Materiały źródłowe

• #1 Inflammatory mechanisms and oxidative stress in prostatitis: the possi | RRU

  https://www.dovepress.com/inflammatory-mechanisms-and-oxidative-stress-in-prostatitis-the-possib-peer-reviewed-fulltext-article-RRU

  Prostatitis is the most common urologic disease in adult males younger than 50 years and the third most common urologic diagnosis in males older than 50 years. […] If the germ-causing acute prostatitis is not eliminated, the inflammatory process becomes chronic. Persistent inflammation causes ongoing production of large quantities of pro-inflammatory cytokines and both oxygen and nitrogen reactive species, with consequent activation of transcription factor nuclear factor-kappa B (NF-B) and genes encoding for further production of pro-inflammatory cytokines, chemotactic factors, and growth factors. […] High concentrations of free radicals are produced in the tissues during chronic prostatitis, leading to marked tissue damage and DNA fragmentation; excessive epithelial proliferation may then occur, with possible development of prostate cancer.

• #2 Prostatitis: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/785418-overview

  Prostatitis is characterized by the presence of acute inflammatory cells in the glandular epithelium and lumens of the prostate, with chronic inflammatory cells in the periglandular tissue. […] The etiology of chronic prostatitis and chronic pelvic pain syndrome is poorly understood but may involve an infectious or inflammatory initiator that results in neurologic injury and pelvic floor dysfunction characterized by increased pelvic tone. […] Chronic pelvic pain syndrome is diagnosed based on pain in the setting of negative cultures of urine and prostatic secretions. Neuromuscular dysfunction or congenital reflux of urine into the ejaculatory and prostatic ducts may be a precipitating factor. […] The causes of chronic prostatitis and chronic pelvic pain syndrome may include functional or structural bladder pathology, such as primary vesical neck obstruction, pseudodyssynergia, impaired detrusor contractility, or acontractile detrusor muscle. […] Inflammatory conditions (eg, sarcoidosis) may also play a role in the pathogenesis of chronic prostatitis.

• #3 Preclinical models and evaluation criteria of prostatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10203503/

  Prostatitis is an inflammatory disease of the prostate glands with a variety of complicated symptoms, including generalized pain in the pelvic and lower abdomen areas and obstructive and erectile dysfunction. Prostatitis is classified into four categories: acute bacterial prostatitis (I), chronic bacterial prostatitis (II), chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)(III), and asymptomatic inflammatory prostatitis (IV). Prostatitis, especially non-bacterial ones, is etiologically and pathogenetically complex. Prostatitis is associated with infectious and non-bacterial factors, such as spontaneousness, immune disorders, hormones, diet, stress, chemicals, urine reflux, exosomes, and autonomic nerves. […] However, most treatments treat the symptoms but not the root cause, mainly because the mechanism is not clear. The causative factors of prostatitis are so diverse that it is essential to promptly choose the associated preclinical models from the various models to easily and efficiently investigate the condition.

• #4

  https://bpac.org.nz/2023/prostatitis.aspx

  Prostatitis is the collective term for four distinct clinical conditions. […] Prostatitis can be categorised into four distinct conditions: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and asymptomatic inflammatory prostatitis. […] Acute bacterial prostatitis is characterised by the rapid onset of pelvic or genitourinary pain and lower urinary tract symptoms; prompt recognition and antibiotic treatment is essential to avoid complications, e.g. sepsis. […] Antibiotic penetration of the prostate tissue limits the choice of effective medicines for both acute (and chronic) bacterial prostatitis. […] Chronic bacterial prostatitis is characterised by persistent infection causing intermittent genitourinary pain and ongoing lower urinary tract symptoms lasting for three months or longer, with evidence of bacterial infection.

• #5 Acute Bacterial Prostatitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459257/

  Bacterial prostatitis (BP) is an infection of the prostate gland occurring in a bimodal distribution in younger and older men. It can be acute (ABP) or chronic (CBP) in nature and, if not treated appropriately, can result in significant morbidity. […] The proposed mechanisms of BP all involve the infiltration of pathogenic organisms that are capable of overcoming the prostate gland’s natural immune defenses. Most commonly, BP is secondary to ascending infection from urethritis, cystitis, and epididymal-bronchitis, but BP is also often caused by direct inoculation from prostate biopsy or manipulation. Less commonly, BP can be caused by hematogenous or lymphatic seeding from sepsis or other sources of infection in the body. The pathophysiology of CBP is less well understood but may involve the development of bacterial biofilms. […] In young men, the most common pathology includes an ascending urethral infection following anal or vaginal intercourse. In the elderly, prolonged catheterization and instrumentation are two common causes.

• #6 Acute Bacterial Prostatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0115/p114.html

  Most cases of acute bacterial prostatitis are caused by ascending urethral infection or intraprostatic reflux and are facilitated by numerous risk factors. These infections may occur from direct inoculation after transrectal prostate biopsy and transurethral manipulations (e.g., catheterization and cystoscopy). Occasionally, direct or lymphatic spread from the rectum or hematogenous spread via bacterial sepsis can cause acute bacterial prostatitis. Overall, community-acquired infections are three times more common than nosocomial infections. […] Acute bacterial prostatitis is most frequently caused by Escherichia coli, followed by Pseudomonas aeruginosa, and Klebsiella, Enterococcus, Enterobacter, Proteus, and Serratia species. Infections that occur after transurethral manipulation are more likely to be caused by Pseudomonas species, which have higher rates of resistance to cephalosporins and carbapenems. Transrectal prostate biopsies can cause postoperative infections.

