Inflammatory marker high, endorphins low in prostatitis.

[Anonymous]

Inflammatory marker high, endorphins low
in prostatitis.

Scott Tennant 04/01/2001 Urology Times

Arlington, VA--No matter their diagnostic
category, men with chronic pelvic pain
syndrome (CPPS) have high levels of a
marker for inflammation and low levels of a
natural opioid, suggesting that agents that
reverse these trends may be of benefit to
CPPS patients.

Daniel Shoskes, MD, director of renal
transplantation within the department of
urology at Cleveland Clinic Florida, recently
presented a study in which levels of beta-
endorphin and PGE-2 (a COX-2-mediated
product) were measured in the expressed
prostatic secretions of men with CPPS
category II, IIIa, or IIIb. "I believe there
are different etiologies that produce the
same clinical syndrome of chronic
prostatitis, but the one thing they all have in
common is pain," Dr. Shoskes said in a
presentation at the International Prostatitis
Collaborative Network workshop here.
"When you have inflammation, white cells
at the inflammatory site produce this beta-
endorphin, a natural opioid. So one of the
questions we had was whether pain in CPPS
is related to an interaction between the
inflammatory mediators and opioid
mediators that may naturally exist to quell
inflammation-related pain."

Prostatic secretions were collected from 35
patients and frozen until analysis. The
secretions were centrifuged, and small
samples (5 to 10 microliters) were used to
measure levels of beta-endorphin and PGE-
2. The investigators stratified samples
according to prostatitis category. They also
compared levels in men who had samples
taken before and after successful therapy
(which included patients treated with
antibiotics for infection, phytotherapy for
inflammation, or physiotherapy and various
agents for neuromuscular pain).

"Statistically speaking, there were no
significant differences in levels of beta-
endorphin and PGE-2 among the three
diagnostic categories," Dr. Shoskes said.
"But when we looked at levels before and
after successful therapy, it was a different
story."

Etiology unimportant

Indeed, effective treatments yielded a more
than two-fold increase in endorphins and a
similarly large decrease in PGE-2.

"So from that we concluded that patients
with chronic pelvic pain syndrome do have
elevated levels of PGE-2 and low levels of
beta-endorphins in their prostatic
secretions, regardless of the etiology of
their condition," said Dr. Shoskes.
"Successful treatments--whatever they may
be--were associated with both a reduction
in the inflammatory mediator and an
increase in beta-endorphins in the
prostate."

These findings could help to explain the
mechanisms of action for certain agents
such as antioxidants, Dr. Shoskes explained,
and may imply targets for novel
interventions.

"If this is a final common pathway for
symptom pathogenesis, all we may need to
look for are agents that serve as modulators
of inflammation and pain perception," Dr.
Shoskes concluded.