慢性前列腺炎组织中IL-1β、TNF-α和NGF的表达

目的 探讨白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)和神经生长因子(NGF)在慢性前列腺炎(CP)发病机制中的作用.方法 162份前列腺标奉取材于周围带,分别进行病理观察及IL-1β、TNF-α和NGF免疫组化分析.结果 31.5%(51/162)的组织病理呈CP改变,其中轻度灶性间质炎44例,轻度灶性间质伴腺体周围炎5例,轻度灶性腺体周围炎2例.IL-1β、TNF-α和NGF在前列腺间质及上皮细胞中均有表达,在CP标本中的表达显著增加(P<0.01).IL-1β和TNF-α之间的表达(r=0.797,P<0.01)、NGF和IL-1β(r=0.674,P<0.01)及TNF-α之间的表达(r=0.714,P<0.01)均存在正相关.结论 CP的发病机制中可能存在神经免疫调节的参与,IL-1β、TNF-α和NGF可能参与了CP的神经免疫调节.     

前列腺组织中细菌16S rRNA基因、IL-1β、TNF-α和NGF的表达

目的:探讨慢性前列腺炎(CP)的细菌学病因。方法:前列腺标本取自162例猝死于非前列腺疾病的器官捐献者,年龄20～38岁。取前列腺周围带组织,一式两份,一份做常规病理检查和白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、神经生长因子(NGF)的免疫组化分析,另一份用PCR方法检测细菌16S rRNA基因(16S rDNA)。结果:31.5%(51/162)的组织病理呈CP改变,其中轻度灶性间质炎44例,轻度灶性间质伴腺体周围炎5例,轻度灶性腺体周围炎2例。16S rDNA阳性率为19.1%(31/162),其中CP标本阳性率为51.0%(26/51),非CP标本阳性率为4.5%(5/111),CP标本阳性率高于非CP标本(χ2=29.783,P<0.01)。在CP标本中,16S rDNA阳性组IL-1β、TNF-α和NGF表达高于16S rDNA阴性组(P<0.01)。结论:细菌感染可能是引起CP的重要原因。     

在bcl-2升高的前列腺癌根治术标本中慢性前列腺炎的分布

作者基于前列腺炎与ｂｃｌ 2基因上调之间的关系研究了良性前列腺增生及前列腺癌与慢性前列腺炎之间的解剖学关系。作者观察了 40例完整切除的前列腺标本中慢性炎性浸润的存在与分布 ,发现所有标本中 95 %的外周带炎症与 87%移行带炎症诊断为慢性前列腺炎。40例前列腺标本移行带中炎性浸润均存在于良性增长之中或之外。 5 8%的标本在显微镜下可见炎性浸润与前列腺癌有关。患有良性前列腺增生而无慢性前列腺炎的患者较患有慢性前列腺炎的患者前列腺较小 ,年龄也相对小。 10例良性增生的腺体中ｂｃｌ 2染色增强。结论 :慢性前列腺炎在前列腺全…     

前列腺液内毒素测定在慢性前列腺炎诊治的意义

测定４７例慢性前列腺炎，１５例前列腺痛病人和１１例对照者中段尿（ＶＢ２，称标本１），前列腺按摩后前列腺液和尿液（ＶＢ３，与ＥＰＳ合称标本２）内毒素浓度，同时作细菌培养。结果表明，革兰阴性菌或Ｇ＾－菌合并革兰阳性菌性前列腺炎患者标本２的内毒素浓度较标本１升高非常显著高于对照组和前列腺痛组（Ｐ＜０．００１），显著高于Ｃ＾＋菌性慢性前列腺炎或细菌数低于低于诊断标准的慢性前列腺炎患者（Ｐ＜０．０５）；Ｇ＾     

前列腺增生症与慢性前列腺炎临床关系的研究

目的探讨慢性前列腺炎（CP）与症状性良性前列腺增生（BPH）的临床关系。方法对2005年10月。2007年10月,在我院泌尿外科门诊就诊的,既往已明确诊断为“良性前列腺增生”而常规使用非那雄胺与α-受体阻滞剂联合治疗半年以上,但国际前列腺症状评分（IPSS）及生活质量评分（QOL）仍为中-重度的123例患者,行前列腺液常规（EPS）涂片和细菌培养。参照慢性前列腺炎症状评分标准（NIH—CPSI）,作为慢性前列腺炎的诊断和分类标准。在原有治疗基础上,使用敏感抗生素治疗4周。结果123例患者中伴有CP者105例（85．4％）。其中Ⅰ度前列腺增生38例,合并CP30例（78．9％）;Ⅱ度52例,合并CP45例（86．5％）;Ⅲ度33例,合并CP30例（90．1％）。使用敏感抗生素治疗4周后,三组患者IPSS改善率分别为：30．0％,31．1％,13．3％。结论BPH患者多合并慢性前列腺炎,腺体增生体积与CP发生呈正相关,炎症与诱发膀胱出口梗阻有关联度。抗炎治疗对轻-中度BPH患者效果比对重度BPH患者好。     

