Two EPS cytokines may guide chronic prostatitis treatment

Measurement of two cytokines in expressed prostatic secretions (EPS) might provide diagnostic guidance for patients with chronic prostatitis/chronic pelvic pain syndrome (CPPS), according to a study presented at the AUA annual meeting.

Levels of macrophage inflammatory protein 1-alpha (MIP-1alpha) and monocyte chemoattractant protein-1 (MCP-1) were significantly elevated in patients with CPPS compared to a control group of men without CPPS. The two cytokines were elevated in noninflammatory as well as inflammatory CPPS, the first report of elevated levels of the two proinflammatory proteins in patients with noninflammatory CPPS.

"The key thing is that in the past people have said that the [noninflammatory CPPS] patients are 'crazy,' that there are no objective markers for the disease process, except for the fact they have symptoms," lead author Jeffrey Stern, MD, told Urology Times. "The nice thing about this study is that it shows that maybe something actually is going on, that we can find the elevated cytokine levels in that subset of CPPS."

The study involved a total of 89 men, including 13 control patients, 32 with inflammatory CPPS (NIH category IIIa), and 44 with noninflammatory CPPS (NIH category IIIb). Enzyme-linked immunosorbent assays of EPS were performed for MIP-1alpha in all 89 men and for MCP-1 in 72.Mean levels of MIP-1alpha were 140.07 pg/ml for controls, 1057.75 pg/ml for patients with inflammatory CPPS, and 978.37 pg/ml for those with noninflammatory CPPS, said Dr. Stern, chief urology resident at Northwestern University Medical Center in Chicago. The control group had a mean MCP-1 level of 599.43 pg/ml, compared to 3261.20 pg/ml for inflammatory CPPS, and 2271.67 pg/ml for noninflammatory CPPS. For both cytokines, the CPPS groups had significantly higher levels compared to the control group (p=.0003 and p=.0002).

Combining the two cytokines, using a cutoff of 146 pg/ml for MIP-1alpha and 704 for MCP-1 resulted in a sensitivity of 88.7% and a specificity of 80%. The results suggest that the two cytokines have potential as biomarkers for inflammatory and noninflammatory CPPS, Dr. Stern concluded.The senior investigator in the study was Anthony J. Schaeffer, MD, chair of urology at Northwestern.