Abstracts
Antioxidant Vitamins
Antioxidant vitamins
Vitamins C and E may counteract some of the negative effects of androgens that induce prostate cancer. This study determined that these antioxidants might reduce the presence of reactive oxygen species, ROS, on androgens by 57%. ROS are widely known to damage DNA particles and may lead to tumor development and aging. Thus, vitamins C and E may inhibit ROS binding onto androgens, thereby restraining the development of prostate cancer.
Ripple MO, Henry WF, Schwarze SR, Wilding G, Weindruch R: Effect of antioxidants on androgen-induced AP-1 and NF-kappaB DNA-binding activity in prostate carcinoma cells, J Natl Cancer Inst 1999 Jul 21;91(14):1227-32
Diets with Fruit
Diets with fruit
Diets high in butter and margarine and high concentrations of zinc found in meat and seed oil might increase the risk of developing an enlarged prostate gland. However, diets high in fruit may lower the risk of benign prostatic hyperplasia (BPH). Also found in clinical studies, increasing age increased the zinc levels in blood as well as the risk of BPH. Thus, diets low in zinc and fats, including butter and margarine, and high in fruits may reduce the risk of BPH among the older male population.
Lagiou P, et al.: Diet and benign prostatic hyperplasia: a study in Greece: Urology. 1999 Aug;54(2):284-90.
Differential Diagnosis & Prostatitis
Differential diagnosis
Chronic muscle and tendon injuries to the groin are common sports injuries. The symptoms of groin injuries are often uncharacteristic which can result in a delay in the correct and specific diagnosis being reached. The most common injury is the overuse strain resulting in chronic tendinitis of the adductor muscle/tendon units, especially the adductor longus. The rectus femoris and rectus abdominous muscles and tendons are also commonly affected.
The differential diagnoses are many and often difficult to reach. The most commonly overlooked differential diagnoses are chronic prostatitis and hernias.
Karlsson J et al., Chronic groin injuries in athletes. Recommendations for treatment and rehabilitation. Sports Med, 1994 Feb, 17:2, 141-8.
PSA
PSA
Prostate-specific antigen (PSA) is now widely accepted as a useful tumor marker for the diagnosis and follow-up of prostatic cancer. An elevated level of PSA has been asserted to be highly specific for prostate cancer, although patients with large benign prostate glands and those with bacterial prostatitis may also have slightly elevated levels.
Measured the serum PSA level in the patients with acute and chronic bacterial prostatitis and consecutively monitored the PSA level in 6 patients who had acute prostatitis and an elevated PSA level.
The PSA level was found to be elevated during the acute phase of prostatic inflammation, and the elevated, PSA level in the patients with acute prostatitis returned to the normal level within 14 days after initiation of antimicrobial therapy in all 6 patients.
In 1 patient with chronic prostatitis the elevated PSA level persisted after antibiotic treatment. He was found to have adenocarcinoma by transrectal ultrasonography and biopsy.
A markedly elevated serum PSA level in bacterial prostatitis can cause confusion in the diagnosis of prostatic carcinoma. Therefore, PSA determination should be obtained after complete clinical resolution of inflammation to exclude prostatic malignant involvement.
Yamamoto M et al., Prostate-specific antigen levels in acute and chronic bacterial prostatitis. Hinyokika Kiyo, 1993 May, 39:5, 445-9.
PSA (2)
Evaluated the occurrence of increased prostate-specific antigen (PSA) serum concentration in patients with prostatitis and low incidence of benign prostatic hyperplasia and prostatic cancer, PSA was measured in a selected population.
An increased PSA (> 4 ng/ml) was found in 5/7 (71%) patients with acute prostatitis, and in 2/13 (15%) and 2/32 (6%) patients with chronic bacterial and abacterial prostatitis, respectively.
No patient with prostatodynia had an increased PSA.
In patients with bacterial prostatitis PSA level decreased to normal value after effective antibiotic therapy in most cases.
Prostatitis must be considered when using PSA as tumor marker.
Pansadoro V et al., Prostate-specific antigen and prostatitis in men under fifty. Eur Urol, 1996, 30:1, 24-7.
Psychology
Psychology
Men with chronic prostatitis are frequently seen in urological practice and are difficult to treat with standard antimicrobial medications.
Assessed chronic prostatitis patients with pain using a standard chronic pain clinic psychological approach.
Prostatitis patients were employed but reported that their symptoms greatly interfered with their sexual/romantic relationships.
Back pain patients reported that their pain interfered primarily with work; most of these patients had long-term marital relationships, whereas few prostatitis patients did.
Half of the prostatitis patients met criteria for major depression, but back pain patients were more somatically focused, depressed, and anxious.