强直性脊柱炎肾损害的临床病理特点

目的探讨强直性脊柱炎（AS）合并肾损害的临床及病理特点。方法回顾性分析18例经肾脏活体组织检查的AS患者的临床及肾脏病理表现。结果18例患者中,9例呈隐匿性肾小球肾炎表现,5例呈慢性肾小球肾炎表现,1例呈肾病综合征表现,3例为慢性肾功能不全;4例血压增高,14例血压正常。24h尿蛋白定量平均为（1．17±1．39）g。15例肾功能正常,3例肾功能异常患者血肌酐平均为（153．2±36．8）umol／L。8例患者血清IgA水平升高,10例c反应蛋白升高,13例红细胞沉降率（EsR）增快,且血清IgA水平和C反应蛋白呈正相关（r=0．707,P=0．001）,血清IgA水平和ESR呈正相关（r=0．858,P〈0．001）。病理检查结果发现15例为IgA肾病（其中10例为轻度系膜增生性肾炎,1例为轻度系膜增生性肾炎并慢性肾小管间质肾病,2例为局灶增生性肾炎,1例为局灶增生坏死性肾炎,1例为局灶节段性肾小球硬化症）,1例为膜性肾病,1例为局灶增生性肾炎伴慢性肾小管间质肾病,1例为慢性。肾小管间质肾病。有慢性肾小管间质肾病者均有服中药史。结论AS相关性肾损伤的病理改变多样,但主要为IgA肾病,也可表现为膜性肾病、局灶增生性肾炎和慢性肾小管间质。肾病,其肾损伤可能与AS疾病本身和（或）治疗用药相关。     

老年患者Ⅲ_B型前列腺炎的病理特点分析

目的:通过对BPH合并Ⅲ_B型前列腺炎组织的病理学分析,探讨老年患者Ⅲ_B型前列腺炎的病理特点与可能的发病机制。方法:选取就诊于我院并行TURP术的BPH患者412例,术前经实验室与临床检查,筛选出合并Ⅲ_B型前列腺炎患者66例,并行TURP,术后前列腺组织根据Nickel前列腺炎症程度和主要炎症类型的诊断标准进行病理分型与分级的对比研究。结果:66例BPH并Ⅲ_B型前列腺炎患者经病理检查证实合并不同程度炎症,主要以基质与腺周炎症浸润为主。根据不同病理类型分为腺体炎组、基质炎组、腺周炎组,比较三组炎症程度分布(G_1为轻度,G_2/G_3为中重度)及分级情况,差异有统计学意义(P0.05)。腺体炎与基质炎、腺周炎比较,差异有统计学意义(P0.01);腺周炎与基质炎比较,差异无统计学意义(P0.05)。结论:老年患者Ⅲ_B型前列腺炎患病率较高,病理炎症较重,炎细胞主要浸润前列腺腺周与基质,为腺周炎与基质炎,梗阻可能是其重要发病因素之一。     

慢性前列腺炎病原学的初步研究

目的对慢性前列腺炎的尸体前列腺组织标本进行病原学、病理组织学变化的研究,并对病原体与病理组织学变化的相关性进行初步探讨。方法从１９９６年５月～１９９７年１２月,对１１４例２０～４０岁慢性前列腺炎组织标本用细菌学培养、多聚酶链反应（ＰＣＲ）,对组织内的沙眼衣原体、解脲脲原体、病毒、淋球菌进行检测及病理组织学检查。结果１１４例前列腺组织标本中病原体检测阳性５９例（５２％）,其中单纯细菌性病原体阳性４２例,单纯沙眼衣原体（ＣＴ）６例,人类巨细胞病毒（ＣＭＶ）２例,解脲脲原体（ＵＵ）１例,人体乳头状病毒（ＨＰＶ）１例,７例为复合病原体。所有标本均存在不同程度的灶性慢性前列腺炎病理组织学变化。临床检测的病原体并不引起特异性病理组织学变化。结论慢性前列腺炎有单纯的病原体感染,还有复合感染,应予重视。慢性前列腺炎发病机制多为逆行感染,其病理组织学变化可能与检测到的病原体无关     

