Category IV Prostatitis

J Dimitrakov · Post by **J Dimitrakov** » Thu Jan 09, 2003 9:17 pm

The Journal of Urology 2003; 169(2):589-591

The Prevalence of Men With National Institutes of Health Category IV Prostatitis and Association With Serum Prostate Specific Antigen
BRETT S. CARVER; CALEB B. BOZEMAN; B. J. WILLIAMS; DENNIS D. VENABLE
ABSTRACT
Purpose:
We evaluated the prevalence and relationship of serum prostate specific antigen (PSA) levels in a screening population of men diagnosed with National Institutes of Health (NIH) category IV prostatitis.

Materials and Methods:
In September of 2001, 300 men were randomly selected from our prostate cancer awareness screening program to be evaluated for NIH category IV prostatitis. After informed consent was obtained all patients completed the NIH prostate cancer awareness survey and had a serum sample obtained for PSA before examination. Expressed prostatic secretions were obtained from 227 of the 300 participants. Patients were classified according to findings on examination of the expressed prostatic secretions. The records were entered into our data base and subsequently reviewed.

Results:
The prevalence of NIH category IV prostatitis was 32.2% in our population of men. Patient age, American Urological Association symptom scores and clinical prostate gland size did not differ between men with or without evidence of prostatitis on expressed prostatic secretion examination. Men with NIH category IV prostatitis had a mean serum PSA level of 2.3 which was significantly higher (p <0.0004) than those without prostatitis (mean PSA 1.4).

Conclusions:
These data suggest that NIH category IV prostatitis is fairly prevalent (32.2%) among men in the general population who present for prostate cancer screening and appears to contribute to increased serum PSA levels in some men.

Key Words: prostatitis; prostate-specific antigen, mass screening; prostatic neoplasms; National Institutes of Health (U.S.)

Post by **webslave** » Thu Jan 09, 2003 9:23 pm

This study says that 1 in 3 men are walking around with no prostatitis/CPPS symptoms, but the PSA is slightly raised and they have WBCs in their EPS.

Hepcat · Post by **Hepcat** » Thu Jan 09, 2003 9:36 pm

If I understand correctly, assuming the sample represented a truly random sample of the population, 1/3 men have asymptomatic inflammatory prostatitis?

Holy cow!

Wonder how many of those eventually shift (back?) into the IIIA category?

Post by **webslave** » Thu Jan 09, 2003 10:13 pm

None, is my guess. When you say "shift back" you imply they once had symptoms, but of course they never did.

The CPPS beast is more complex than we thought at first.

Hepcat · Post by **Hepcat** » Thu Jan 09, 2003 10:55 pm

Hrm.

Well, I don't know what the selection criteria were for the candidates, but wouldn't a IIIa in symptomatic remission essentially be a class IV? And, almost certainly if inflammation is present, but asymptomatic, one would think they might be on the threshold at least of becoming so? ie. Perhaps early detection of inflammatory disease could catch the monster before it becomes full blown? Or, if your lucky, simply BHP?

Just pitching some thoughts...

Post by **webslave** » Thu Jan 09, 2003 11:13 pm

Hepcat wrote:Well, I don't know what the selection criteria were for the candidates, but wouldn't a IIIa in symptomatic remission essentially be a class IV?

Technically yes, but I'm sure the study would have excluded this sort of situation.

And, almost certainly if inflammation is present, but asymptomatic, one would think they might be on the threshold at least of becoming so? ie. Perhaps early detection of inflammatory disease could catch the monster before it becomes full blown? Or, if your lucky, simply BHP?

Your thoughts seem logical, but the situation is counter-intuitive. The fact remains that one third of all men show inflammation in their EPS, and never get CPPS. On the other hand, many men with CPPS do not show abnormally high WBCs, but other parameters are unusual (PGE2, TNF etc).

To my mind, the Cat I, II, IIIa/IIIb and IV are not so useful anymore. We need a new system, based on new measures, not WBCs. And Cat I and II should be a separate classification altogether.

Hepcat · Post by **Hepcat** » Fri Jan 10, 2003 2:57 am

The fact remains that one third of all men show inflammation in their EPS, and never get CPPS.

Actually, unless your aware of a longitudinal study that demonstrated this point, all we know is that 1/3 of all men show inflammation in their EPS.

As far as I can tell, no group has been followed for very long, as serious interest in prostatitis can only be measured in years. As this subgroup has not been explicitly identified a priori, how could we have known their outcomes as a group, particularly on a lifetime scale? In fact, following up on the progression of any disease in this subgroup of men could be a next logical step in this analysis. I'd actually like to see the whole paper.

However, your point is well taken. I've cracked open my old neuro texts and few immunology texts to brush up the exact mechanisms of inflammation, neural in particular. Hopefully we can stimulate a discussion of how a set of biochemical markers could be found to uniquely identify CPPS (or it's cause if it is related to other autoimmiune, nervous, ect conditions) and possibly differing forms of CPPS from another (assuming differing etiologies).

I think also the classifications were always meant to be 'working' classifications that would be tweaked as more information became available. I suppose they have served their purpose as a useful framework for now. There certainly seems to be more value in a Pelvic pain categorization of which prostatitis may be one.

However, I'll leave it to Dr D. To correct the err of my ways if I'm way out to lunch on this. No sense beating a dead horse

I also plan to discuss some diagnositic imaging questions I have with a few radiologists. Since that was my early background, I think Ga67 imaging or newer more specific compunds could possibly be developed to localize to areas of inflammation.

Hepcat · Post by **Hepcat** » Fri Jan 10, 2003 4:16 am

Luckily my current position allows me access to all Blackwell e-journals, so I was able to read the entire paper.

Categorization was based on current EPS and subjects were not excluded by previous diagnoses as far as I can tell. Far more ominous however is the question of whether increased PSA in prostatitis signals a higher risk of cancer later in life *shiver*

A couple of other interesting articles including one dealing with bladder vannilin receptors (capsaicin is a vannilin) and another that points out we still have much to learn neuroanatomically about the bladder (and the rest of the urinary system I'm guessing).

Cool stuff

Post by **webslave** » Fri Jan 10, 2003 4:34 am

The incidence of IC is <2% and although the figures for CPPS are all over the place, my guess is it is also low. This puts the 32% figure into perspective.

Mike · Post by **Mike** » Sat Jan 11, 2003 3:37 am

Is the global population not like over 6 billion people? Taking 2% of that figure leaves a big number to be suffering IC and CPPS assuming they are linked in some way. Women and Men I mean.

Is 2% enough to make these diseases in essence common?

Post by **webslave** » Sat Jan 11, 2003 4:45 am

However you cut it, there are millions of people in the world with IC and CPPS. For some reason, we are not hearing from them

Richard.N · Post by **Richard.N** » Sat Jan 11, 2003 1:49 pm

So that's a third of the male population, plus 10% with CPPS.

So that's 40%. Or is my math(s) out?

Then as Mike suggests there's IC to consider.

This is an amazing statistic. Shouldn't research now focus on what the difference is between Category iii and iv men?

Something is making us more sensitive I presume.

With regards to why we are not hearing from them, the accepted notion (in my early experience, before I found this site) is to 'put up with it' and maybe some are resigned to that.

Post by **webslave** » Sat Jan 11, 2003 3:30 pm

Richard.N wrote:So that's a third of the male population, plus 10% with CPPS. So that's 40%. Or is my math(s) out?

One third have signs of inflammation, but no symptoms, and less than 10% have CPPS. I personally think the incidence is more like 1-3%, and I have a study supporting me.