Current Urology Reports

, Volume 4, Issue 4, pp 327–334 | Cite as

Prostatitis versus pelvic pain syndrome: Immunologic studies

  • Caroline Maake
  • Hubert John
Article

Abstract

The pathogenesis of chronic pelvic pain syndrome continues to be an enigma. The observation of inflammatory cells in urine, ejaculate, prostate fluid, and prostate tissue combined with changed local expressions of cytokines, immunoglobulins, complement, and other inflammatory markers led to the hypothesis of an involvement of the immune system in this clinical entity. This review presents a survey of the immunology-related data available for chronic pelvic pain syndrome and attempts to explain them in the context of causes and consequences.

Keywords

Benign Prostatic Hyperplasia Prostatitis Seminal Plasma Chronic Prostatitis Pelvic Pain Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References and Recommended Reading

  1. 1.
    Krieger JN, Nyberg L Jr, Nickel JC: NIH consensus definition and classification of prostatitis. JAMA 1999, 282:236–237. This paper provides the basics of the prostatitis classification system that is used.PubMedCrossRefGoogle Scholar
  2. 2.
    True LD, Berger RE, Rothman I, et al.: Prostate histopathology and the chronic prostatitis/chronic pelvic pain syndrome: a prospective biopsy study. J Urol 1999, 162:2014–2018.PubMedCrossRefGoogle Scholar
  3. 3.
    Doble A, Walker MM, Harris JR, et al.: Intraprostatic antibody deposition in chronic abacterial prostatitis. Br J Urol 1990, 65:598–605.PubMedGoogle Scholar
  4. 4.
    John H, Barghorn A, Funke G, et al.: Noninflammatory chronic pelvic pain syndrome: immunological study in blood, ejaculate and prostate tissue. Eur Urol 2001, 39:72–78.PubMedCrossRefGoogle Scholar
  5. 5.
    Ludwig M, Steltz C, Huwe P, et al.: Immunocytological analysis of leukocyte subpopulations in urine specimens before and after prostatic massage. Eur Urol 2001, 39:277–282.PubMedCrossRefGoogle Scholar
  6. 6.
    Anderson RU, Weller C: Prostatic secretion leukocyte studies in non-bacterial prostatitis (prostatosis). J Urol 1979, 121:292–294.PubMedGoogle Scholar
  7. 7.
    Nishimura T, Kanamori S, Akimoto M, Kawai H: Macrophages in prostatic fluid. Br J Urol 1980, 52:381–385.PubMedGoogle Scholar
  8. 8.
    Doble A, Walker MM, Witherow RO, et al.: The immunopathology of chronic pelvic pain syndrome: type IIIa. www. prostatitis.org/a242000.html 2002. Accessed June, 2003.Google Scholar
  9. 9.
    Alexander RB, Ponniah S, Hasday J, Hebel JR: Elevated levels of proinflammatory cytokines in the semen of patients with chronic prostatitis/chronic pelvic pain syndrome. Urology 1998, 52:744–749.PubMedCrossRefGoogle Scholar
  10. 10.
    Orhan I, Onur R, Ilhan N, Ardicoglu A: Seminal plasma cytokine levels in the diagnosis of chronic pelvic pain syndrome. Int J Urol 2001, 8:495–499.PubMedCrossRefGoogle Scholar
  11. 11.
    Nadler RB, Koch AE, Calhoun EA, et al.: IL-1beta and TNFalpha in prostatic secretions are indicators in the evaluation of men with chronic prostatitis. J Urol 2000, 164:214–218.PubMedCrossRefGoogle Scholar
  12. 12.
    Nishimura T, Abe H, Ito H, et al.: IL-1ra versus IL-1 levels in prostatic fluid from prostatitis patients. Urol Int 1998, 60:92–96.PubMedCrossRefGoogle Scholar
  13. 13.
    Drachenberg DE, Elgamal AA, Rowbotham R, et al.: Circulating levels of interleukin-6 in patients with hormone refractory prostate cancer. Prostate 1999, 41:127–133.PubMedCrossRefGoogle Scholar
  14. 14.