血清T-PSA、F/T在前列腺疾病诊断中的意义

目的：探讨总前列腺特异抗原（T－PSA）、游离PSA（F－PSA）与T－PSA比值（F／T）在良性前列腺增生（BPH）、慢性前列腺炎及前列腺癌（PCa）诊断中的作用。方法：检测80例BPH、26例慢性前列腺炎、30例PCa患者的T－PSA、F－PSA，并计算出相应的F／T值。结果：三组患者之间的T－PSA差异存在非常显著性意义（P＜O．01）；BPH患者的F／T与PCa患者差异存在显著性意义，与慢性前列腺炎患者差异无显著性意义；当T－PSA在4．0－10μg/L时，三组患者的T－PSA差异无显著性意义，而BPH患者的F／T与PCa患者差异存在显著性意义，与慢性前列腺炎患者差异无显著性意义；在10μg/L＜T－PSA＜30μg/L时，前列腺炎与PCa患者之间的F／T差异有非常显著性意义（P＜0．01）。结论：F／T可以提高T－PSA对PCa、慢性前列腺炎、BPH的鉴别诊断的特异性。     

慢性前列腺炎／慢性盆腔疼痛综合征患者症状与前列腺周围括约肌超声改变的相关性

作者探讨慢性前列腺炎／慢性盆腔疼痛综合征患者前列腺周围括约肌超声图像的变化，了解这种改变的发生几率。并将超声检查标准化，评价超声改变与患者症状的相关性。37例慢性前列腺炎／慢性盆腔疼痛综合征的患者和23例健康志愿者人组。经直肠超声检测前列腺体积、尿道周围低回声区域体积、前列腺后唇厚度、膀胱颈厚度、逼尿肌厚度和前纤维肌基质回声强度，同时测定患者尿流率和排尿后剩余尿量。采用国际前列腺症状评分表（IPSS）和美国国立卫生研究院慢性前列腺炎评分（NIH—CPSI）评价患者症状。所有检查均由3名操作人员独立完成。结果：37例患者中36例存在尿道周围低回声区域。     

Distribution of chronic prostatitis in radical prostatectomy specimens with up-regulation of bcl-2 in areas of inflammation

PURPOSE: We examined the anatomical relationship of chronic prostatitis with prostate cancer and benign prostatic hyperplasia (BPH) based on the hypothesis that there may be an association of prostatitis with these other entities that may involve up-regulation of bcl-2. MATERIALS AND METHODS: We examined 40 whole mount radical prostatectomy specimens for the presence and distribution of chronic inflammatory infiltrate. Immunostaining for bcl-2 was done in 10 cases. RESULTS: Chronic prostatitis was identified in all 40 cases with peripheral zone inflammation in 95% and transition zone inflammation in 87.5%. In all cases of transition zone inflammation the infiltrate was noted within and/or around BPH. Inflammatory infiltrate was microscopically associated with prostate cancer in 23 of the 40 cases (57.5%). In these 23 cases, there was no association of inflammation with Gleason score, preoperative prostate specific antigen, positive margins, or seminal vesicle invasion. Patients with BPH unassociated with prostatitis had significantly smaller prostate weight (median 32 gm.) and were younger (mean age 54.4 years) than those with BPH associated with prostatitis (median weight 40 gm. and mean age 61.4 years, p <0.05). Bcl-2 staining was intensified in benign glands within areas of prostatitis in all 10 cases examined. CONCLUSIONS: Chronic prostatitis is a common finding in radical prostatectomy specimens. Inflammation was associated with BPH and cancer but had a greater tendency to be associated with BPH. Bcl-2 was prominently expressed in areas of prostatitis. Our findings indirectly support a potential role for prostatitis in the pathogenesis of BPH.     

