OBJECTIVE: To describe the multiparametric magnetic resonance imaging (MRI) appearance of prostate tuberculosis. MATERIALS AND METHODS: Six patients with prostate tuberculosis were analyzed retrospectively. The mean age of the patients was 60.5 years (range, 48-67 years). The mean prostate specific antigen concentration was 6.62 ng/mL (range, 0.54-14.57 ng/mL). All patients underwent a multiparametric MRI examination. RESULTS: The histopathological results were obtained from biopsies in four men and from transurethral resection of the prostate in two men after the MRI examination. Nodular (33%, 2/6 patients) and diffuse lesions (67%, 4/6 patients) were seen on MRI. The nodular lesions were featured by extremely low signal intensity (similar to that of muscle) on T2-weighted imaging (T2WI). The T2WI signal intensity of the diffuse lesions was low but higher than that of muscle, which showed high signal intensity on diffusion weighted imaging and low signal intensity on an apparent diffusion coefficient map. MR spectroscopic imaging of this type showed a normal-like spectrum. Abscesses were found in one patient with the nodular type and in one with the diffuse type. CONCLUSION: The appearance of prostate tuberculosis on MRI can be separated into multiple nodular and diffuse types. Multiparametric MRI may offer useful information for diagnosing prostate tuberculosis.
Aged ; Biopsy ; Diffusion Magnetic Resonance Imaging/*methods ; Humans ; Male ; Middle Aged ; Prostate/*pathology ; Prostate-Specific Antigen/blood ; Prostatitis/*diagnosis/pathology ; Retrospective Studies ; Tuberculosis/*diagnosis/pathology

PURPOSE: We are often confronted with patients in the "gray zone" (prostate-specific antigen [PSA]<10 ng/mL) whose biopsies reveal no malignancy but only inflammation. We investigated the relationship between histological inflammation and total PSA (tPSA), free PSA (fPSA), and percentage of free PSA (f/tPSA) levels in patients without prostate cancer (PC). MATERIALS AND METHODS: We studied 106 men with tPSA<10 ng/mL who had undergone biopsy that was negative for PC and who had no clinical prostatitis. Inflammation observed at biopsies was scored for inflammation type in each biopsy core by use of a four-point scale and was then correlated with tPSA, fPSA, and f/tPSA. RESULTS: Different patterns of inflammation were found in each set of biopsies. Regression factor analysis was used to form two groups according to inflammation type: more chronic and more acute. Median tPSA, fPSA, and f/tPSA levels in the more chronic and more acute inflammation groups were 6.4 ng/mL, 1.09 ng/mL, and 15%, and 7.3 ng/mL, 0.79 ng/mL, and l2%, respectively. A significant difference was found in fPSA (p=0.003) and f/tPSA (p<0.001), whereas the difference in tPSA was not significant (p=0.200). Total PSA correlated with fPSA (r=0.4, p<0.001) but not with inflammation type (r=0.12, p>0.010). A correlation existed between inflammation type and fPSA (r=-0.31, p=0.001) and f/tPSA (r=-0.43, p<0.001) in that the fPSA and f/tPSA were lower in the group with more acute inflammation. CONCLUSIONS: Subclinical inflammation has a significant influence on fPSA in patients with tPSA<10 ng/mL but without PC or clinical prostatitis. Subclinical inflammation is not characterized by elevated tPSA alone but also by a decreased fPSA, a tendency similar to that in PC.
Acute Disease ; Aged ; Aged, 80 and over ; Asymptomatic Diseases ; Biopsy, Large-Core Needle ; Chronic Disease ; Diagnosis, Differential ; Humans ; Kallikreins/*blood ; Male ; Middle Aged ; Prostate/pathology ; Prostate-Specific Antigen/*blood ; Prostatic Neoplasms/blood/diagnosis ; Prostatitis/*blood/diagnosis/pathology

Adenocarcinoma ; metabolism ; pathology ; Atrophy ; Biomarkers ; metabolism ; Diagnosis, Differential ; Humans ; Male ; Prostate ; pathology ; Prostatic Diseases ; metabolism ; pathology ; Prostatic Hyperplasia ; metabolism ; pathology ; Prostatic Neoplasms ; metabolism ; pathology ; Prostatitis ; metabolism ; pathology ; Xanthomatosis ; metabolism ; pathology

OBJECTIVETo explore the diagnosis and treatment of xanthogranulomatous prostatitis.

METHODSA 75-year-old man presented with a 3-month history of difficult urination and frequent micturition, which was exacerbated for 2 days. Digital rectal examination indicated an enlarged prostate size of II degrees with hard texture but no tenderness. Serum total PSA was 172.5 microg/L. TRUS revealed 200 ml of post-micturition residual urine, thickened bladder wall, prostate size of 4.3 cm x 3.8 cm x 5.0 cm and no isochrones. MRI showed an enlarged prostate gland, with marked enlargement of the central zones and low-signal intensity of the peripheral gland, part of the prostate gland protruding to the bladder with no clear dividing line. It was diagnosed as prostate cancer initially, and confirmed by needle biopsy.

