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Journal of Reproductive Immunology Nov 2020Mucosal immunity defines the relationship of surfaces in contact with the environment and integrates diverse tissues such as epidermis, gum, nose, gut, uterus and... (Review)
Review
Mucosal immunity defines the relationship of surfaces in contact with the environment and integrates diverse tissues such as epidermis, gum, nose, gut, uterus and prostate with the immune system. Although considered part of a system, each mucosa presents specific immune features beyond the barrier and secretory functions. Information regarding the mucosal immunology of the male reproductive tract and the prostate gland in particular is scarce. In this review, we approach the prostate as an epithelial barrier and as part of the mucosal immune system. Finally, we also raise a series of questions that will improve the understanding of this gland, its role in reproduction and its sensitivity/resistance to disease.
Topics: Animals; Disease Models, Animal; Host-Pathogen Interactions; Humans; Immunity, Mucosal; Immunoglobulin A; Immunoglobulin G; Male; NLR Proteins; Prostate; Reproductive Tract Infections; Semen; Signal Transduction; Toll-Like Receptors
PubMed: 32853844
DOI: 10.1016/j.jri.2020.103190 -
The Journal of Urology Feb 2024Transrectal prostate biopsy has come under scrutiny due to potential for postbiopsy infections and transperineal prostate biopsy is being offered as the safer... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Transrectal prostate biopsy has come under scrutiny due to potential for postbiopsy infections and transperineal prostate biopsy is being offered as the safer alternative. However, there is a lack of randomized comparative studies. Our goal was to directly evaluate infectious and noninfectious complications following the 2 biopsy procedures.
MATERIALS AND METHODS
We conducted a prospective, pragmatic, randomized clinical study in men undergoing prostate biopsy. The participants underwent either transrectal or transperineal prostate biopsy in the office under local anesthesia. The primary outcome was a 30-day composite infectious complication rate, comprising of 1 or more components including fever, genitourinary infection, antibiotic prescriptions, office or emergency visits, hospitalization, or sepsis. Secondary outcomes included 30-day composite noninfectious complications (urinary or hemorrhagic).
RESULTS
Of the 763 randomized participants, 718 underwent either transrectal (351) or transperineal (367) prostate biopsy. A composite infectious complication event occurred in 9 participants (2.6%) in the transrectal and 10 participants (2.7%) in the transperineal group (odds ratio, 1.06; 95% CI, 0.43 to 2.65; = .99). None of the participants developed sepsis in either group. There were no between-group differences in any of the individual component infectious events. A composite noninfectious complication occurred in 6 (1.7%) and 8 (2.2%) participants in the transrectal and transperineal groups, respectively (odds ratio, 1.28; 95% CI, 0.44 to 3.73; = .79). No participants required hospitalization or other interventions.
CONCLUSIONS
Among men undergoing transperineal or transrectal prostate biopsy, we could not demonstrate any difference in the infectious or noninfectious complications. Both biopsy approaches remain clinically viable and safe.
Topics: Humans; Male; Biopsy; Image-Guided Biopsy; Prospective Studies; Prostate; Prostatic Neoplasms; Rectum; Sepsis
PubMed: 37976319
DOI: 10.1097/JU.0000000000003788 -
Current Opinion in Urology Nov 2019Prostate cancer (PCa) diagnostics have undergone a number of changes as a result of efforts to reduce the detection rate of indolent prostate cancer and to increase the... (Review)
Review
PURPOSE OF REVIEW
Prostate cancer (PCa) diagnostics have undergone a number of changes as a result of efforts to reduce the detection rate of indolent prostate cancer and to increase the hit rate for clinically significant prostate cancer (csPCa). Here, we look at those studies that have shifted our knowledge and the impact these have had on clinical practice.
RECENT FINDINGS
The introduction of multiparametric MRI (mpMRI) and approaches to active surveillance have changed the landscape in prostate cancer diagnostics, reducing the number of men that need biopsy, but increasing the need for accuracy in mapping the extent of prostate cancer. As mpMRI reporting has become more accurate at predicting PCa, biopsy techniques have also evolved towards lesion (PI-RADS score 3-5) targeted biopsies. Uncertainty remains regarding the preferred approach to targeted biopsy, the need for systematic biopsies, and the place of software ultrasound/MRI fusion or in-bore MRI biopsy techniques versus 'cognitive' fusion techniques.
SUMMARY
Prostate biopsies remain essential for the diagnosis of PCa. But how best to do this? Latest guidelines advocate performing both targeted and systematic biopsies. Traditionally, prostate biopsies have been performed transrectally (TRUS) with hospital readmission rates of around 3% mainly because of infection. Additionally, TRUS prostate biopsies can miss anterior prostatic lesions. The transperineal approach addresses both these issues, but has historically required general anaesthetic such that adoption for front-line diagnostics is very difficult. Recent techniques to undertake transperineal biopsy under local anaesthetic have fundamentally changed this paradigm offering the genuine possibility that in 5 years' time, all front-line diagnostic biopsies will be performed as LATP.