BPH组织无症状性炎症的模式及临床意义

目的:揭示BPH患者前列腺组织无症状性炎症的模式及临床意义。方法:对40例BPH患者经TURP或开放手术获取的前列腺标本行白细胞共同抗原(LCA)免疫组织化学染色,并对前列腺组织内的炎细胞应用图像分析系统进行扫描,计算炎细胞面积占整个切片面积的百分比。结果:40例患者前列腺组织均有明显的炎细胞浸润,炎症模式分为腺周围型(34/40)、腺型(26/40)和基质型(23/40),约近一半的患者(18/40)在同一张切片上可以同时见到明显的二种甚至三种炎症类型改变。炎细胞面积在前列腺细菌培养阳性者和阴性者之间、术前留置导尿管者和未留置导尿管者之间的差异均无统计学意义(均P>0.05)。结论:BPH患者前列腺组织的炎细胞浸润是非常常见的组织学改变,这种无症状性前列腺炎与BPH关系密切,其临床意义有待进一步确定。     

Asymptomatic inflammation and/or infection in benign prostatic hyperplasia

OBJECTIVE: To determine the extent, pattern and clinical significance of asymptomatic histological inflammation and latent infection (National Institute of Health Category IV prostatitis) in benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: The study included 80 patients (from a cohort of 100 consecutive potentially eligible subjects) with a diagnosis of BPH, but no history or symptoms of prostatitis. Histological sections were obtained from specimens collected prospectively at transurethral resection of the prostate (TURP), immunostained for leukocyte common antigen and scanned using a computerized image-analysis system. Foci of inflammation were categorized as glandular, periglandular, stromal or peri-urethral, and the inflammatory cell density graded from 1 to 3. Relationships and correlations were calculated between the volume, degree and type of inflammation, presence and type of bacteria (culture of deep prostatic biopsies), the use of catheters and prostate specific antigen (PSA) levels. RESULTS: Inflammation was identified in all patients but the mean tissue surface area involved was only 1.1% of the total specimen, with periglandular inflammation being the predominant pattern (0.5%). Of the prostate specimens, 44% showed bacterial growth (in 67% of the catheterized patients and 28% of those uncatheterized; 42% of patients were catheterized before TURP). There was no significant difference between any combination of inflammation pattern, volume or grade of inflammation in those catheterized or not (P=0.15) or culture-positive (pathogenic or not) and culture-negative cases (P=0.06). Neither total PSA or PSA density was significantly correlated (P>0.05) with the amount, degree or distribution of inflammation. CONCLUSION: Prostatic inflammation is an extremely common histological finding in patients with symptoms of BPH who have no symptoms of prostatitis. There was no correlation between the degree and pattern of inflammation, catheterization, presence of bacteria, serum PSA or PSA density. The clinical significance of asymptomatic Category IV chronic prostatitis associated with BPH has yet to be determined.     

早泄病人慢性前列腺炎的发生率调查

目的 :调查早泄男性中慢性前列腺炎的发生率。　方法 :对 10 6例早泄病人和 38例正常人前列腺按摩前后尿液标本及前列腺按摩液 (EPS)进行显微镜和 /或细菌学检查 ,并评估 12 0例慢性前列腺炎病人中早泄的发生率。　结果 :在早泄病人中发现 49例 (46 .2 %)有慢性前列腺炎 ,其中 34 .7%存在慢性细菌性前列腺炎 ,与对照组相比均有统计学差异 (P <0 .0 5 )。 12 0例慢性前列腺炎病人中 5 7例 (47.5 %)存在不同程度的早泄。　结论 :本研究结果提示慢性前列腺炎症在某些早泄病人的发病机制中可能具有一定作用 ,在针对早泄治疗前进行前列腺仔细检查具有重要意义。     

Evaluation of the bacterial flora of the prostate using a 16S rRNA gene based polymerase chain reaction

