a great deal of evidence from our Prostatitis Center, presented above, that fungi do not play a major role in the pathogenesis of Chronic Active Prostatitis. However, much of that evidence was collected using methods which were not designed specifically for fungi, and therefore are less sensitive. Therefore, we propose to search for fungi using methods which are designed specifically for fungi, and which, therefore, are more sensitive their detection. | ||
| Fungi in the setting of prostatitis will be looked for in the three following areas: | ||
| (1). The EPS from prostatitis patients attending the Prostatitis Center will be checked for fungi using methods specially designed to culture and identify the vast majority of fungi known to cause disease in humans. Each sample will also have a smear examined microscopically for the presence of fungi. These samples of EPS, collected on sterile transport swabs, will be processed by the Clinical Fungal Laboratory at Carondelet St. Joseph's Hospital, a laboratory with vast experience with fungi of medical importance. There will be no charge to the patients. About 100 EPS samples will be checked. Most will be from patients early in their stay at the Prostatitis Center, before they have received any antibacterial therapy. Repeat samples of EPS will be checked if there is a clinical reason to suggest the possibility of a fungal overgrowth during antibiotic therapy. | ||
| (2). The EPS from prostatitis patients attending the Prostatitis Center will be checked for fungi using a method specially designed to facilitate the identification of fungi cytologically: silver staining. These samples of EPS, collected on slides and then air-dried, will be processed by the Pathology Department at Carondelet St. Joseph's Hospital. They will be examined and interpreted individually by Dr. L. Eduardo Vega, a pathologist with a vast clincal experience in the area of prostate pathology. There will be no charge to the patients. Again, about 100 EPS samples will be checked. Most will be from patients early in their stay at the Prostatitis Center, before they have received any antibacterial therapy. Repeat samples of EPS will be checked if there is a clinical reason to suggest the possibility of a fungal overgrowth during antibiotic therapy. | ||
| (3). Surgical samples of prostate from needle biopsies, TURP's and prostatestomies will be checked for fungi using a method specially designed to facilitate the identification of fungi histologically: silver staining. These tissue samples, fixed and embedded in paraffin, will be processed by the Pathology Department at Carondelet St. Joseph's Hospital. They, too, will be examined and interpreted individually by Dr. L. Eduardo Vega. There will be no charge to the patients. Again, about 100 EPS samples will be checked. Most will be from patients without any clinical history available. However, efforts will be made to obtain clinical information from these patients or from their surgeons (urologists), especially as it pertains to any previous symptoms compatible with the diagnosis of chronic active prostatitis. | ||
| The results will be tabulated and subject to statistical analysis, if appropriate. | ||
| References: | ||
| Ghormley, K.O., and Needham, G.M.: Chronic Prostatitis; a Urologic Quandary. J.A.M.A., 153: 915-918, 1953 | ||
| Hennenfent, B.R., Feliciano, A.E.: Clinical Remission of Chronic Refractory Pelvic Symptoms in Three Men. Digital Urology Journal, Article 4, 1998.http://www.duj.com/ | ||
| Meares Jr. E. M., and Stamey T. A.: Bacteriologic Localization Patterns in Bacterial Prostititis and Urethritis. Invest Urol., 5:492, 1968. | ||
| Weidner W., Schiefer H. G., Krauss H., Jantos C. H., Freidrich H.J., Altmannsberger M.: Chronic Prostatitisî; A Thorough Search for Etiologically Involved Microorganisms in 1,461 Patients. Infection 19(Suppl. 3): S119 - S125, 1991. | ||
Contacts |
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