    Hochreiter WW, Nadler RB, Koch AE, et al.: Evaluation of the cytokines interleukin 8 and epithelial neutrophil activating peptide 78 as indicators of inflammation in prostatic secretions. Urology 2000, 56:1025–1029.PubMedCrossRefGoogle Scholar
  15. 15.
    Miller LJ, Fischer KA, Goralnick SJ, et al.: Interleukin-10 levels in seminal plasma: implications for chronic prostatitischronic pelvic pain syndrome. J Urol 2002, 167:753–756.PubMedCrossRefGoogle Scholar
  16. 16.
    Ludwig M, Kummel C, Schroeder-Printzen I, et al.: Evaluation of seminal plasma parameters in patients with chronic prostatitis or leukocytospermia. Andrologia 1998, 30:41–47.PubMedCrossRefGoogle Scholar
  17. 17.
    Pasqualotto FF, Sharma RK, Potts JM, et al.: Seminal oxidative stress in patients with chronic prostatitis. Urology 2000, 55:881–885.PubMedCrossRefGoogle Scholar
  18. 18.
    Shahed AR, Shoskes DA: Oxidative stress in prostatic fluid of patients with chronic pelvic pain syndrome: correlation with gram positive bacterial growth and treatment response. J Androl 2000, 21:669–675.PubMedGoogle Scholar
  19. 19.
    Shortliffe LM, Wehner N: The characterization of bacterial and nonbacterial prostatitis by prostatic immunoglobulins. Medicine (Baltimore) 1986, 65:399–414.Google Scholar
  20. 20.
    Vinje O, Fryjordet A, Bruu AL, et al.: Laboratory findings in chronic prostatitis-with special reference to immunological and microbiological aspects. Scand J Urol Nephrol 1983, 17:291–297.PubMedCrossRefGoogle Scholar
  21. 21.
    Liu AY, True LD: Characterization of prostate cell types by CD cell surface molecules. Am J Pathol 2002, 160:37–43.PubMedGoogle Scholar
  22. 22.
    Theyer G, Kramer G, Assmann I, et al.: Phenotypic characterization of infiltrating leukocytes in benign prostatic hyperplasia. Lab Invest 1992, 66:96–107.PubMedGoogle Scholar
  23. 23.
    Twillie DA, Eisenberger MA, Carducci MA, et al.: Interleukin-6: a candidate mediator of human prostate cancer morbidity. Urology 1995, 45:542–549.PubMedCrossRefGoogle Scholar
  24. 24.
    Anim JT, Udo C, John B: Characterisation of inflammatory cells in benign prostatic hyperplasia. Acta Histochem 1998, 100:439–449.PubMedGoogle Scholar
  25. 25.
    Schatteman PH, Hoekx L, Wyndaele JJ, et al.: Inflammation in prostate biopsies of men without prostatic malignancy or clinical prostatitis: correlation with total serum PSA and PSA density. Eur Urol 2000, 37:404–412.PubMedCrossRefGoogle Scholar
  26. 26.
    Carver BS, Bozeman CB, Williams BJ, Venable DD: The prevalence of men with National Institutes of Health category IV prostatitis and association with serum prostate specific antigen. J Urol 2003, 169:589–591.PubMedCrossRefGoogle Scholar
  27. 27.
    Kramer G, Steiner GE, Handisurya A, et al.: Increased expression of lymphocyte-derived cytokines in benign hyperplastic prostate tissue, identification of the producing cell types, and effect of differentially expressed cytokines on stromal cell proliferation. Prostate 2002, 52:43–58.PubMedCrossRefGoogle Scholar
  28. 28.
    Steiner G, Gessl A, Kramer G, et al.: Phenotype and function of peripheral and prostatic lymphocytes in patients with benign prostatic hyperplasia. J Urol 1994, 151:480–484.PubMedGoogle Scholar
  29. 29.
    Handisurya A, Steiner GE, Stix U, et al.: Differential expression of interleukin-15, a pro-inflammatory cytokine and T-cell growth factor, and its receptor in human prostate. Prostate 2001, 49:251–262.PubMedCrossRefGoogle Scholar
  30. 30.