PURPOSE: The role of bacteria in the chronic pelvic pain syndrome (nonbacterial prostatitis and prostatodynia) is controversial and difficult to assess because the bacterial flora of the prostate is not well defined. Polymerase chain reaction (PCR) is a highly sensitive molecular method of bacterial detection. It confirms the sterility of tissue with a high level of confidence and detects small numbers of microbial agents that may represent pathogens. We performed PCR to determine bacterial colonization of the prostate in presumably healthy men and in those undergoing simple or radical prostatectomy. MATERIALS AND METHODS: We analyzed 28 prostate samples from 18 organ donors from whom prostate tissue was obtained under sterile surgical conditions at organ withdrawal, 14 sterile surgical prostate specimens from 7 patients undergoing radical prostatectomy for prostate cancer who previously underwent transrectal biopsy and 6 sterile surgical specimens from 2 men who underwent simple prostatectomy for benign prostatic hyperplasia (BPH), including 1 with an indwelling catheter for several weeks. For PCR we used 2 sets of primers to detect bacterial 16S rRNA gene sequences. Normal prostate tissue seeded in vitro with known numbers of Escherichia coli was used to assess the sensitivity of PCR. RESULTS: Only 3 of the 28 organ donor samples had histological signs of minimal inflammation and all other samples appeared to be normal without evidence of inflammatory reaction. All of these samples were PCR negative. Of several PCR control reactions the mixture of prostate tissue seeded with known numbers of E. coli demonstrated the high sensitivity of the assay, allowing the detection of as few as 6 bacteria in the presence of 25 mg. of prostate tissue. A focal and heterogeneous distribution of inflammation and infection was noted in the 14 radical prostatectomy specimens. In the prostate cancer and BPH groups there was a strong association of inflammation with positive PCR findings. Of 11 samples 3 without but all 9 with inflammation were PCR positive. CONCLUSIONS: PCR is a highly sensitive method for detecting bacteria in the prostate. In our study negative PCR reactions in the prostate tissue of apparently healthy men made the presence of normal bacterial flora in the prostate extremely unlikely. The presence of bacteria and/or inflammation in radical prostatectomy specimens was found to be a localized process. Concordance between inflammation and positive PCR results in simple and radical prostatectomy specimens suggests that bacteria may frequently have a role in histologically inflammatory prostatitis.     

Pilot and feasibility study of serum chemokines as markers to distinguish prostatic disease in men with low total serum PSA

BACKGROUND: The incidence and prevalence of both benign prostatic hypertrophy (BPH) and prostate cancer (PCa) increase with the aging process. Our laboratory recently showed that the chemokines CXCL5 and CXCL12, which normally function as inflammatory mediators, are secreted at higher levels by aging prostate stromal fibroblasts and elicit proliferative responses from both prostate stromal fibroblast and epithelial cells. Because both CXCL5 and CXCL12 are secreted molecules, we hypothesized that their levels in patient serum might serve as biomarkers to distinguish between BPH and PCa. METHODS: Serum CXCL5 and CXCL12 levels were determined using sandwich ELISAs for 51 men demonstrating low serum PSA values of < or =10 ng/ml who underwent diagnostic needle biopsy for the detection of PCa. The bivariate relationship of circulating chemokine levels, age, and disease status in the prostate was tested using the Wilcoxon rank-sum test. RESULTS: Total serum CXCL12 levels were significantly higher for men who were biopsy positive compared to those who were biopsy negative for cancer and histological prostatitis (P = 0.050). Among men who were biopsy negative for PCa, total serum CXCL5 levels were inversely associated with prostate volume and were significantly higher in men with concomitant BPH and histological prostatitis compared to those without evidence of prostatic disease (P < 0.003). CONCLUSIONS: The results of this pilot and feasibility study suggest that serum or plasma CXCL5 and CXCL12 levels may potentially distinguish between BPH and PCa among patients presenting with low serum PSA, and may be useful toward facilitating decisions to perform diagnostic needle biopsy in this patient population.     

RATIO OF FREE-TO-TOTAL PROSTATE SPECIFIC ANTIGEN IN SERUM CANNOT DISTINGUISH PATIENTS WITH PROSTATE CANCER FROM THOSE WITH CHRONIC INFLAMMATION OF THE PROSTATE

Purpose

We demonstrate the effect of chronic inflammation of the prostate on the ratio of free-to-total prostate specific antigen (PSA) in serum calculated as a percentage of free PSA and, therefore, that percentage of free PSA is an unspecific means to distinguish among prostate cancer, chronic prostatitis and benign prostatic hyperplasia (BPH).

Materials and Methods

Total, free and percentage of free PSA was measured in 66 men with prostate cancer, 119 with BPH and 17 with asymptomatic chronic prostatitis. In all patients the diagnosis was histopathologically confirmed by microscopic examination of prostatic specimens after sextant biopsy, transurethral prostatic resection or prostatectomy.

Results

The median values of total, free and percentage of free PSA were 4.11 micro g./l., 0.75 micro g./l. and 20.4% in patients with BPH, 10.0 micro g./l., 0.84 micro g./l. and 8.5% in those with prostate cancer, and 7.60 micro g./l., 1.23 micro g./l. and 10.6% in those with chronic prostatitis. Patients with prostate cancer and chronic prostatitis had a significantly lower percentage of free PSA than those with BPH. Receiver operating characteristics curve analysis showed that percentage of free PSA as a discriminator between prostate cancer and BPH was not suitable for differentiating between prostate cancer and chronic prostatitis.