• #7 Acute Bacterial Prostatitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2002872-overview

  Theories regarding the pathogenesis of acute bacterial prostatitis include the following: […] Intraprostatic urinary reflux is the most widely accepted theory. In this scenario, infected urine refluxes into the ejaculatory and prostatic ducts that empty into the posterior urethra. Because of the anatomy of the prostate gland, ducts that drain the large peripheral zone are positioned more horizontally than other prostatic ducts and, thus, facilitate the reflux of urine into the prostate. Consequently, most infections occur in the peripheral zone. […] In younger men, ascending urethral infection may occur following sexual intercourse. Meatal inoculation may occur during unprotected anal intercourse, instrumentation, and prolonged catheterization.

• #8 Prostatitis – TeachMeSurgery

  https://teachmesurgery.com/urology/prostate/prostatitis/

  Most cases of acute bacterial prostatitis are caused by ascending urethral infection, although occasionally direct or lymphatic spread from the rectum or hematogenous spread via bacterial sepsis can be the cause. […] Causative organisms include E. Coli (most common), Enterobacter, Serratia, Pseudomonas, and Proteus species. Sexually transmitted infections, such as Chlamydia or Gonorrhoea, are a rare cause. […] Chronic bacterial prostatitis is chronic bacterial infection of the prostate with or without prostatitis symptoms and is thought to be the sequelae of inadequately treated acute prostatitis.

• #9 Prostatitis

  https://www.atsu.edu/faculty/chamberlain/website/lectures/lecture/prostate.htm

  Prostatitis is an inflammation of the prostate gland. The term prostatitis describes a wide spectrum of disorders ranging from acute bacterial infection to chronic pain syndromes. Prostatitis describes a wide number of maladies with variable etiologies, prognoses and treatments. Unfortunately, these conditions have not been well studied, and most recommendations for treatment are based primarily on case series and anecdotal experience. Prostatitis can be a challenging condition to treat. […] Etiology depends on the classification of the prostatitis. Most of the cases of acute bacterial prostatitis are the result of gram-negative bacteria. […] Acute bacterial prostatitis (ABP): The strains of E coli that cause ABP usually produce the following virulence factors: P fimbria, S fimbria, alpha-hemolysin, and cytotoxic necrotizing factor 1. Two main mechanisms for acute bacterial prostatitis have been proposed. Reflux of infected urine into the glandular prostatic tissue via the ejaculatory and prostatic ducts. Ascension of a urethral infection from the meatus, particularly during sexual intercourse.

• #10 KAKEN — Research Projects | Analysis of the pathogenesis of bacterial prostatitis (KAKENHI-PROJECT-08671809)

  https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-08671809/

  Escherichia coli is the most frequent pathogen in acute bacterial prostatitis as well as in acute uncomplicated urinary infections. […] To assess the virulence profiles of E.coil in acute prostatitis, the serotypes and virulence factor (VF) genotypes were determined. […] More all VFs were significantly associated with the prostatitis than with the fecal isolates. […] The prevalence of hly and cnfl was higher in the prostatitis isolates than in the pyelonephritis and cystitis isolates. […] The results of multivariate analysis revealed that AFA-I and FIC fimbria had high relative virulence. […] Nine 0 serotypes (01, 02, 04, 06, 016, 018, 022, 025 and 075) accounted for 79.4%, 73.7% and 78.4% of the prostatitis, pyelonephritis and cystitis strains, respectively. […] Predominance of 0 serotypes prevalent in female urinary tract infections and a high percentage of multiple VFs among the prostatitis isolates suggested that VFs have important roles in the pathogenesis of acute bacterial prostatitis. […] Our results indicate that the pathogen of prostatitis may come from their sexual partner in a part of the patients.

• #11 Characteristics of the Major Types of Prostatitis | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/1015/p1821a.html

  Both types of bacterial prostatitis are typically caused by Escherichia coli, Proteus or Provedentia species. The pathogenesis of this type of prostatitis is not well known, but it may be caused by reflux of infected urine or by ascending urethral infection. […] Host defenses against these types of infection include urination and ejaculation. Prostatic antibacterial factor, a zinc-containing polypeptide secreted by the prostate gland, may also play a role. […] Chronic nonbacterial prostatitis and chronic pelvic pain syndrome tend to affect younger men but are similar in presentation to chronic bacterial infection. Dysuria is not usually a prominent symptom of these syndromes; rather, chronic pelvic and ejaculatory pain are the most common.

• #12 A Host Defense Mechanism Involving CFTR-Mediated Bicarbonate Secretion in Bacterial Prostatitis | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0015255

  Prostatitis is associated with a characteristic increase in prostatic fluid pH; however, the underlying mechanism and its physiological significance have not been elucidated. […] Here we reported the involvement of CFTR, a cAMP-activated anion channel conducting both Cl and HCO3, in mediating prostate HCO3 secretion and its possible role in bacterial killing. […] The CFTR and its mediated HCO3 secretion may be up-regulated in prostatitis as a host defense mechanism. […] The present study has investigated the possible mechanism underlying this pH change and demonstrated for the first time the involvement of CFTR in mediating prostatic HCO3 secretion, which may be enhanced upon bacterial infection or inflammation. […] The observed upregulation of CFTR and CAII upon bacterial infection or LPS challenge could be due to the elevated levels of cytokines induced by the pathogens. […] Taken together, the present finding has revealed a previously undefined role of CFTR and its mediated prostatic HCO3 secretion in the host defense against bacterial infection.

