Prostaic Stones and Prostatitis

There could be a connection between prostaic stones and prostatitis this article highlights some of the research and studies conducted on this matter. This came to attention to researchers based on prostate cancer.

Prostate cancer is the second most frequent cause of mortality due to cancer in males in the United States. Transuretral resection, radical prostatectomy, radiation therapy and hormone therapy are the usual prostate cancer treatments. Prostate removal leads to the observation of prostatic calculi (Stones). Because almost 99% of surgically removed prostates contain stones, these stones are generally considered clinically insignificant. Until now, as there could be a correlation between having prostate stones and prostatitis symptoms.

The is a large chemical diversity of these prostatic stones. Carbonated calcium phosphate apatite (carbapatite; CA) seems to be the major component, but several investigations show the presence of other mineral phases such as calcium oxalate monohydrate and dihydrate , brushite , and whitlockite.

More recently, several other mineral phases previously not reported in prostatic calculi were octacalcium phosphate pentahydrate and amorphous carbonated calcium phosphate. Such chemical diversity indicates significant variations in the local biochemistry, which may be linked to different conditions.

A previous investigation involving stone culture revealed that infected calculi in the prostate were implicated in relapsing urinary tract infection. This work aimed to assess a possible relationship between infection and prostatic calculi, taking into account the chemical and structural characteristics of such calculi.

A chemical analysis with Fourier transform infra-red (FTIR) spectroscopy and structural investigation at the mesoscopic scale by scanning electron microscopy (SEM). FTIR spectroscopy has helped us to examine the presence of chemical phases involved in infection of other organs. Moreover, SEM observations allowed for assessing the presence of bacterial imprints on prostatic stones.

One particular SEM study revealed a high occurrence of bacterial imprints (78%) in 23 prostatic stones, which reveals a past or present infection of the prostate tissue; however, urinary tract infection was detected in only 6 (26%) cases. The large difference between number of reported infections and markers of infection within stones implies that aging may not be the only cause of prostatic calcifications. Infection and a lithogenic process induced by infection may play a role in most of the 99% of surgically removed prostate-containing stones.

The bacterial imprints had a specific spherical shape, which suggests infection by Cocci germs. More precisely, the grape-like clustering, shape and size are common with staphylococci infection. In 2 cases of proven infection, the species was Staphylococcus aureus. Nevertheless, these imprints were not seen on all stone surfaces. Similarly to kidney stones, the bacteria can imprint on a particle surface such as CA or ACCP but not other crystal types such as whitlockite, octacalcium phosphate or brushite. Indeed, the size of CA and ACCP crystals is smaller than that of other phases, such as struvite.

As well, SEM examination was restricted to some parts of small and partial samples collected during prostate removal. However, all stones contained at least 15% CA or ACCP, so a careful observation by SEM allows for detection of bacterial imprints on the surface of these minerals.

Prostatic stones are often considered to have no clinical significance, but the use of SEM showed for the first time the high frequency of bacterial imprints in these stones. Moreover, data underlines the specific chemistry of calcium phosphate phases, particularly the preponderance of whitlockite and ACCP in these calcifications. These results demonstrate the high occurrence of bacterial infections in the prostate, often without any clinical symptoms.

Inflammation induced by an infection may lead to cancerization of the tissue. Early detection of prostatic calcifications or stones could suggest a search for asymptomatic chronic infection. If an infection is detected, medical management and antibiotic treatment could avoid chronic inflammation of the tissue and further deleterious consequences. Thus, we suggest that discovery of prostate calcifications by imaging such as computerized tomodensitometry might warrant further investigations and management to search for chronic infection of the prostate gland.

The presence of large prostatic calculi has been shown to be a significant associated factor of moderate LUTS. In another study, patients with prostate stones were reported to have more severe LUTS and decreased the maximum urinary flow rates compared to patients without prostate stones. However, based on multivariate analyses, prostate stone was not an independent predictive factor of severe LUTS (lower urinary tract symptoms). Rather, older age and larger prostate volume were independent predisposing factors for prostate stone.

Larger prostate stones were suggested to have a relation with clinical prostatitis/ chronic pelvic pain syndrome. Histo-pathological inflammation with varying degrees of severity may accompany prostate stones. However, it is unclear whether inflammation is a cause or the result of calculi formation. The prostatic stones do not raise PSA, which increases with inflammation, indirectly indicating that these calculi do not increase inflammation.

On the other hand, intra-prostatic reflux related to prostate stone formation may play a role in the accompanying inflammation of prostate gland. In a study using anti-nanobacterial agent it was shown that prostatic stones diminished 50% ultrasonographically and chronic prostatitis symptom scores were decreased.

In Summary

In the prostate gland acini, the small round luminal hyaline masses are called corpora amylacea and their calcifications form prostate stones. Suggested mechanism is the intraprostatic reflux of urine which causes the deposition of hydroxyapatite crystallites in corpora amylacea and mineralization with calcium. Some pathological conditions like alkaptonuria and vitamin D overdose have been reported to cause prostatic calculi. Major calcium components of prostate stone are calcium phosphate or calcium oxalate, along with carbonate-apatite and hydroxyapatite, whereas most prevalent proteins are lactoferrin, myeloperoxidase, and S100 calcium-binding proteins A8 and A9. Being predominantly located in the cephalic portion of the posterior lobe and in the larger ducts and acini of the lateral lobes of the prostate, prostate stones are mostly clinically asymptomatic. When it is symptomatic the symptoms are generally related to lower urinary tract symptoms. Few cases with large prostate stones causing infravesical obstruction and necessitating surgical intervention have been reported. No direct or indirect relationship has been reported between prostate stone and prostate cancer.

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