    Zisman A, Lindner A, Zisman E, et al.: Prostate-specific antigen induces proliferation of peripheral blood lymphocytes and cytokine secretion in benign prostate hypertrophy patients. Eur Urol 1999, 36:258–265.PubMedCrossRefGoogle Scholar
  31. 31.
    Sharpe JC, Abel PD, Gilbertson JA, et al.: Modulated expression of human leukocyte antigen class I and class II determinants in hyperplastic and malignant human prostatic epithelium. Br J Urol 1994, 74:609–616.PubMedGoogle Scholar
  32. 32.
    Naoe M, Marumoto Y, Ishizaki R, et al.: Correlation between major histocompatibility complex class I molecules and CD8+ T lymphocytes in prostate, and quantification of CD8 and interferon-gamma mRNA in prostate tissue specimens. BJU Int 2002, 90:748–753.PubMedCrossRefGoogle Scholar
  33. 33.
    Shoskes DA, Albakri Q, Thomas K, Cook D: Cytokine polymorphisms in men with chronic prostatitis/chronic pelvic pain syndrome: association with diagnosis and treatment response. J Urol 2002, 168:331–335.PubMedCrossRefGoogle Scholar
  34. 34.
    Krieger JO, Ross SU, Riley DO: Chronic prostatitis: epidemiology and role of infection. Urology 2002, 60:8–12.PubMedCrossRefGoogle Scholar
  35. 35.
    Lee JC, Muller CH, Rothman I, et al.: Prostate biopsy culture findings of men with chronic pelvic pain syndrome do not differ from those of healthy controls. J Urol 2003, 169:584–587.PubMedCrossRefGoogle Scholar
  36. 36.
    Kirby RS, Lowe D, Bultitude MI, Shuttleworth KE: Intra-prostatic urinary reflux: an aetiological factor in abacterial prostatitis. Br J Urol 1982, 54:729–731.PubMedCrossRefGoogle Scholar
  37. 37.
    Persson BE, Ronquist G: Evidence for a mechanistic association between nonbacterial prostatitis and levels of urate and creatinine in expressed prostatic secretion. J Urol 1996, 155:958–960.PubMedCrossRefGoogle Scholar
  38. 38.
    Lang MD, Nickel JC, Olson ME, et al.: Rat model of experimentally induced abacterial prostatitis. Prostate 2000, 45:201–206.PubMedCrossRefGoogle Scholar
  39. 39.
    Alexander RB, Brady F, Ponniah S: Autoimmune prostatitis: evidence of T cell reactivity with normal prostatic proteins. Urology 1997, 50:893–899.PubMedCrossRefGoogle Scholar
  40. 40.
    Batstone GR, Doble A, Gaston JS: Autoimmune T cell responses to seminal plasma in chronic pelvic pain syndrome (CPPS). Clin Exp Immunol 2002, 128:302–307.PubMedCrossRefGoogle Scholar
  41. 41.
    Trammell R, Jewett T, Neal DE, et al.: Identification of hightiter autoantibodies to prostate-associate antigens in some patients with chronic abacterial prostatitis. www.prostatitis.org/a282000.html 2002. Accessed June, 2003.Google Scholar
  42. 42.
    Ponniah S, Arah I, Alexander RB: PSA is a candidate self-antigen in autoimmune chronic prostatitis/chronic pelvic pain syndrome. Prostate 2000, 44:49–54.PubMedCrossRefGoogle Scholar
  43. 43.
    Havranek EG, Whelan MA, Greenhalgh R, et al.: Advances in prostate cancer immunotherapy. Surg Oncol 2002, 11:35–45.PubMedCrossRefGoogle Scholar
  44. 44.
    Zisman A, Zisman E, Lindner A, et al.: Autoantibodies to prostate specific antigen in patients with benign prostatic hyperplasia. J Urol 1995, 154:1052–1055.PubMedCrossRefGoogle Scholar
  45. 45.
    Riley DE, Krieger JN: X Chromosomal short tandem repeat polymorphisms near the phosphoglycerate kinase gene in men with chronic prostatitis. Biochim Biophys Acta 2002, 1586:99–107.PubMedGoogle Scholar
  46. 46.
