Can asymptomatic inflammatory prostatitis be predicted based on C-reactive protein and sterile pyuria?

AMAÇ: İnflamasyon, yüksek serum prostat spesifik antijen (PSA) seviyeleri ile başvuran hastaların biyopsi numuneleri incelendiğinde en sık görülen histolojik bulgulardan biri olmasına rağmen PSA seviyeleri üzerindeki etkisi hakkında çok az şey bilinmektedir. Bu çalışma, histolojik olarak saptanan asemptomatik prostatit olgularında c-reaktif protein (CRP) ve steril piyürinin klinik öneminin olup olmadığını araştırmak için yapılmıştır. GEREÇ ve YÖNTEM: Bu makalede veriler kesitsel prospektif klinik çalışma ile elde edildi. Klinik prostatit bulguları olmayan ardışık 111 hasta normal rektal muayene bulguları, 3 ile 20 ng/mL arasında değişen PSA seviyeleri ve steril idrar kültürü sonuçlarına sahip idi. Tüm hastalara transrektal ultrasonografi eşliğinde 12 kadran prostat biyopsisi yapıldı. Operasyon öncesi üriner lökosit sayısı mikroskobik bir büyütme alanında (h.p.f) üç veya daha az olan hastalar non-piyüri grubu, üriner lökosit sayısı 3’ten fazla olan hastalar piyüri grubu olarak sınıflandırıldı. Ayrıca CRP seviyeleri biyopsi öncesi hastaları gruplandırmak için kullanıldı. Alt gruplar birkaç klinik değişkene göre karşılaştırıldı. BULGULAR: Histolojik incelemede piyüri grubu hastalarının %69’unda, non-piyüri grubu hastaların %38,9’unda inflamasyon saptandı. Histolojik olarak saptanan inflamasyon oranları gruplar arasında anlamlı olarak farklıydı (p=0,008). Piyüri grubu, non-piyüri grubuna kıyasla anlamlı ölçüde daha yüksek total PSA seviyeleri ve serum CRP seviyeleri sergiledi (p=0,041, p=0,001, sırasıyla). CRP negatif ve pozitif gruplar klinik değişkenler ve histolojik olarak saptanan inflamasyon oranları açısından benzerdi. SONUÇ: Prostatik inflamasyonun CRP’den daha ziyade üriner lökosit sayısı ile daha güvenilir bir şekilde saptanabileceği gösterildi. Piyürili hastalar yüksek serum PSA seviyeleri sergiledi. Klinik prostatit bulguları olmayan hastalarda PSA yüksekliğinin nedeni olarak steril piyüri akılda tutulmalıdır. Üriner lökosit sayısı basitliği, kolaylığı ve invaziv olmamasından dolayı rutin ürolojik değerlendirmeye dahil edilmelidir.

Asemptomatik inflamatuvar prostatit C-reaktif protein ve steril piyüri temelinde tahmin edilebilir mi?

OBJECTIVE: Inflammation is one of the most common histological evidence when prostate biopsy specimens of patients presenting with high PSA (Prostatespecific antigen) levels are examined, but little is known about its effect on PSA levels. This study was conducted to evaluate whether C-reactive protein (CRP) and sterile pyuria has clinical significance in histologically-detected asymptomatic prostatitis cases. MATERIAL and METHODS: In this article, the data were obtained by a crosssectional and prospective clinical study. One hundred eleven consecutive patients without clinical prostatitis had normal digital rectal examination findings, PSA levels ranging from 3 to 20 ng/mL, and sterile urine culture results. All of them underwent transrectal ultrasound-guided 12-core prostatic biopsy. Preoperatively, patients who had urinary leukocyte count 3 or less than 3/high power field (h.p.f) were classified as non-pyuria, while those with urinary leukocyte count more than 3/high power field (h.p.f) were classified as pyuria. The serum CRP level was also used to categorize patients before the biopsy. The subgroups were compared regarding a number of clinical variables. RESULTS: Histological examination revealed inflammation in 69% of pyuria patients and 38.9% of non-pyuria patients. Histologically-detected inflammation rate was significantly different in the groups (p=0.008). The pyuria group exhibited significantly higher total PSA levels compared to the non-pyuria group (p=0.041), as well as significantly higher serum CRP levels (p=0.001). CRP positive and negative groups were similar regarding clinical variables and histologically-detected inflammation rates. CONCLUSION: It has been shown that prostatic inflammation can be detected more reliably with urinary leukocyte count rather than serum CRP. Patients with pyuria exhibited high levels of serum PSA. Sterile pyuria should be kept in mind as a cause of elevated PSA in patients without clinical prostatitis findings. Urinary leukocyte count should be incorporated in routine urological evaluation thanks to its simplicity, convenience, and non-invasiveness.

