What is the role of the secretory dysfunction of prostate gland in the pathogenesis of chronic bacterial prostatitis (CBP)?

Updated: Jan 15, 2019
  • Author: Samantha D Kraemer, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Secretory dysfunction of prostate gland 

  • Altered secretions can reduce the natural antibacterial nature of prostatic secretions. Findings in prostatic secretions during infections include a decrease in fructose, citric acid, acid phosphatase, zinc, magnesium, calcium, and prostatic antibacterial factor, as well as an increase in ceruloplasmin and complement C3. 
  • It is unclear whether the changes in prostatic fluid are a cause or consequence of inflammation, but they correlate with inflammation and are blamed for reducing the antibacterial nature of prostatic secretions.
  • Alkaline pH (up to 8.0) of prostatic fluid is associated with inflammation and can also reduce its antibacterial properties, as well as limit diffusion of some basic antimicrobials into the prostate. 
  • Prostatic fluid is generally acidic, with a pH of 6.4 (compared with plasma pH of 7.4), thus creating a pH gradient that further inhibits diffusion of acidic antibiotics into the prostatic fluid. Basic antibiotics are able to dissociate and concentrate in the prostatic fluid because of ion trapping within the prostatic fluid due to the pH gradient. Therefore, the best antibiotics for use in prostatitis have high dissociation constants (ie, measure of acid strength), are basic instead of acidic, and are not tightly protein bound. This combination can allow up to a six-fold higher concentration of antibiotic in the prostatic fluid compared with plasma.
  • Infection often persists because antibiotics do not easily penetrate the prostate and no active transport mechanism exists whereby antibiotics can enter the prostatic ducts. Therefore, antibiotics depend on passive diffusion to enter the epithelial-lined prostatic glandular acini. The epithelial cells do not allow the free passage of antibiotics unless they meet certain criteria (ie, non-ionized, lipid-soluble, not firmly protein bound).

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