    Roberts RO, Lieber MM, Rhodes T, et al.: Prevalence of a physician-assigned diagnosis of prostatitis: the Olmsted County Study of Urinary Symptoms and Health Status Among Men. Urology 1998, 51:578–584.PubMedCrossRefGoogle Scholar
  47. 47.
    Batstone R, Doble A: The results of an auto-immune screen in patients with types IIIa and IIIb prostatitis. www.prostatitis.org/a182000.html 2002. Accessed June, 2003.Google Scholar
  48. 48.
    Schaeffer AJ, Landis JR, Knauss JS, et al.: Demographic and clinical characteristics of men with chronic prostatitis: the National Institutes of Health Chronic Prostatitis Cohort Study. J Urol 2002, 168:593–598.PubMedCrossRefGoogle Scholar
  49. 49.
    Pacheco-Rupil B, Depiante-Depaoli M, Casadio B: Experimental autoimmune damage to rat male accessory glands. II: T cell requirement in adoptive transfer of specific tissue damage. Am J Reprod Immunol 1984, 5:15–19.PubMedGoogle Scholar
  50. 50.
    Rivero VE, Iribarren P, Riera CM: Mast cells in accessory glands of experimentally induced prostatitis in male Wistar rats. Clin Immunol Immunopathol 1995, 74:236–242.PubMedCrossRefGoogle Scholar
  51. 51.
    Maccioni M, Rivero V, Riera CM: Autoantibodies against rat prostate antigens: association of specific IGG2b and IGG2c with the DTH response. J Autoimmun 1996, 9:485–491.PubMedCrossRefGoogle Scholar
  52. 52.
    Orsilles MA, Depiante-Depaoli M: Oxidative stress-related parameters in prostate of rats with experimental autoimmune prostatitis. Prostate 1998, 34:270–274.PubMedCrossRefGoogle Scholar
  53. 53.
    Depiante-Depaoli M, Pacheco-Rupil B, Britos S, Casas A: Experimental autoimmune damage to rat male accessory glands. I: transfer of autoimmune response by spleen cells. Am J Reprod Immunol 1984, 5:9–14.PubMedGoogle Scholar
  54. 54.
    Iribarren P, Correa SG, Riera CM: Characterization of an immunoregulatory cell subset involved in the up-regulation of the autoimmune response to rat male accessory glands. Am J Reprod Immunol 1993, 30:239–245.PubMedGoogle Scholar
  55. 55.
    Pistoresi-Palencia MC, Galmarini M, Vottero-Cima E: Participation of different cellular types in the enhancement of autoimmune response of old animals to sex accessory glands in male rats: importance of macrophages. J Reprod Immunol 1988, 14:257–265.PubMedCrossRefGoogle Scholar
  56. 56.
    Correa SG, Riera CM, Iribarren P: Involvement of peritoneal dendritic cells in the induction of autoimmune prostatitis. J Autoimmun 1997, 10:107–113.PubMedCrossRefGoogle Scholar
  57. 57.
    Donadio AC, Gagliano H, Remedi MM, et al.: Time-course study of cellular immune response and testosterone metabolism in an autoimmune model for chronic prostatic inflammation. J Urol 1998, 160:1546–1550.PubMedCrossRefGoogle Scholar
  58. 58.
    Liu KJ, Chatta GS, Twardzik DR, et al.: Identification of rat prostatic steroid-binding protein as a target antigen of experimental autoimmune prostatitis: implications for prostate cancer therapy. J Immunol 1997, 159:472–480.PubMedGoogle Scholar
  59. 59.
    Maccioni M, Rivero VE, Riera CM: Prostatein (or rat prostatic steroid binding protein) is a major autoantigen in experimental autoimmune prostatitis. Clin Exp Immunol 1998, 112:159–165.PubMedCrossRefGoogle Scholar
  60. 60.
    Rivero V, Carnaud C, Riera CM: Prostatein or steroid binding protein (PSBP) induces experimental autoimmune prostatitis (EAP) in NOD mice. Clin Immunol 2002, 105:176–184.PubMedCrossRefGoogle Scholar
  61. 61.
