Chronic prostatitis may have autoimmune component
Anonymous
component : Research documents evidence
of self-reactivity to PSA; may point to a
therapeutic target.
Scott Tennant 04/01/2001 Urology Times
Arlington, VA--With each piece of data he
collects and every study his team publishes,
Richard Alexander, MD, is becoming
increasingly convinced that autoimmunity
may be a potential etiology for at least a
subset of patients with chronic nonbacterial
prostatitis syndrome.
"It can be difficult sometimes for people to
understand that immunology plays a much
larger role in our daily lives than just
fighting off microbial infections," Dr.
Alexander said at the International
Prostatitis Collaborative Network workshop
here. "It's clear that some men with chronic
prostatitis may have their symptomatology
attributable to autoimmunity or self-
recognition by the immune system." Dr.
Alexander repeatedly emphasized that
autoimmunity appears to play a role in only
some patients with chronic prostatitis. He
said bacterial infections are responsible for
a small percentage of cases.
"But what we're faced with is this: There
are some men who are acutely symptomatic
and to whom you give antibiotics, and they
get better. That's the end of it. But the
overwhelming majority of patients have this
long-standing, chronic, episodic, relapsing
problem that rarely goes away with
antimicrobial therapy. These are the people
we have to deal with and have the least
ability to help," said Dr. Alexander,
associate professor of urology at the
University of Maryland School of Medicine,
Baltimore, and a recognized leader in the
field of prostate immunology.
Recognizing that inflammation of the
prostate is common and is often a sign of a
cell-mediated immune response, Dr.
Alexander and colleagues wondered
whether prostatitis could in be a
manifestation of autoimmunity. If so, one
may find evidence of T-cell reactivity in men
experiencing this autoimmune reaction.
They obtained peripheral blood
mononuclear cells from 10 men with a
history of chronic prostatitis/chronic pelvic
pain syndrome (CP/CPPS) and 15 controls.
Seminal plasma, from normal donors and
men with seminal vesicle atresia, was the
antigen used to attract a T-cell response.
Such a response to seminal plasma was
observed in three of the 10 men with
CP/CPPS, compared with none of the
controls. The investigators interpreted this
as direct evidence that some men with
CP/CPPS have an autoimmune component
to their disease (Urology 1997; 50:893-9).
"But we wanted to know the specific
antigen being recognized in this response,"
Dr. Alexander said. "So we repeated these
assays using a little different methodology
to look at proliferation."
Evidence of self-reactivity
The Maryland researchers tried to
determine whether any of the principal
secretory proteins of the prostate could be
candidate antigens for autoimmunity in
chronic prostatitis. They again obtained
peripheral blood mononuclear cells from 14
CP/CPPS patients and 12 normal volunteers.
These cells were examined for responses to
PSA, prostatic acid phosphatase, and beta-
microseminoprotein.
The cells from the CP/CPPS patients yielded
a significant response only to PSA. On the
other hand, the 12 normal men (who had
no history of genitourinary disease or
symptoms) did not respond to any of the
three proteins (Prostate 2000; 15:49-54).
"We repeated the trial in a man with
granulomous prostatitis and again found
PSA-specific response in immune cell
proliferation," said Dr. Alexander. "What this
at least told us is that self-reactivity to
prostatic proteins [in this case PSA] is a
reality."
Dr. Alexander's group also found that some
men with CP/CPPS had higher seminal
levels of the pro-inflammatory cytokines
interleukin-1 beta and tumor necrosis
factor-alpha (TNF) than normal controls
(Urology 1998; 52:744-9).
"When we observed this, we thought that
perhaps we had finally found an objective
way to detect and measure an autoimmune
response," said Dr. Alexander. "It could also
be a target for therapy, since TNF is a very
toxic cytokine with a host of negative
effects in the body."
He said that patients with autoimmune
disorders such as rheumatoid arthritis have
benefited from agents that block TNF,
leading to his current involvement with a
trial of etanercept (Enbrel), a TNF inhibitor.
The placebo-controlled, randomized,
double-blind prospective study is recruiting
prostatitis patients and will be conducted at
the University of Maryland and UCLA.