RESULTSHistopathological examination revealed large numbers of "foamy macrophages" in the lesion, with a few multinucleated giant cells, leukocytes, mononuclear, plasmocytes and fibroplasia. Immunohistochemistry showed CD68 (+) and PSA (-). The patient was treated with oral Tamsulosin and glucocorticoid and by temporary catheterization, and followed up for 20 months. Urination symptoms began to alleviate and serum PSA to decrease at 4 months. The PSA level was 9.2 microg/L at 13 months and 3.6 microg/L at 17 months.

CONCLUSIONXanthogranulomatous prostatitis is a rare clinically, which can be confirmed by histopathological examination. It is treated mainly by supportive therapy and, for the cases with severe lower urinary tract obstruction, TURP can be employed. Follow-up must be performed by possible examination of PSA and necessary needle biopsy of the prostate.

Aged ; Humans ; Male ; Prostatitis ; diagnosis ; pathology ; therapy ; Xanthomatosis ; diagnosis ; pathology ; therapy

The prostate gland, like other glandular organs, is rich in blood and lymphatic vessels and nerves, which are the important histological factors for obtaining nutrition as well as for the endocrine and exocrine functions of the glands. Antimicrobial and non-antimicrobial drugs administered to patients by the oral, IM, IV or even topical routes are absorbed into the blood and transported to the prostate and other organs, where they can diffuse into the extravascular tissues through the walls of normal and damaged capillaries. The permeability of the prostate is enhanced by inflammatory reactions in the prostatic tissue, which is responsible for exudation or leakage of leukocytes and red blood cells, and drugs in the blood can enter the extravascular tissue of the prostate as well as diffuse into the prostatic secretions. The prostate lesions in patients with prostatitis or other prostatic diseases are caused by different types of pathogenic agents with various properties, and these diseases are characterized by a longer process of damage and a variety of pathological changes. Therefore, the diagnosis and treatment of prostatitis are relatively complex and difficult challenges hut meanwhile simple and easy matters for clinicians, and the difficulty or easiness is related not to the drug penetrability of the prostate, but largely to the understanding of the biological properties of the pathogenic agents, the physiological and pathological conditions of the patient's body and prostate, and the properties of drugs. The common factors that cause difficult treatment of prostatitis include clinical and laboratory misdiagnoses, release of pathogenic agents within pyogenic or necrotic prostatic tissues, variation of pathogenic agents, reinfection by other pathogens, and choice and administration of drugs.
Anti-Bacterial Agents ; pharmacokinetics ; therapeutic use ; Humans ; Male ; Prostate ; drug effects ; microbiology ; pathology ; Prostatitis ; diagnosis ; microbiology ; pathology

Considering that antibiotic treatment may elevated the level of prostate-specific antigen (PSA) and hence limit the specificity of PSA test for prostate cancer, urologists use empiric antibiotic treatment for men with increased PSA levels. But it is controversial whether antibiotic treatment can exclude inflammation in the differential diagnosis of PSA elevation. Some researchers have found that antibiotic treatment can decrease inflammation-induced PSA elevation and help to reduce unnecessary biopsies, while others have reported that antibiotic treatment has no significant effect on the PSA level, and the lowered level of PSA following antibiotic treatment does not mean the decreased risk of prostate cancer. Further researches are needed to confirm the value of antibiotic treatment before biopsy.
Anti-Bacterial Agents ; therapeutic use ; Biomarkers, Tumor ; blood ; Biopsy ; Diagnosis, Differential ; Humans ; Inflammation ; metabolism ; pathology ; Male ; Prostate ; pathology ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; diagnosis ; pathology ; Prostatitis ; pathology

Aged, 80 and over ; Antigens, CD20 ; metabolism ; CD79 Antigens ; metabolism ; Diagnosis, Differential ; Humans ; Interferon Regulatory Factors ; metabolism ; Ki-67 Antigen ; metabolism ; Leukosialin ; metabolism ; Lymphoma, Large B-Cell, Diffuse ; metabolism ; pathology ; surgery ; Male ; Neoplasms, Muscle Tissue ; metabolism ; pathology ; Prostatic Neoplasms ; metabolism ; pathology ; surgery ; Prostatitis ; metabolism ; pathology ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; Receptor Protein-Tyrosine Kinases ; metabolism

OBJECTIVETo determine the level of uric acid (UA) in the expressed prostatic secretion (EPS) of chronic prostatitis patients and explore its clinical significance.

METHODSA total of 91 patients with chronic prostatitis diagnosed by NIH standard were divided into a III A (n = 48) and a III B (n = 43) group, and healthy volunteers were selected as the control. The scores on the NIH-Chronic Prostatitis Symptom Index (CPSI) and the WBC count, pH value and UA level in EPS were evaluated for all the three groups.