Topics: Biopsy; Humans; Image-Guided Biopsy; Magnetic Resonance Imaging; Magnetic Resonance Imaging, Interventional; Male; Prostate; Prostatic Neoplasms; Sensitivity and Specificity
PubMed: 31567434
DOI: 10.1097/MOU.0000000000000678 -
Urologie (Heidelberg, Germany) May 2023Prostate biopsy has been at the center of controversy in recent years due to high infection complications associated with the transrectal route and the withdrawal of... (Meta-Analysis)
Meta-Analysis Review
Prostate biopsy has been at the center of controversy in recent years due to high infection complications associated with the transrectal route and the withdrawal of authorization for fluoroquinolones and fosfomycin trometemol as prophylaxis. The Urological Infections Guideline Group of the European Association of Urology (EAU) recently published a meta-analysis in two parts based on randomized controlled trials (RCTs) and annually updates the data for the EAU guidelines. The meta-analyses show that transperineal prostate biopsy is associated with significantly fewer infectious complications than transrectal biopsy and should therefore be preferred. If transrectal biopsy is still used, then intrarectal cleansing with povidone-iodine and antibiotic prophylaxis should be used. Antibiotic prophylaxis strategies include targeted prophylaxis after sensitivity testing of the rectal flora, augmented prophylaxis with several antibiotics and empirical monoprophylaxis. Data from RCTs are available for aminoglycosides and third-generation cephalosporins.
Topics: Male; Humans; Prostate; Biopsy; Rectum; Anti-Bacterial Agents; Povidone-Iodine
PubMed: 36882551
DOI: 10.1007/s00120-023-02065-w -
Scientific Reports Oct 2023The involvement of human papillomavirus (HPV) in the prostate carcinogenesis is a controversial issue. The presented meta-analysis was carried out to systematize the... (Meta-Analysis)
Meta-Analysis
The involvement of human papillomavirus (HPV) in the prostate carcinogenesis is a controversial issue. The presented meta-analysis was carried out to systematize the currently available research results regarding this question. The meta-analysis includes case-control studies from 1991 to 2022, which were collected from publicly available bibliometric databases. The meta-analysis was performed using Meta-Essentials_1.5 software. We used Begg's and Egger's methods to assess publication bias. Cochran's Q test was used to assess heterogeneity and the I index was employed for calculating the variation in the pooled estimations. The analysis was based on data from 27 case-control studies, which in total yielded 1607 tumour tissue samples of prostate and 1515 control samples (317 samples of normal tissue, 1198 samples of benign prostatic hyperplasia (BPH)). According to the data obtained, there was high risk of prostate cancer by HPV infection in both cases. HPV was found in prostate cancer in 25.8% of cases, while in normal tissue samples the virus was detected in 9.2% of cases and in 17.4% with BPH as a control. In particular, more studies on the association of HPV and prostate cancer are needed to prove the role of HPV in the development of prostate cancer. In addition to the controversial question of whether HPV infection is associated with prostate cancer risk, it is worth considering whether the samples used as a control have an impact on the results. The impact of HPV in prostate tumour tissue samples on outcome should also be investigated.
Topics: Male; Humans; Human Papillomavirus Viruses; Papillomavirus Infections; Prostatic Hyperplasia; Papillomaviridae; Prostatic Neoplasms
PubMed: 37789036
DOI: 10.1038/s41598-023-43767-7 -
Current Opinion in Urology Jan 2022Prostate biopsy is a very commonly performed office procedure leading to the diagnosis of the most prevalent solid-organ malignancy in American men. Although the... (Review)
Review
PURPOSE OF REVIEW
Prostate biopsy is a very commonly performed office procedure leading to the diagnosis of the most prevalent solid-organ malignancy in American men. Although the transrectal technique for prostate biopsy remains the gold standard, there is increasing interest in the transperineal approach as it offers a clean, percutaneous approach that significantly decreases the risk for infection. In this review, we discuss emerging developments in transperineal prostate biopsy that may optimize the way biopsies are performed in clinical practice.
RECENT FINDINGS
Similarly, to transrectal biopsy, the transperineal approach also allows for the performance of systematic and MRI-targeted biopsy cores. As transperineal biopsy obviates the translocation of rectal bacteria to the prostate or bloodstream, in contrast to transrectal biopsy, it is feasible to forgo peri-procedural antibiotics in accordance with professional guidelines. This may attenuate antimicrobial resistance that may be associated with augmented prophylaxis. In addition, although transperineal biopsy may be traditionally performed under general anesthesia using a template grid, it may also be performed freehand under local anesthesia or sedation. Avoiding prophylactic antibiotics and general anesthesia as well as reducing infections/hospitalizations for transperineal biopsy scaled nationally will likely result in significant healthcare savings.
SUMMARY
Transperineal biopsy with combined systematic and MRI-targeted cores, offers several advantages over conventional transrectal biopsy. Transperineal biopsy under local anesthesia and without periprocedural antibiotic is emerging as a promising method for prostate cancer diagnosis and surveillance.