• #13

  https://bpac.org.nz/2023/prostatitis.aspx

  CP/CPPS is the most prevalent form of prostatitis, and is diagnosed by excluding other genitourinary conditions. […] The pathophysiology of CP/CPPS is not fully understood and likely multifactorial. […] One proposed mechanism is central sensitisation; disruption of central pain pathways by ongoing inflammation or infection of the prostate, resulting in an altered perception of pain. […] It is also likely that psychological stress plays a significant role in CP/CPPS. […] Chronic bacterial prostatitis is a persistent or recurrent infection of the prostate resulting in episodes of genitourinary pain and lower urinary tract symptoms over three months or longer. […] Infection may be the result of a UTI migrating from the urethra to the prostate, or haematogenous or lymphogenous spread from elsewhere in the body, e.g. rectum. […] In some cases, undertreated or recurrent acute bacterial prostatitis can progress to a chronic infection. […] A small subset of patients diagnosed with acute bacterial prostatitis may develop chronic bacterial prostatitis, however, the exact progression rate is uncertain.

• #14 Prostatitis

  https://www.atsu.edu/faculty/chamberlain/website/lectures/lecture/prostate.htm

  Chronic Bacterial Prostatitis (CBP): Research suggests that the E coli strains obtained from patients with CBP produce more virulence factors (P fimbria, S fimbria, alpha-hemolysin, and cytotoxic necrotizing factor 1) and are more likely to produce a biofilm than the strains obtained from patients with uncomplicated urinary tract infections. This may explain why CBP is difficult to treat. […] Mechanisms involved in other chronic forms of prostatitis are just beginning to be proposed and appear to result from an interaction between physiological factors and dysfunction in the immune, neurological and endocrine systems. […] Chronic forms of prostatitis: Less inflammation of the prostate. Plasma cells and macrophages infiltrate in and around the acini.

• #15 Prostatitis – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/benign-prostate-disease/prostatitis

  Prostatitis can be bacterial or, more commonly, nonbacterial. However, differentiating bacterial and nonbacterial causes can be difficult, particularly in chronic prostatitis. […] How these pathogens enter and infect the prostate is unknown. Chronic infections may be caused by sequestered bacteria that antibiotics have not eradicated, such as can happen in patients with prostatic calcifications. […] The mechanism is unknown but may involve incomplete relaxation of the urinary sphincter and dyssynergic voiding. The resultant elevated urinary pressure may cause urine reflux into the prostate (triggering an inflammatory response) or increased pelvic autonomic activity leading to chronic pain without inflammation.

• #16 Prostatitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Prostatitis_pathophysiology

  The pathogenesis of prostatitis is not completely understood. An infection ascending from the urethra, chemical damage caused by the reflux of urine through the ejaculatory and prostatic ducts and autoimmune involvement are a few possible theories related to the pathogenesis of various types of prostatitis.[1][2] […] Chronic prostatitis/chronic pelvic pain syndrome is thought to be caused by an abnormality in the hypothalamic-pituitary-adrenal axis and hormonal derangements involving the adrenocortical hormone that can stem from variable response to stress, neurogenic inflammation, and myofascial pain syndrome. […] The exact pathogenesis of acute prostatitis is not fully understood. Possible pathogenesis may include: […] The pathogenesis of chronic bacterial prostatitis is not very clear but an ascending infection from the distal urethra to the prostate is considered a possibility.[1]

• #17 Inflammatory mechanisms and oxidative stress in prostatitis: the possi | RRU

  https://www.dovepress.com/inflammatory-mechanisms-and-oxidative-stress-in-prostatitis-the-possib-peer-reviewed-fulltext-article-RRU

  Prostatitis is the most common urologic disease in adult males younger than 50 years and the third most common urologic diagnosis in males older than 50 years. […] If the germ-causing acute prostatitis is not eliminated, the inflammatory process becomes chronic. Persistent inflammation causes ongoing production of large quantities of pro-inflammatory cytokines and both oxygen and nitrogen reactive species, with consequent activation of transcription factor nuclear factor-kappa B (NF-B) and genes encoding for further production of pro-inflammatory cytokines, chemotactic factors, and growth factors. […] High concentrations of free radicals are produced in the tissues during chronic prostatitis, leading to marked tissue damage and DNA fragmentation; excessive epithelial proliferation may then occur, with possible development of prostate cancer.

• #18 Chronic prostatitis/chronic pelvic pain syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Chronic_prostatitis/chronic_pelvic_pain_syndrome

  Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), previously known as chronic nonbacterial prostatitis, is long-term pelvic pain and lower urinary tract symptoms (LUTS) without evidence of a bacterial infection. The cause is unknown. […] One theory is that CP/CPPS is a psychoneuromuscular (psychological, neurological, and muscular) disorder. The theory proposes that anxiety or stress results in chronic, unconscious contraction of the pelvic floor muscles, leading to the formation of trigger points and pain. The pain results in further anxiety and thus worsening of the condition. […] Another proposal is that it may result from an interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems. A 2016 review suggested that although the peripheral nervous system is responsible for starting the condition, the central nervous system (CNS) is responsible for continuing the pain even without continuing input from the peripheral nerves.