Conclusions

Chronic prostatitis is not characterized by elevated total PSA concentrations alone but also by a decreased percentage of free PSA, a tendency similar to that in prostate cancer. This unspecific change in percentage of free PSA must be considered to interpret the percentage of free PSA correctly.     

Do men with prostate abnormalities (prostatitis/benign prostatic hyperplasia/prostate cancer) develop immunity to spermatozoa or seminal plasma?

Prostate is an immunocompetent and not an immunoprivileged organ. It has an active immunologic armamentarium. There are three major prostate abnormalities namely, prostatitis, benign prostatic hyperplasia (BPH) and prostate cancer. In all these abnormalities, infection/inflammation has been implicated. As infection/inflammation of the male genital tract can also be involved in induction of antisperm antibodies (ASA), this study was conducted to examine if these prostate abnormalities lead to the formation of ASA. Sera were obtained from normal healthy men (n = 20), men with chronic prostatitis (n = 20), men with BPH (n = 25), men with prostate cancer (n = 25) and immunoinfertile men (n = 10). The presence of antisperm antibodies against lithium diiodosalicylate (LIS)-solubilized human sperm extract (HSE), seminal plasma and synthetic peptides based upon sperm-specific antigens namely fertilization antigen (FA-1) and YLP(12), were analysed using the sperm immobilization technique (SIT), tray agglutination technique (TAT), enzyme-linked immunosorbent assay (ELISA) and indirect immunobead binding technique (IBT). All the sera from normal men and men with prostate abnormalities (chronic prostatitis/BPH/prostate cancer) were found to be negative in SIT and TAT. In ELISA, a few sera from men having prostate abnormalities (4-24%) showed a weak positive immunoreactivity (2-3 SD units) with some of the spermatozoa/seminal plasma antigens. Majority of the samples did not show any immunoreactivity (<2 SD units) in ELISA. Even the samples that showed a weak positive immunoreactivity in ELISA did not bind to live human sperm in IBT, indicating lack of sperm binding antibodies in these sera. In all these assays, the sera from immunoinfertile men were positive. Our findings indicate that chronic prostatitis, BPH and prostate cancer do not induce antibodies to spermatozoa, sperm-specific antigens and seminal plasma components. Although prostate is an immunologically competent organ, and its abnormalities cause a rise in circulating prostate-specific antigen (PSA), it appears that there is no concomitant induction of immunity to spermatozoa/seminal components including sperm-specific fertility-related antigens, thus not causing ASA-induced immunoinfertlity. This is the first study to our knowledge reporting the absence of ASA in men with BPH and prostate cancer.     

Relationship between Serum Prostate Specific Antigen and the Pattern of Inflammation in Both Benign and Malignant Prostatic Disease in Middle Eastern Men

To determine the effect of prostatitis on serum prostate specific antigen in the diagnosis of prostate cancer in Middle Eastern men, H&E-stained sections of all consecutive prostate specimens were reviewed for diagnosis (malignant or benign) and pattern of inflammation. Inflammation was categorized into acute, active chronic and chronic inactive and graded semi-quantitatively according to previously published criteria. Results were correlated with serum PSA obtained from patients’ records. Of 513 prostate specimens reviewed; 435 (84.8%) were benign and 78 (15.2%) were malignant. Chronic inactive prostatitis was present in 259 (204 benign, 55 malignant) and active chronic prostatitis in 221 (204 benign, 17 malignant). Acute prostatitis alone was not observed and prostatitis was absent in 33 (27 benign, 6 malignant). There was no significant difference in the prevalence of inactive chronic prostatitis between benign and malignant specimens (p < 0.071), but active chronic prostatitis was more prevalent in benign specimens (p < 0.001). Increasing serum PSA was observed for increasing grades of both inactive and active chronic prostatitis in both benign and malignant disease. Prostate cancer showed higher serum PSA levels than benign, at different cut-off points (4 ng/ml = p < 0.0001; 8 ng/ml = p < 0.0001; 12 ng/ml = p < 0.0001). However, significant numbers of patients with benign prostate biopsies presented with PSA above 12 ng/ml (82/260 = 32%). We conclude that active chronic prostatitis is common in Middle Eastern men with benign prostatic disease and a significant number of these present with very high PSA levels, some over 300 ng/ml.