Although the symptoms of CP/CPPS mimic those of a true prostatic infection, there has yet to be a clear association between bacteria and the presence of CP/CPPS. Localizing cultures in men with CP/CPPS and asymptomatic controls showed almost identical numbers of bacteria isolated from urine, prostatic fluid, and post-prostate massage urine.8 A history of sexually transmitted disease Inhibitors,research,lifescience,medical is almost twice as common in men with CP/CPPS compared with men

without the condition, indicating a possible role for urethritis as a causative factor.6 A recent report indicates that blood samples examined for Helicobacter pylori antibodies were positive in 76% of men with CP/CPPS compared with 62% in controls (P < .05). Although this is significantly greater, a large number of patients Inhibitors,research,lifescience,medical without symptoms were seropositive.9 The role of inflammation is also unclear in CPPS. The fact that men with category IIIB have no inflammation but pain makes this link questionable. Also, in men with CPPS who have inflammation, the amount of inflammation does not correlate with symptoms.10 There is evidence, however, that autoimmunity may be a factor in some men. CD4 T cells purified from 31 men with CPPS were compared with 27 controls with exposure

to antigens consisting of parts of the prostatic acid phosphatase (PAP) and prostate-specific Inhibitors,research,lifescience,medical antigen (PSA) molecules. Activation and release of INFα are markers of ZD6474 in vitro recognition of the antigens. A region of the PAP molecule, 173–192, Inhibitors,research,lifescience,medical was recognized in 15 of 23 patients and in only 5 of 22 controls (P < .01). Recognition of parts of the PSA molecule was also greater in CPPS (12 of 24 CPPS vs 4 of 22 controls; P < .05).11 These data indicate the

likelihood of autoimmunity in some men with CPPS. Although the utility of cytokines as biomarkers has been mixed so far in CPPS, two new candidate molecules have emerged as likely being important in this syndrome. Macrophage inflammatory protein 1-α(MIP-1α) and monocyte chemo-attractant protein-1 (MCP-1) have both been found in significantly greater amounts Inhibitors,research,lifescience,medical in the expressed prostatic secretions of men with CP/CPPS compared with asymptomatic controls and men with benign prostatic hyperplasia (P = .0002).12 In addition, MIP-1α levels correlated with pain levels in these men (P = .0007). Given that the cardinal symptom in CP/CPPS is pain, it also makes sense that the nervous system see more plays a role. In addition to MIP-1α, another marker that correlates with pain is nerve growth factor (NGF).13 NGF is a neuropeptide that plays a role in nociception and regulates the sensitivity of adult neurons to capsaicin, which excites C-fibers in addition to mediating long-term depolarization via Nmethyl-D-aspartate receptors. Men with CPPS have been found to have alterations in both afferent and efferent autonomic nervous system function.14 Also, affecting both immune and nervous system function are endocrine factors.