• #19 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.220248

  Currently, the pathogenesis of CP/CPPS involves immunological, endocrine, and psychological etiologies and autonomic nervous systems. The autonomic nervous system seems to be the link between them. The autonomic nervous system comprises sensory, sympathetic, and parasympathetic nerves and the central nervous system (CNS). Sensory nerves are related to neuro-inflammation. The persistence of chronic pelvic pain and its sensitization might also be responsible for recurrent conditions and prolonged pain in chronic prostatitis. […] Research indicated that the autonomic nervous system regulates smooth muscles of the cardiovascular system and prostatic glandular secretion; therefore, the sympathetic and parasympathetic nerves are closely related to CP/CPPS. […] The autonomic nervous system comprises autonomic nerves, their command center, and the CNS. The autonomic nerves are subdivided into sensory, sympathetic, and parasympathetic nerves, and the CNS is divided into the spinal cords lower centers and the brains higher centers. They are all involved in the production and development of inflammation, pain, and dysfunction of organs in CP/CPPS.

• #20 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.220248

  Sensory nerves are associated with neurogenetic inflammation and pain. Sensory nerves activate and release substance P (SP) and calcitonin gene-related peptide (CGRP) when nociceptors are stimulated in their terminals. CGRP- and SP-expressing nerves densely innervate vascular smooth muscles. Therefore, these substances will directly affect the vascular endothelial cells to participate in vascular effects, mediating the generation of neurogenetic inflammation. […] The sympathetic and parasympathetic nerves play an essential role in the generation and development of inflammation, pain, and dysfunctional organs. […] Overall, sympathetic and parasympathetic nerves play a vital role in developing prostatitis, chronic pain, cross-sensitization, and organ dysfunction. The symptoms of the urinary system are similar to CP/CPPS.

• #21 Prostatitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Prostatitis_pathophysiology

  The symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) are related to association between physiological factors and dysfunction in the immune, neurological and endocrine systems. Possible mechanisms include hypothalamic-pituitary-adrenal axis dysfunction and abnormalities in adrenocortical hormone, neurogenic inflammation, or myofascial pain syndrome. […] Another important theory about non bacterial prostatitis includes the increased content of creatinine, urate and white blood cells due to reflux into the prostatic ducts. […] Autoimmune phenomenon has also been proposed in some studies. Infiltration of the stroma and surroundings of the prostatic gland by lymphocytes is seen in such cases.[12][13] […] Type 3 or chronic inflammatory or non inflammatory prostatitis is associated with polymorphism of IL-10 gene.[14] […] A genotype that favours decreased IL-10 production and thus a decreased anti-inflammatory effect leading to immunosupression leads to development of prostatitis.[15]

• #22 Chronic prostatitis/chronic pelvic pain syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Chronic_prostatitis/chronic_pelvic_pain_syndrome

  Theories behind the disease include stress-driven hypothalamic-pituitary-adrenal axis dysfunction and adrenocortical hormone (endocrine) abnormalities, and neurogenic inflammation. […] The role of androgens is studied in CP/CPPS, with C21 11-oxygenated steroids (pregnanes) presumed to be precursors to potent androgens. Specifically, steroids like 11-hydroxyprogesterone and 11-ketoprogesterone can be converted to 11-ketodihydrotestosterone, an 11-oxo form of DHT with the same potency. The relationship between steroid serum levels and CP/CPPS suggests that deficiencies in the enzyme CYP21A2 may lead to increased biosynthesis of 11-oxo androgens and androgens biosynthesized via a backdoor pathway, that contribute to the development of CP/CPPS. […] The bacterial infection theory was shown to be unimportant in a 2003 study which found that people with and without the condition had equal counts of similar bacteria colonizing their prostates.

• #23 AUTOIMMUNITY AS A POSSIBLE MECHANISM OF PROTACTIN-INDUCED PROSTATITIS | Science Inventory | US EPA

  https://cfpub.epa.gov/si/si_public_record_Report.cfm?dirEntryId=61122

  AUTOIMMUNITY AS A POSSIBLE MECHANISM OF PROLACTIN-INDUCED PROSTATITIS. RW Luebke, CB Copeland, and LR Bishop. US EPA, Research Triangle Park, NC Stoker et al. reported inflammation of the lateral prostate (LP) lobes in 120 day old Wistar rats after manipulation of prolactin (PRL) levels during the prepubertal period. The inflammatory response, comprised of intraductal neutrophils plus monocytes within the stroma, is similar to that observed in human nonbacterial prostatitis (NBP). […] PRL also has potent immunomodulatory properties, including upregulation of TNF and iNOS expression and to stimulate activation of T cells. Hyperprolactinemia has been associated with increased severity of arthritis, SLE and type 1 diabetes, and may be a risk factor for other autoimmune diseases. […] However, mRNA for IFN ICAM-1 and MIP-1 were increased by PND45, well before frank inflammation was present.