Topics: Anti-Bacterial Agents; Biopsy; Humans; Image-Guided Biopsy; Male; Perineum; Prostate; Prostatic Neoplasms; Retrospective Studies
PubMed: 34783715
DOI: 10.1097/MOU.0000000000000947 -
Cell Calcium Sep 2019Calcium stones and calculi are observed in numerous human tissues. They are the result of deposition of calcium salts and are due to high local calcium concentrations.... (Review)
Review
Calcium stones and calculi are observed in numerous human tissues. They are the result of deposition of calcium salts and are due to high local calcium concentrations. Prostatic calculi are usually classified as endogenous or extrinsic stones. Endogenous stones are commonly caused by obstruction of the prostatic ducts around an enlarged prostate resulting from benign prostatic hyperplasia or from chronic inflammation. The latter occurs mainly around the urethra and is generally caused by reflux of urine into the prostate. Calcium concentrations higher than in the plasma at sites of infection may induce the chemotactic response that eventually leads to recruitment of inflammatory cells. The calcium sensing receptor (CaSR) may be crucial for this recruitment as its expression and activity are increased by cytokines such as IL-6 and high extracellular calcium concentrations, respectively. The links between calcium calculi, inflammation, calcium supplementation, and CaSR functions in prostate cancer patients will be discussed in this review.
Topics: Animals; Calcinosis; Calcium; Calculi; Humans; Inflammation; Male; Neoplasms; Prostate; Prostatic Hyperplasia; Receptors, Calcium-Sensing; Signal Transduction
PubMed: 31276858
DOI: 10.1016/j.ceca.2019.06.005 -
MMW Fortschritte Der Medizin Sep 2022
Review
Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Infections; Chronic Disease; Humans; Male; Prostatitis
PubMed: 36064922
DOI: 10.1007/s15006-022-1815-x -
Frontiers in Cellular and Infection... 2022We aimed to clarify the presence and localization of the prostate microbiota and examine its association with benign prostate enlargement (BPE).
INTRODUCTION
We aimed to clarify the presence and localization of the prostate microbiota and examine its association with benign prostate enlargement (BPE).
METHODS
The microbiota of prostate tissues and catheterized urine from 15 patients were analyzed by 16S metagenomic analysis and compared to show that the prostate microbiota was not a contaminant of the urinary microbiota. Fluorescence in situ hybridization (FISH) and in situ hybridization (ISH) using the specific probe for eubacteria was performed on prostate tissue to show the localization of bacteria in the prostate. The BPE group was defined as prostate volume ≥30 mL, and the non-BPE group as prostate volume <30 mL. The microbiota of the two groups were compared to clarify the association between prostate microbiota and BPE.
RESULTS
Faith's phylogenetic diversity index of prostate tissue was significantly higher than that of urine (42.3±3.8 vs 25.5±5.6, P=0.01). Principal coordinate analysis showed a significant difference between the microbiota of prostate tissue and catheterized urine (P<0.01). FISH and ISH showed the presence of bacteria in the prostatic duct. Comparison of prostate microbiota between the BPE and non-BPE groups showed that the Chao1 index of the BPE group was significantly lower than that of the latter [142 (50-316) vs 169 (97-665), P=0.047] and the abundance of Burkholderia was significantly higher in the BPE group than in the latter.
CONCLUSIONS
We demonstrated that the prostate microbiota was located in the prostatic duct and reduced diversity of prostate microbiota was associated with BPE, suggesting that prostate microbiota plays a role in BPE.
Topics: Humans; Male; Prostate; In Situ Hybridization, Fluorescence; Phylogeny; Prostatic Hyperplasia
PubMed: 36569206
DOI: 10.3389/fcimb.2022.1048319 -
International Journal of Molecular... Jul 2023Benign prostatic hyperplasia (BPH) is a chronic proliferative disease showing stromal-dominant proliferation. However, the detailed proliferation mechanism has remained... (Review)
Review
Benign prostatic hyperplasia (BPH) is a chronic proliferative disease showing stromal-dominant proliferation. However, the detailed proliferation mechanism has remained unclear. Although aging and androgen have been reported as definitive risk factors for BPH, recent studies have focused on the involvement of androgen-independent factors. Androgen-independent factors include ischemia, oxidative stress, metabolic syndrome, infection, autoimmune reactions, and inflammation, with inflammation in BPH tissues playing a central role in the BPH proliferative process. Inflammation in BPH tissues by various factors finally leads to tissue remodeling and stromal proliferation through the wound healing process of the prostate. To elucidate the proliferative mechanism of BPH, a study using whole-genome gene expression analysis in a stromal-dominant BPH rat model was performed and showed that immune response-related pathways and complement classical pathways are activated. Furthermore, expression analysis using this BPH rat model showed that the autoimmune reaction triggered complement pathway activation in the proliferative process of BPH. BPH is a multifactorial disease, and understanding the role of androgen-independent factors including immune responses contributes to elucidating the pathogenesis of BPH. Androgen-independent factors may lead to new therapeutic targets for BPH, and further development of this research is expected.
Topics: Humans; Male; Rats; Animals; Prostatic Hyperplasia; Androgens; Prostate; Inflammation; Cell Proliferation
PubMed: 37511400
DOI: 10.3390/ijms241411634