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Polascik TJ, Oesterling JE, Partin AW. Prostate specific antigen: a decade of discovery –What we have learned and where we are going. J Urol 1999;162:293–306. [CrossRef]
Constantinou J, Feneley MR. PSA testing: an evolving relationship with prostate cancer screening. Prostate Cancer Prostatic Dis 2006;9:6–13. [CrossRef]
Kawakami J, Siemens DR, Nickel JC. Prostatitis and prostate cancer: implications for prostate cancer screening. Urology 2004;64:1075–80. [CrossRef]
Brawn PN, Speights VO, Kuhl D, Riggs M, Spiekerman AM, McCord RG, et al. Prostate-specific antigen levels from completely sectioned, clinically benign, whole prostates. Cancer 1991;68:1592–9. [CrossRef]
Irani J, Levillain P, Goujon JM, Bon D, Doré B, Aubert J. Inflammation in benign prostatic hyperplasia: correlation with prostate specific antigen value. J Urol 1997;157:1301–3. [CrossRef]
Schatteman PH, Hoekx L, Wyndaele JJ, Jeuris W, Van Marck E. Inflammation in prostate biopsies of men without prostatic malignancy or clinical prostatitis: correlation with total serum PSA and PSA density. Eur Urol 2000;37:404–12. [CrossRef]
Yaman O, Göğüş C, Tulunay O, Tokatli Z, Ozden E. Increased prostate-specific antigen in subclinical prostatitis: the role of the aggressiveness and extension of inflammation. Urol Int 2003;71:160–4. [CrossRef]
Simardi LH, Tobias-MacHado M, Kappaz GT, Taschner Goldenstein P, Potts JM, Wroclawski ER. Influence of asymptomatic histologic prostatitis on serum prostate-specific antigen: a prospective study. Urology 2004;64:1098–101. [CrossRef]
Kwak C, Ku JH, Kim T, Park DW, Choi KY, Lee E, et al. Effect of subclinical prostatic inflammation on serum PSA levels in men with clinically undetectable prostate cancer. Urology 2003;62:854– 9. [CrossRef]
Nickel JC. Prostatitis. Can Urol Assoc J 2011;5:306–15. [CrossRef]
Dalton DL. Elevated serum prostate-specific antigen due to acute bacterial prostatitis. Urology 1989;33:465. [CrossRef]
Neal DE, Moon TD, Clejan S, Sarma D. Prostate specific antigen and prostatitis I. Effect of prostatitis on serum PSA in the human and nonhuman primate. Prostate 1992;20:105–11. [CrossRef]
Yli-Hemminki TH, Laurila M, Auvinen A, Määttänen L, Huhtala H, Tammela TL, Kujala PM. Histological inflammation and risk of subsequent prostate cancer among men with initially elevated serum prostate-specific antigen (PSA) concentration in the Finnish prostate cancer screening trial. BJU Int 2013;112:735–41. [CrossRef]
Buddingh KT, Maatje MGF, Putter H, Kropman RF, Pelger RCM. Do antibiotics decrease prostate-specific antigen levels and reduce the need for prostate biopsy in type IV prostatitis? A systematic literature review. Can Urol Assoc J 2018;12:E25–30. [CrossRef]
Kato T, Suzuki H, Komiya A, Imamoto T, Naya Y, Tobe T, Ichikawa T. Clinical significance of urinary white blood cell count and serum C-reactive protein level for detection of non-palpable prostate cancer. Int J Urol 2006;13:915–9. [CrossRef]
Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999;282:236–7. [CrossRef]
Oliyide AE, Tijani KH, Jeje EA, Anunnobi CC, Adeyomoye AA, Ojewola RW, et al. The role of transrectal ultrasound-guided fineneedle aspiration biopsy in the diagnosis of prostate cancer: Sextant versus extended protocol. Niger Postgrad Med J 2017;24:236–9. [CrossRef]
Hammerer PG, McNeal JE, Stamey TA. Correlation between serum prostate specific antigen levels and the volüme of the individual glandular zones of the human prostate. J Urol 1995;153:111–4. [CrossRef]
Fleshner NE, O’Sullivan M, Fair WR. Prevalence and predictors of a positive repeat transrectal ultrasound guided biopsy of the prostate. J Urol 1997;158:505–8. [CrossRef]
Park SJ, Miyake H, Hara I, Eto H. Predictors of prostate cancer on repeat transrectal ultrasound-guided systematic prostate biopsy. Int J Urol 2003;10:68–71. [CrossRef]
Tobias-Machado M, Corrêa TD, De Barros EL, Wroclawski ER. Antibiotic prophylaxis in prostate biopsy: a comparative randomized clinical assay between ciprofloxacin, norfloxacin and chloramphenicol. Int Braz J Urol 2003;29:313–9. [CrossRef]
Blumenfeld W, Tucci S, Narayan P. Incidental lymphocytic prostatitis. Selective involvement with nonmalignant glands. Am J Surg Pathol 1992;16:975–81. [CrossRef]
Kandirali E, Boran C, Serin E, Semercioz A, Metin A. Association of extent and aggressiveness of inflammation with serum PSA levels and PSA density in asymptomatic patients. Urology 2007;70:743– 7. [CrossRef]
Gui-Zhong L, Libo M, Guanglin H, Jianwei W. The correlation of extent and grade of inflammation with serum PSA levels in patients with IV prostatitis. Int Urol Nephrol 2011;43:295–301. [CrossRef]
Arthur R, Williams R, Garmo H, Holmberg L, Stattin P, Malmström H, et al. Serum inflammatory markers in relation to prostate cancer severity and death in the Swedish AMORIS study. Int J Cancer 2018;142:2254–62. [CrossRef]
Toriola AT, Laukkanen JA, Kurl S, Nyyssönen K, Ronkainen K, Kauhanen J. Prediagnostic circulating markers of inflammation and risk of prostate cancer. Int J Cancer 2013;133:2961–7. [CrossRef]
Platz EA, De Marzo AM. Epidemiology of inflammation and prostate cancer. J Urol 2004;171:S36–40. [CrossRef]
Thurner E, Krenn-Pilko S, Langsenlehner U, Stojakovic T, Pichler M, Gerger A, et al. The elevated C-reactive protein level is associated with poor prognosis in prostate cancer patients treated with radiotherapy. Eur J Cancer 2015;51:610–9. [CrossRef]
Xu Q, Chen YJ, Liu ZQ, Chu L, Fang JM, Zhang X, Zhao HX. Prognostic role of C-reactive protein in prostate cancer: a systematic review and meta-analysis. Asian J Androl 2014;16:467– 71. [CrossRef]
Aldemir M, Ener K, Dehni D, Ağras K, Kayıgil Ö. Evaluation of the relationship between prostate cancer and serum inflammation markers. Int J Nephrol Urol 2010;2:244–50.

ISSN: 2587-2524
Yayın Aralığı: Yılda 4 Sayı
Başlangıç: 1999
Yayıncı: Turgay Arık

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