• #24 Mechanisms in Prostatitis/Chronic Pelvic Pain Syndrome

  https://www.periodicos.capes.gov.br/index.php/acervo/buscador.html?task=detalhes&id=W4235287640

  We reviewed the current literature on mechanisms involved in the pathogenesis of prostatitis/chronic pelvic pain syndrome (CPPS). […] The etiology of CP/CPPS is unknown. […] An imbalance toward increased proinflammatory and decreased anti-inflammatory cytokines has been implicated and a few studies have shown some correlation of this with pelvic pain. […] An autoimmune process may be involved and experimental evidence indicates that this can be under hormonal influence. […] Recent findings include possible defects in the androgen receptor. […] Pelvic pain also correlates with the neurotrophin nerve growth factor implicated in neurogenic inflammation and central sensitization. […] The symptoms of CP/CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological and endocrine systems.

• #25 Acupuncture, Treating Chronic Prostatitis/Pelvic Pain Synd. | IJGM

  https://www.dovepress.com/the-role-of-acupuncture-and-its-related-mechanism-in-treating-chronic–peer-reviewed-fulltext-article-IJGM

  Furthermore, interleukin-1 (IL-1) and tumor necrosis factor- (TNF-) are two important proinflammatory cytokines that may play a role in the development of CP/CPPS. […] Alexander et al observed increased levels of TNF- and IL-1 in the seminal plasma of patients with CP. […] Nadler et al also reported that TNF- and IL-1 levels were significantly higher in the prostatic fluid of patients with CP/CPPS than in the prostatic fluid of healthy controls and that a correlation existed between these cytokines. […] Furthermore, acupuncture has been shown to have an effect on inflammatory mediators in patients with CP/CPPS, with TNF- and IL-1 expression levels being significantly reduced. […] Acupuncture may modulate immune responses in patients or models with CP/CPPS. […] Immune mechanisms, particularly autoreactive T lymphocytes, may play a role in the development of CP/CPPS.

• #26 Inflammatory mechanisms and oxidative stress in prostatitis: the possi | RRU

  https://www.dovepress.com/inflammatory-mechanisms-and-oxidative-stress-in-prostatitis-the-possib-peer-reviewed-fulltext-article-RRU

  Oxidative stress is the most important cause of tissue damage in chronic prostatitis. […] The excessive production of iNOS leads to high local levels of ROS and RNS, which can cause cell and tissue damage, ECM damage, even through the lipidic peroxidation. […] The high concentration of reactive species (ROS and RNS) that occurs during chronic prostatic inflammation is capable of causing direct DNA damage, with consequent sperm DNA fragmentation and its negative effects on fertility. […] Thus, the abnormal inflammatory response becomes dysfunctional and capable of causing significant alterations in tissue and organ functions; this occurs in chronic prostatitis and other more serious conditions, eg, atherosclerosis, chronic heart failure, neurodegenerative diseases, cancer, diabetes. […] Confirming the role played by oxidative stress in chronic prostatic inflammation, several studies have proven the presence of oxidative stress markers in genital secretions or urine of patients suffering from the disease. […] In conclusion, antioxidants can play an essential role in the treatment of chronic prostatitis.

• #27 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.220248

  Central nervous sensitization contributes to the pathogenesis of pain and dysfunctional changes in organs. Central sensitization is characterized by extensive pain, multi-site hyperalgesia, and abnormal pain. […] Several researchers have suggested that autonomic nervous system dysfunction is closely associated with CP/CPPS. Sensory nerves lead to persistent inflammation and pain. Sympathetic and parasympathetic alterations affect the dysfunction of organs and the development of prostatitis. Central sensitization decreases pain thresholds and increases pelvic pain perception in chronic prostatitis.

• #28 Acupuncture, Treating Chronic Prostatitis/Pelvic Pain Synd. | IJGM

  https://www.dovepress.com/the-role-of-acupuncture-and-its-related-mechanism-in-treating-chronic–peer-reviewed-fulltext-article-IJGM

  Acupuncture may reduce pain symptoms by modulating the associated neurotransmitters. […] The final stage of CP/CPPS may be a neuropathic pain syndrome characterized by chronic pain, recurrent inflammation, voiding disorders, and sexual dysfunction. […] The pain syndrome can be neurogenically mediated by upregulating the local pelvic/perineal afferent sensory neuronal system and winding it up within the spinal cord and central nervous system, including endogenous opioid system regulation and gating control theories. […] The pain-relieving efficacy of acupuncture can be attributed to a complex phenomenon involving numerous neuropeptides and neurotransmitters. […] Activation of primary sensory neurons induces the release of inflammatory neuropeptides, such as substance P (SP), which can exacerbate inflammatory cell accumulation.

• #29 Preclinical models and evaluation criteria of prostatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10203503/

  Exosomes are involved in intercellular communication and play a role in a variety of physiological and pathological processes. […] The autonomic nervous system and the immune system are closely linked, and they communicate with each other through various pathways. […] Prostatitis is a common condition observed in the urology department, with a high prevalence. Despite the complexity and uncertainty of the pathogenesis and etiology, effective treatment is imperative, so it is crucial to choose the appropriate models quickly and conveniently.