The constellation of relationship problems, disruptions in sexual functioning, levels of depression, along with failure of multiple previous medical treatments in men with chronic prostatitis indicates that continued antimicrobial therapy is unlikely to provide the "cure" these patients seek.
Psychological evaluation, couples' counseling, individual counseling, and medications for depression all may play a role in a comprehensive approach to these patients.
Egan KJ & Krieger JN: Psychological problems in chronic prostatitis patients with pain. Clin J Pain, 1994 Sep, 10:3, 218-26.
Questionnaire (Holland)
Questionnaire (Holland)
Dutch urologists (n = 250, 136 responded) and regional general practitioners (GPs; n = 400, 176 responded) were contacted concerning current diagnostics and treatment modalities applied in patients with prostatitis syndromes.
The patients seen by urologists seem to be younger (30-40 years) and they mostly complain of pain in the perineum, penis or scrotum, while GPs see older patients (> 40 years) mainly presenting with micturition complaints.
Urologists think nonbacterial causes (40%) most important, while GPs mention bacterial infections (63%) as the most important cause.
The first choice of therapy is antibiotics, mostly co-trimoxazole Sulfatrim for 3 weeks, but patients seen by urologists are more resistant to this therapy. If not successful, urologists frequently prescribe a second course with antibiotics. However, many urologists think psychosomatic causes are an important factor in the etiology of prostatitis.
de la Rosette JJ et al., Results of a questionnaire among Dutch urologists and general practitioners concerning diagnostics and treatment of patients with prostatitis syndromes. Eur Urol, 1992, 22:1, 14-9.
Urethral Flora
Urethral flora
Long term use of antibiotics for prostatitis has been found to destroy the normal urethral flora that would otherwise interfere with virulent organisms.
The application to prevent urinary tract infections with lactobacilli is a relatively new concept.
16 commercial lactobacillus products were examined; 11 were found to be contaminated with pathogens and only 4 contained the lactobacillus acidophilus as stated on the label. There is evidence from the literature that lactobacilli can prevent urogenital as well as intestinal infections.
"Vaginal Flora and Urinary Tract Infections", Reid, Gregor, MD., et al, Current Opinion in Infectious Disease, 1991;4:37-41.
Voiding
Voiding
Chronic lower urinary tract symptoms in young men (less than 50 years) are often attributed to misdiagnosed chronic nonbacterial prostatitis.
The distribution of urodynamic abnormalities included 74 (54%) patients with primary vesical neck obstruction, 33 (24%) with obstruction localized to membranous urethra (pseudodyssnergia), 23 (17%) with impaired bladder contractility, and the remaining 7 (5%) with an acontractile bladder. Detrusor instability was present in 67 men (49%).
Voiding dysfunction among young men is common and is often misdiagnosed. Videourodynamic evaluation is very useful in establishing the correct diagnosis and ultimately in delivery of appropriate therapy.
Kaplan SA e al., Etiology of voiding dysfunction in men less than 50 years of age. Urology, 1996 Jun, 47:6, 836-9.
Zinc and Magnesium
Zinc and Magnesium
In comparison with other organs, the human prostate is characterized by high Zn and Mg content. In BPH the Zn levels are increased. They are markedly decreased in carcinoma of the prostate and in prostatitis.
Zn and Mg play an important role as catalysts in various enzymatic reactions. It has been postulated that changes in concentrations of these two elements are parallel.
Zinc ions inhibit androgen metabolism in the prostate. Physiologic Zn serum levels are equal to or above 90 micrograms/dl.
Magnesium, unlike zinc, is uniformly distributed within different areas of the gland. In BPH, both normal and increased Mg levels in the prostate have been reported. Mg plays an important role as an activator of enzymes (phosphatases) involved in ATP metabolism, thus affecting both katabolic and anabolic processes.
Dutkiewicz S: Zinc and magnesium serum levels in patients with benign prostatic hyperplasia (BPH) before and after prazosin therapy. Mater Med Pol, 1995 Jan-Mar, 27:1, 15-7.
Vitamins C and E
Vitamins C and E
Vitamins C and E may counteract some of the negative effects of androgens that induce prostate cancer. This study determined that these antioxidants might reduce the presence of reactive oxygen species, ROS, on androgens by 57%. ROS are widely known to damage DNA particles and may lead to tumor development and aging. Thus, vitamins C and E may inhibit ROS binding onto androgens, thereby restraining the development of prostate cancer.
Ripple MO, Henry WF, Schwarze SR, Wilding G, Weindruch R: Effect of antioxidants on androgen-induced AP-1 and NF-kappaB DNA-binding activity in prostate carcinoma cells, J Natl Cancer Inst 1999 Jul 21;91(14):1227-32
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