    Casas-Ingaramo A, Depiante-Depaoli M, Pacheco-Rupil B: Activation of cytotoxic cells by syngeneic prostate antigens in experimental autoimmune vesiculo-prostatitis. Autoimmunity 1991, 9:151–157.PubMedCrossRefGoogle Scholar
  62. 62.
    Bach JF: Protective role of infections and vaccinations on autoimmune diseases. J Autoimmun 2001, 16:347–353.PubMedCrossRefGoogle Scholar
  63. 63.
    Gatenbeck L, Aronsson A, Dahlgren S, et al.: Stress stimuliinduced histopathological changes in the prostate: an experimental study in the rat. Prostate 1987, 11:69–76.PubMedCrossRefGoogle Scholar
  64. 64.
    Robinette CL: Sex-hormone-induced inflammation and fibromuscular proliferation in the rat lateral prostate. Prostate 1988, 12:271–286.PubMedCrossRefGoogle Scholar
  65. 65.
    Seethalakshmi L, Bala RS, Malhotra RK, et al.: 17 beta-estradiol induced prostatitis in the rat is an autoimmune disease. J Urol 1996, 156:1838–1842.PubMedCrossRefGoogle Scholar
  66. 66.
    Naslund MJ, Strandberg JD, Coffey DS: The role of androgens and estrogens in the pathogenesis of experimental nonbacterial prostatitis. J Urol 1988, 140:1049–1053.PubMedGoogle Scholar
  67. 67.
    Harris MT, Feldberg RS, Lau KM, et al.: Expression of proinflammatory genes during estrogen-induced inflammation of the rat prostate. Prostate 2000, 44:19–25.PubMedCrossRefGoogle Scholar
  68. 68.
    Moron G, Maletto B, Ropolo A, Pistoresi-Palencia MC: Changes in the development of experimental autoimmune prostatitis (EAP) by castration in aged rats. Dev Comp Immunol 2000, 24:673–682.PubMedCrossRefGoogle Scholar
  69. 69.
    Vottero-Cima E, Galmarini M, Pesoa S, et al.: Humoral autoimmune response to rat male accessory glands: effect of castration on the humoral response. Int Arch Allergy Appl Immunol 1984, 75:203–207.PubMedGoogle Scholar
  70. 70.
    Tangbanluekal L, Robinette CL: Prolactin mediates estradiolinduced inflammation in the lateral prostate of Wistar rats. Endocrinology 1993, 132:2407–2416.PubMedCrossRefGoogle Scholar
  71. 71.
    Miller LJ, Fischer KA, Goralnick SJ, et al.: Nerve growth factor and chronic prostatitis/chronic pelvic pain syndrome. Urology 2002, 59:603–608.PubMedCrossRefGoogle Scholar
  72. 72.
    Schaeffer AJ, Knauss JS, Landis JR, et al.: Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: the National Institutes of Health Chronic Prostatitis Cohort Study. J Urol 2002, 168:1048–1053.PubMedCrossRefGoogle Scholar
  73. 73.
    Nishimura T, Kanamori S, Yoshida K, et al.: Longitudinal study of macrophages in prostatic fluid from nonbacterial prostatitis patients. Urology 1981, 18:255–257.PubMedCrossRefGoogle Scholar
  74. 74.
    Krieger JN, Ross SO, Penson DF, Riley DE: Symptoms and inflammation in chronic prostatitis/chronic pelvic pain syndrome. Urology 2002, 60:959–963.PubMedCrossRefGoogle Scholar
  75. 75.
    Geiss A, Varadi E, Steinbach K, et al.: Psychoneuroimmunological correlates of persisting sciatic pain in patients who underwent discectomy. Neurosci Lett 1997, 237:65–68.PubMedCrossRefGoogle Scholar
  76. 76.
    Sachs D, Cunha FQ, Poole S, Ferreira SH: Tumour necrosis factor-α, interleukin-1beta and interleukin-8 induce persistent mechanical nociceptor hypersensitivity. Pain 2002, 96:89–97.PubMedCrossRefGoogle Scholar
  77. 77.