• #30 Prostatic fluid exosome-mediated microRNA-155 promotes the pathogenesis of type IIIA chronic prostatitis – Zhao – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/69601/html

  Exosomes play an important role in cell-to-cell communication and are closely related to the occurrence of many chronic inflammatory diseases. […] This study aimed to explore the relationship between prostatic fluid exosomes and CP/CPPS-A and reveal new pathogenesis. […] Exosomes were abundantly enriched in the prostatic fluid of CP/CPPS-A patients and selectively overloaded with microRNA-155 (miRNA-155). […] In in vivo experiments, histological results showed that prostatic fluid exosomes induced prostatitis in rats. […] Exosomes in the prostatic fluid and the miRNA-155 contained therein were may be involved with the pathogenesis of CP/CPPS-A. […] We speculate that exosomes and their carried contents may play an important role in the occurrence and progression of CP/CPPS-A. […] These results will aid subsequent functional analysis of exosomes.

• #31 The Molecular Basis and Clinical Consequences of Chronic Inflammation in Prostatic Diseases: Prostatitis, Benign Prostatic Hyperplasia, and Prostate Cancer

  https://www.mdpi.com/2072-6694/15/12/3110

  Chronic inflammation is now recognized as one of the major risk factors and molecular hallmarks of chronic prostatitis, benign prostatic hyperplasia (BPH), and prostate tumorigenesis. However, the molecular mechanisms by which chronic inflammation signaling contributes to the pathogenesis of these prostate diseases are poorly understood. […] Prostate inflammation, also known as prostatitis, is one of the most common pathologies of the prostate in men. It is characterized as the inflammation or swelling of the prostate gland. Prostatitis can be categorized into four subsets: Acute Bacterial Prostatitis (Category 1), Chronic Bacterial prostatitis (Category 2), Chronic Prostatitis or Chronic Pelvic Pain Syndrome (Category 3), and Asymptomatic Inflammatory Prostatitis (Category 4). […] Chronic inflammation can damage and repair cellular DNA, thus creating genetic instability within prostate cells, which attracts the production of many cytokines, chemokines, and growth factors.

• #32 The Molecular Basis and Clinical Consequences of Chronic Inflammation in Prostatic Diseases: Prostatitis, Benign Prostatic Hyperplasia, and Prostate Cancer

  https://www.mdpi.com/2072-6694/15/12/3110

  In prostate biopsies showing lesions due to chronic inflammation, the risk of high-grade PCa was shown to be higher than those without these lesions. […] As previously mentioned, many external factors promote the development of PCa; a particular intrinsic and extrinsic factor that is gradually restimulating the interest of many researchers is pro-tumorigenic inflammation developing in the prostate as a result of causal factors such as genomic instability, epigenetic changes, hormonal changes, infections or microbial dysbiosis, dietary factors, and other unknown factors from the environment. […] Chronic inflammation is associated with higher rates of cellular mutations and genetic alterations, which could drive tumorigenesis. […] The potential contribution of the IL1R-TLR-IRAK-NF-κBs signaling molecules and NLR/inflammasomes in prostate pathologies, as well as the prospective benefits of selectively targeting the midstream molecules in the various inflammatory cascades, are also discussed.

• #33 The Molecular Basis and Clinical Consequences of Chronic Inflammation in Prostatic Diseases: Prostatitis, Benign Prostatic Hyperplasia, and Prostate Cancer

  https://www.mdpi.com/2072-6694/15/12/3110

  The activation of Myeloid differentiation primary response 88 (MyD88) adaptor-dependent pathway by TLRs (except TLR3) or IL-1Rs leads to recruitment and interaction with IRAK4 and IRAK2 to form a complex called Myddosome. […] Overall, the intracellular dysregulation of IL1/TLR/IRAK signaling within tumor cells or infiltrating immune cells in the tumor microenvironment may contribute to chronic inflammation-driven cancer survival, growth, invasion, immune evasion, and chemoresistance.

• #34 Acupuncture, Treating Chronic Prostatitis/Pelvic Pain Synd. | IJGM

  https://www.dovepress.com/the-role-of-acupuncture-and-its-related-mechanism-in-treating-chronic–peer-reviewed-fulltext-article-IJGM

  This phenomenon explains the possible peripheral opioid analgesic effect induced by acupuncture treatment. […] According to the neurotransmitter theory, acupuncture may also stimulate the release of neurotransmitters, such as serotonin and norepinephrine, as well as regulate dopamine and 5-hydroxytryptamine. […] However, these mechanisms overlap in some ways, and more experimental data are required to confirm the mechanisms of their roles in the acupuncture treatment of CP/CPPS. […] Acupuncture may regulate the effects of inflammatory factors in patients or models with CP/CPPS. […] COX-2, a key mediator of inflammation, can contribute to the inflammatory response by producing PGE2, which causes local pain and vasodilation. […] Men with symptomatic CP/CPPS have higher PGE2 concentrations in the prostatic fluid than asymptomatic controls, implying that the pain in CP/CPPS may be caused by increased prostaglandin production.

• #35 Acupuncture, Treating Chronic Prostatitis/Pelvic Pain Synd. | IJGM

  https://www.dovepress.com/the-role-of-acupuncture-and-its-related-mechanism-in-treating-chronic–peer-reviewed-fulltext-article-IJGM

  Hence, methods that lower prostaglandin PGE2 or COX-2 levels within the prostate would be beneficial to men with CP/CPPS. […] EA therapy is said to be anti-inflammatory because it regulates the expression of proinflammatory cytokines and COX-2 in peripheral and central nociceptive sites. […] Lee et al collected postmassage urine samples and found that the PGE2 levels in the EA group decreased significantly. […] Furthermore, Jiang et al used a rat model of neuropathic pain to investigate the role of PGE2 in EA analgesia. […] After 7 days of intervention, the expression level of the spinal PGE2 was significantly higher in the model group than in the control group, but it was reversed by EA. […] Therefore, EA on neuropathic pain might alleviate the hyperalgesia state by inhibiting the local secretion of PGE2.