"It's important to again note that we found
evidence of self-reactivity in some men, but
not all," Dr. Alexander said. "I think we're
going to find many different causes for a
disease as poorly defined as chronic pelvic
pain lasting 3 months or longer. But one of
them, I believe, is autoimmunity in some
patients."
Thad Noles
so don't ream me out if you think this is way off base.
I know there's probably some debate about this, but some people think that
sex (or masturbation) raises your PSA level. I talked to some guys who said
they were told by their urologists not to have sex or masturbate for 2 days
prior to having their PSA levels measured. Now if their prostatitis is
resulting from some kind of autoimmune activity involving the prostate,
could this make it worse? Since that protein is possibly the antigen,
wouldn't more of it being dumped into your bloodstream make your symptoms
worse? Kind of like being allergic to pollen and suddenly being exposed to a
lot of it. I know some guys have said sex seems to make them worse, and some
have said that really overdoing it actually caused them to have a flare. I
wonder if, rather than the physical stress of sex on an inflamed prostate,
this possible "antigen increase" might explain it.
Just a thought...
"Anonymous" <nob...@remailer.privacy.at> wrote in message
news:d24b68fbc4ef2c97...@remailer.privacy.at...
Public <Anonymous_Account>
> A curious question occurred to me. I am a relative newbie to a lot of this,
> so don't ream me out if you think this is way off base.
>
> I know there's probably some debate about this, but some people think that
> sex (or masturbation) raises your PSA level. I talked to some guys who said
> they were told by their urologists not to have sex or masturbate for 2 days
> prior to having their PSA levels measured. Now if their prostatitis is
> resulting from some kind of autoimmune activity involving the prostate,
> could this make it worse? Since that protein is possibly the antigen,
> wouldn't more of it being dumped into your bloodstream make your symptoms
> worse? Kind of like being allergic to pollen and suddenly being exposed to a
> lot of it. I know some guys have said sex seems to make them worse, and some
> have said that really overdoing it actually caused them to have a flare. I
> wonder if, rather than the physical stress of sex on an inflamed prostate,
> this possible "antigen increase" might explain it.
>
> Just a thought...
Int Urol Nephrol 1998;30(1):53-8 Related Articles, Books
The effects of ejaculation on serum prostate-specific antigen (PSA).
Yavascaoglu I, Savci V, Oktay B, Simsek U, Ozyurt M.
Department of Urology, Uludag University, Bursa, Turkey.
To determine the effects of ejaculation on serum PSA, we measured serum
levels just before masturbation and 24 hours and 5 days later in a study
group (n=25) aged between 23 and 25 years. In the study group, 16 cases
showed a decrease (mean 22.37%, range 10-50%) in serum PSA levels 24
hours after ejaculation, while 6 had higher levels (mean 38.33%, range
21-67%) and 3 had no changes. No relation was found between seminal
plasma levels or total amounts expelled of this marker and the
difference in serum levels due to ejaculation. In the control group free
of ejaculation in the same period determinations of serum PSA levels
revealed no significant changes between days 0, 1 and 5. As compared
with the control group, the changes in the study group were found to be
statistically insignificant. These results may indicate that ejaculation
has an insignificant effect on serum PSA levels.
Publication Types: Clinical trial Randomized controlled trial
PMID: 9569113 [PubMed - indexed for MEDLINE]
_____________________________________________________
Questions about CPPS/CP/Prostatitis/IC?
Visit http://cpps.50megs.com
Having a biopsy? Be sure to ask for
a mast cell evaluation!
Are you a twin with CPPS, or do you have close relatives
with lower urinary tract symptoms? Contact Dr Jordan
Dimitrakov at jdimi...@my-deja.com with details of
your case to help him with research in progress.
John Garst
Anonymous <nob...@remailer.privacy.at> wrote:
...
> The cells from the CP/CPPS patients yielded
> a significant response only to PSA....
This is scary. Inflammation ups the PSA, and an upped PSA ups the
inflammation! If this kind of autocatalytic situation had no controlling
factor, the PSA would quickly skyrocket to astronomical values. There
must be controlling factors.
These are especially interesting and promising results, I think.