RESULTSThe EPS UA concentration was (257.02 +/- 144.84) micromol/L in Group III B, significantly higher than in Group III A, (159. 73 +/- 121.49) micromol/L, (P < 0.01), and the control, (78.55 +/- 44.53) micromol/L, (P < 0.01). The level of EPS UA was correlated negatively with pH value (r = -0.398, P = 0.000), but positively with CPSI-P, CPSI-U and CPSI-T (r = 0.436, 0.316 and 0.403, P < 0.01).

CONCLUSIONBackflow of urine into prostatic ducts might cause chemical inflammation reaction by increasing UA concentration. There is a close relationship between the UA level in EPS and chronic prostatitis symptoms. Determination of the UA level in EPS is of great significance for the diagnosis and treatment of chronic prostatitis.

Adolescent ; Adult ; Chronic Disease ; Humans ; Male ; Middle Aged ; Prostate ; pathology ; secretion ; Prostatitis ; diagnosis ; metabolism ; physiopathology ; Uric Acid ; analysis

OBJECTIVETo assess the application value of transrectal ultrasound (TRUS) in the diagnosis of chronic prostatitis.

METHODSTRUS and examination of prostatic secretion (EPS) were used in the diagnosis of 3 500 cases of chronic prostatitis from September, 2000 to May, 2006.

RESULTSLower resonance of the inner gland, low-level echo, uneven echo light spots, incomplete outlines and unsmooth borderlines were found in 2279 cases (65.1%), and the enlarged prostate in 1 084 cases (31.0%), with clear integrated amicula and enhanced echogenic spots at the juncture of the external and inner gland. No obvious changes were noted in 137 cases (4.0%), and in another 391 cases (11.2%) were detected alteration of the acoustic image of cystospermitis and blurred margins and uneven echoes of the seminal vesicle. The WBC count in EPS was < 10/HP in 132 cases (3.8%), 10-19/HP in 2 156 cases (61.6%) and > or =20/HP in 1212 cases (34.6%).

CONCLUSIONTRUS, as a diagnostic means for chronic prostatitis, can be easily performed and causes little pain and therefore is readily accepted by patients. Combined with EPS, TRUS can provide more definite diagnostic evidence, and for those who are afraid of pain and reject EPS, it is a desirable alternative in the diagnosis of chronic prostatitis.

Adult ; Chronic Disease ; Humans ; Male ; Middle Aged ; Prostate ; diagnostic imaging ; pathology ; Prostatitis ; diagnosis ; diagnostic imaging ; Rectum ; Sensitivity and Specificity ; Ultrasonography ; methods

PURPOSE: We evaluated the correlation of the pathologic diagnosis, including the grade or location of the inflammation on a prostate biopsy specimen, to the serum prostate-specific antigen(PSA) level. MATERIALS AND METHODS: 172 patients(the patients' PSA was> or=4ng/ml) who received prostate biopsy at our department from January 2000 to August 2003 were retrospectively studied. The pre-biopsy PSA and pathology, including the diagnoses and inflammatory patterns, were analyzed. The pathologic patterns of inflammation were divided as acute or chronic by the predominant inflammatory cell type; especially, the chronic inflammation was divided by grade or location, and then this was reviewed by 1 pathologist. Chronic Inflammation was graded as I, II or III according to the severity of inflammation. The PSA levels were compared among the grades. The presence or absence of chronic inflammation was checked in the periglandular, stromal and perivascular areas, respectively. The PSA levels were compared between the presence and absence of inflammation at each location. RESULTS: Among 172 patients, the number of patients with prostate cancer was 37(21.5%), and 68 patients had only BPH(39.5%), 27 had only prostatitis(15.7%) and 40 patients had benign prostatic hyperplasia(BPH) with prostatitis(23.3%). The number of patients with any prostatitis was 67(39.0%). The age of the patients was 68.4+/-8.7 years(45-91), the serum PSA was 13.30+/-14.38ng/ml(4.30-102.48), and the prostate size was 49.5+/-21.1ml(20-126). One case of BPH with prostatitis had a PSA level above 100ng/ml. Among the 67 specimens that showed prostatitis, 16 patients had histologically acute inflammation(23.9%) and 51 patients had chronic inflammation(76.1%). The PSA levels of the acute or chronic inflammation patients were 24.04+/-25.95ng/ml(4.46-102.48) and 9.93+/-4.73ng/ml(4.3-21.12, p=0.047), respectively. The PSA levels were not different among the 3 grades of chronic inflammation. In periglandular, stromal and perivascular locations, the PSA levels were not different between the presence and absence of chronic inflammation. CONCLUSIONS: About 39% of the prostate biopsy specimens showed prostatitis. The PSA level was higher for the acute inflammation than for the chronic inflammation. However, there was no difference in PSA levels among the each of the grades or locations of chronic prostatic inflammation.
Biopsy ; Diagnosis ; Humans ; Inflammation* ; Pathology* ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms ; Prostatitis* ; Retrospective Studies