• #36 Acupuncture, Treating Chronic Prostatitis/Pelvic Pain Synd. | IJGM

  https://www.dovepress.com/the-role-of-acupuncture-and-its-related-mechanism-in-treating-chronic–peer-reviewed-fulltext-article-IJGM

  Meanwhile, inflammation and enhanced oxidative stress may activate cyclooxygenase-2 (COX-2), which induces the production of prostaglandin E2 (PGE2) and inhibits the release of -endorphin (-EP) secreted by immune cells, resulting in and maintaining CP/CPPS pain symptoms. […] To alleviate CP/CPPS pain, it is necessary to inhibit PGE2 release while promoting EP accumulation. […] Acupuncture increases the concentration of -EP in the cerebrospinal fluid, even in patients with CP/CPPS, as reported by Lee et al. […] Ma et al also found that acupuncture burial therapy was better than oral tamsulosin hydrochloride in raising plasma -EP levels and lowering SP levels in patients with CPPS. […] Furthermore, acupuncture points in the lumbosacral region and below the umbilicus, such as BL33 (Zhongliao), CV4 (Guanyuan), and CV3 (Zhongji), may cause minor damage to local tissues, allowing endorphins, such as -EP, and their receptors to accumulate locally for a certain period of time.

• #37 The Radiology Assistant : Prostate Cancer – PI-RADS v2.1

  https://radiologyassistant.nl/abdomen/prostate/prostate-cancer-pi-rads-v2-1

  Prostatitis or rather inflammation is a common finding in men and can occur in the absense of any clinical history or symptoms. Prostatitis and other benign features like glandular fibrosis, scarring, atrophy and post-biopsy hemorrhage can mimic prostate cancer in the peripheral zone, since all present as a focus of low signal on ADC. However benign features mostly presents as a band-like or wedge-shaped or diffuse area of low signal intensity, while prostate cancer is more round or droplet-shaped. […] The hypointensity on ADC in inflammatory prostatic tissue is usually not accompanied by hyperintensity on high b-value DWI series. Also ADC values in prostate cancer tend to be lower than ADC levels in prostatitis. On DCE there is increased enhancement, which is therefore not helpful in the differentiation. In case of chronic inflammation, concordant fibrosis and focal atrophy may be observed, which presents as focal retraction in the normal anatomic convexity of the peripheral zone.

• #38 Review paperThe enigma of prostatitis. Some historical perspectives on the pathogenesis of prostatitis

  https://www.termedia.pl/Review-paper-The-enigma-of-prostatitis-Some-historical-perspectives-on-the-pathogenesis-of-prostatitis,19,7325,1,1.html

  Paradoxically, areas of cellular proliferation are adjacent to inflammatory lesions, and tumour necrosis factor (TNF), intimately implicated in dysfunctional signal trafficking inducing epithelial atrophy and tissue necrosis, may contemporaneously provoke a compensatory cellular proliferation. […] Some would believe that the inflammatory reaction, atrophy, tissue necrosis, epithelial cell disruption and associated hyperplasia could reflect early precancerous changes, an interesting but provocative concept. […] The contribution that Franks made to the pathology of prostate disease is considerable. […] The close reciprocal interrelationship between stroma and epithelium is now fully accepted. […] The signalling networks governing prostate inflammation are being unravelled and whereas to date the presence of white blood cells offers a simple marker of an inflammatory reaction, levels of proinflammatory cytokines will soon provide parameters by which to manage CPPS.

• #39 Impact of Chronic Prostatitis on Sexual Dysfuncton | Georgiadis Urology

  https://www.georgiadis-urology.com/impact-of-chronic-prostatitis-on-sexual-erectile-dysfunction/

  Chronic prostatitis affects the penile tissue, which in turn causes the erectile dysfunction. There are two main mechanisms that cause ED: […] First Mechanism: Relating to inflammatory agents that are released during inflammation. […] Second Mechanism: Relating to neural damage that happens due to the expansion of the inflammation to the periprostatic genital nerves. […] CP generates a systemic inflammatory response (i.e. spread through the blood) that impairs the endothelial function of corpus cavernosum. During the chronic inflammation process in the prostate the following chain reaction takes place: […] The next stage is atherosclerotic lesions in the penile vasculature, which is what actually leads to erectile dysfunction. Effectively, the aforementioned phenomenon works as an impairment in the penile blood flow during the erectile process.

• #40 Impact of Chronic Prostatitis on Sexual Dysfuncton | Georgiadis Urology

  https://www.georgiadis-urology.com/impact-of-chronic-prostatitis-on-sexual-erectile-dysfunction/

  Chronic inflammation in the prosate, produces cytokines and markers of inflammation that inhibit the expression of eNOS in endothelial cells and reduce its biological activity. As a result, the mechanism that relaxes the vascular wall and smooth muscular penile tissue underperforms which further results in ED. […] We can thus conclude, that chronic prostatitis increases arterial stiffness and vascular endothelial dysfunction. […] Several previous studies have indicated an important role for reactive oxygen species (ROS) in the pathogenesis of ED, through the overproduction of superoxide, resulting in the acute impairment of penile relaxation and longterm vasculopathy of corpus cavernosum. […] This results in the increase of corporal fibrosis. Increasing evidence demonstrated that CP/CPPS inflammation and the resulting oxidative stress may play important roles in pathological mechanisms of corporal fibrosis.

