Noninflammatory chronic pelvic pain syndrome: Immunological study in blood, ejaculate and prostate tissue

Objectives: The aim of this prospective study was to observe immunophenotyp ic patterns in patients with noninflammatory chronic pelvic pain syndrome ( Cat IIIB CPPS) for further description and as possible surrogate markers fo r diagnosis and treatment. Methods: Eighty-eight patients with a referral diagnosis of chronic prostat itis underwent fractionated urinary cultures including expressed prostate s ecretion (EPS) and ejaculate analysis twice on two occasions. Monthly serum analyses included C3c, C4, IL-1 alpha, slL-2R, and IL-6. One hundred sampl es from healthy individuals were used as the control group for serum analys is. Monthly ejaculate testing was done for IgG, IgA, IgM, IL-1 alpha, slL-2 R, and IL-6. The control group for ejaculate analysis was composed of 96 no rmal ejaculates (according to the WHO criteria). Immunohistochemical detect ion of CD3 cells (T lymphocytes) and CD20 cells (B lymphocytes) was perform ed in 71 biopsy cylinders of Cat IIIB CPPS patients and in 25 prostate biop sy cylinders of men without symptoms or obstruction. Results: Complete sampling of urinary, serum and ejaculate specimens was ac hieved in 50/88 (57%) patients. Cat IIIB CPPS was observed in 44/50 (88%) p atients. Intra-acinar T-lymphocytic infiltrates were dominated by T cytotox ic cells (p = 0.05). Immunohistochemical studies showed inflammatory expres sion in serum complement, serum interleukin, and ejaculate interleukin conc entrations in relation to the presence of large numbers of T cells (all p v alues less than or equal to 0.01). No difference was found in the proportio n of B lymphocytes in patients with Cat IIIB CPPS compared to the control g roup. Serum and ejaculate IL-6 and ejaculate IgA increased significantly an d dropped again, correlating with a release of clinical symptoms. Conclusions: Interleukin, complement and immunoglobulin determinations in s erum and ejaculate reveal an inflammatory process even in Cat IIIB CPPS. Th e findings of intra-acinar T-cell-rich infiltrates and the associated infla mmatory reaction may be a significant advance in defining Cat IIIB CPPS cau sed by a possible autoimmune component. Serum and ejaculate IL-6 and ejacul ate IgA are possible surrogate markers for the diagnosis and treatment of C at IIIB CPPS. Copyright (C) 2001 S. Karger AG, Basel.