    Fukuoka H, Kawatani M, Hisamitsu T, Takeshige C: Cutaneous hyperalgesia induced by peripheral injection of interleukin-1 beta in the rat. Brain Res 1994, 657:133–140.PubMedCrossRefGoogle Scholar
  78. 78.
    Bauer HW, Bach D: Prostaglandin E2 in prostatitis and prostatic adenoma. Urol Int 1986, 41:139–144.PubMedGoogle Scholar
  79. 79.
    Vale ML, Marques JB, Moreira CA, et al.: Antinociceptive effects of interleukin-4, -10, and -13 on the writhing response in mice and zymosan-induced knee joint incapacitation in rats. J Pharmacol Exp Ther 2003, 304:102–108.PubMedCrossRefGoogle Scholar
  80. 80.
    Jarow JP, Kirkland JA, Jr, Assimos DG: Association of antisperm antibodies with chronic nonbacterial prostatitis. Urology 1990, 36:154–156.PubMedCrossRefGoogle Scholar
  81. 81.
    Leib Z, Bartoov B, Eltes F, Servadio C: Reduced semen quality caused by chronic abacterial prostatitis: an enigma or reality? Fertil Steril 1994, 61:1109–1116.PubMedGoogle Scholar
  82. 82.
    Engeler D, John H, Hauri D: Prostatitis NIH IIIb (prostadynia) and fertility. Br J Urol 2002, 90 (suppl 2):25.Google Scholar
  83. 83.
    Sharma RK, Pasqualotto FF, Nelson DR, et al.: The reactive oxygen species-total antioxidant capacity score is a new measure of oxidative stress to predict male infertility. Hum Reprod 1999, 14:2801–2807.PubMedCrossRefGoogle Scholar
  84. 84.
    Schoor RA: Prostatitis and male infertility: evidence and links. Curr Urol Rep 2002, 3:324–329.PubMedCrossRefGoogle Scholar
  85. 85.
    Bogolyubov VM, Karpukhin IV, Bobkova AS, et al.: Dynamics of spermatogenesis, hormonal and immune response of patients suffering from chronic prostatitis and sterility under bitemporal treatment with an ultra-high frequency electric field. Int Urol Nephrol 1986, 18:89–97.PubMedCrossRefGoogle Scholar
  86. 86.
    Ludwig M, Vidal A, Diemer T, et al.: Seminal secretory capacity of the male accessory sex glands in chronic pelvic pain syndrome (CPPS)/chronic prostatitis with special focus on the new prostatitis classification. Eur Urol 2002, 42:24–28.PubMedCrossRefGoogle Scholar
  87. 87.
    Brawn PN, Speights VO, Kuhl D, et al.: Prostate-specific antigen levels from completely sectioned, clinically benign, whole prostates. Cancer 1991, 68:1592–1599.PubMedCrossRefGoogle Scholar
  88. 88.
    Hasui Y, Marutsuka K, Asada Y, et al.: Relationship between serum prostate specific antigen and histological prostatitis in patients with benign prostatic hyperplasia. Prostate 1994, 25:91–96.PubMedCrossRefGoogle Scholar
  89. 89.
    Nadler RB, Humphrey PA, Smith DS, et al.: Effect of inflammation and benign prostatic hyperplasia on elevated serum prostate specific antigen levels. J Urol 1995, 154:407–413.PubMedCrossRefGoogle Scholar
  90. 90.
    Litwin MS, McNaughton-Collins M, Fowler FJ Jr, et al.: The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network. J Urol 1999, 162:369–375. This proposed index constitutes an important step toward a systematic evaluation of prostatitis symptoms.PubMedCrossRefGoogle Scholar
  91. 91.
    Nickel JC, True LD, Krieger JN, et al.: Consensus development of a histopathological classification system for chronic prostatic inflammation. BJU Int 2001, 87:797–805.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • Caroline Maake
    • 1
  • Hubert John
  1. 1.Institute of AnatomyUniversity of ZurichZurichSwitzerland

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