• #41 Review paperThe enigma of prostatitis. Some historical perspectives on the pathogenesis of prostatitis

  https://www.termedia.pl/Review-paper-The-enigma-of-prostatitis-Some-historical-perspectives-on-the-pathogenesis-of-prostatitis,19,7325,1,1.html

  Any suggestion of a relationship between prostate inflammation and preneoplasia will invoke controversy. […] The enigma of prostatitis persists, but now controlled clinical studies and the exciting input from molecular biology will do much to increase our understanding of this most complex syndrome and provide a basis for the development of new approaches to treatment and management.

• #42 Molecular mechanism and promising treatments of chronic prostatitis/chronic pelvic pain syndrome: An exploratory bibliometric analysis and literature review of preclinical studies

  https://journal.hep.com.cn/up/EN/10.1002/uro2.34

  As one of the most common diseases in urology, a large number of preclinical studies have been accumulated to explore the etiological mechanism and potential intervention of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). […] According to the results of this study, the most common mechanisms involved in CP/CPPS were as follows: Disturbed immune and inflammation mediators, immune cell dysfunction, oxidative stress, dysregulated signaling pathways, apoptosis, gut microbiota, and testosterone metabolism. […] Further translational studies targeting the above mechanisms and validating the objective efficacy of potential treatments indicated by preclinical studies in clinical patients are needed in the future.

• #43

  https://www.pagepressjournals.org/aiua/article/view/aiua.2016.2.133

  Etiopathogenesis of chronic prostatitis is not well defined. […] We think that in this neuromuscular mechanism interstitial Cajal cells have an important role in chronic prostatitis. […] Our hypothesis is that curability of prostatitis is correlated with the number of Cajal cells not subjected to apoptosis.

• #44 Promise and the Pharmacological Mechanism of Botulinum Toxin A in Chronic Prostatitis Syndrome

  https://www.mdpi.com/2072-6651/11/10/586

  Chronic prostatitis/chronic pelvic pain syndrome (CP/ CPPS) has a negative impact on the quality of life, and its etiology still remains unknown. […] Although many treatment protocols have been evaluated in CP/CPPS, the outcomes have usually been disappointing. […] Here, we review the published evidence from animal models to clinical studies for inferring the mechanism of action underlying the therapeutic efficacy of BoNT in CP/CPPS. […] Animal studies demonstrated that BoNT-A, a potent inhibitor of neuroexocytosis, impacts the release of sensory neurotransmitters and inflammatory mediators. […] This pharmacological action of BoNT-A showed promise of relieving the pain of CP/CPPS in placebo-controlled and open-label BoNT-A and has the potential to serve as an adjunct treatment for achieving better treatment outcomes in CP/CPPS patients.

• #45 Promise and the Pharmacological Mechanism of Botulinum Toxin A in Chronic Prostatitis Syndrome

  https://www.mdpi.com/2072-6651/11/10/586

  Growing evidence suggests that inhibition of exocytotic machinery by BoNT-A could modulate sensory processing, inflammation and glandular function. […] BoNT-A causes muscle relaxation by blocking the release of acetylcholine. […] In addition to the role in blocking motor neurons, BoNT-A also has effects on the modulation of sensory nerves and inflammation as evinced by animal studies. […] A large body of evidence now supports that BoNT-A achieves analgesic effect by hindering the release of mediators responsible for painful sensation, including nerve growth factor (NGF), substance P, calcitonin gene-related peptide (CGRP), glutamate, as well as adenosine triphosphate (ATP) involved in afferent neurotransmission. […] Therefore, it is postulated that BoNT-A may relieve the pain associated with chronic prostatitis by inhibiting the abnormal nociceptive neurotransmission conveyed by prostatic afferent nerves.

• #46 P 07. The rapeutical effect of Tacrolimus on Autoimmune Prostatitis in rat model and preliminary study on its mechanism – Yuan – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/406/html

  Objective: To explore the efficacy of tacrolimus in treating experimental autoimmune prostatitis in rat model and its mechanism. […] Conclusions: Tacrolimus can reduce the number of inflammatory cells in prostatic tissue in EAP Rat model. This effect may be related to its suppression of the production of IL-2 and activation of T cells.

• #47 Prostatitis | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/prostate/what-is-prostate-cancer/prostatitis

  Prostatitis can be caused by an infection or inflammation that isn’t related to an infection. […] Prostatitis can be caused by an infection with bacteria, viruses or fungi. […] Surgical procedures, such as a prostate biopsy or getting a catheter, can expose the prostate or urethra to infection. […] Having unprotected sex can expose the prostate to sexually transmitted infections (STIs) that can cause prostatitis. […] Other risks for prostatitis are: muscle spasms of the bladder or pelvic floor, a blockage (obstruction) in the bladder or in an ejaculatory duct, trauma that causes inflammation or nerve damage in the pelvis, a history of urinary tract infections. […] Quercetin is an extract found in red wine, green tea and onions. […] Cernilton is a flower pollen extract. […] These drugs have been shown to reduce inflammation in the prostate and help relieve symptoms in men with CP/CPPS.

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