A Urine-Based Biomarker for Chronic Prostatitis/Chronic Pelvic Pain Syndrome

A Retrospective Multi-Center Study

Weining Liang; Zhigang Wu; Guowei Zhang; Weikang Chen; Xiangnong Hu; Jianjun Yang; Jie Meng; Yan Zeng; Hongjun Li; Xuejun Shang

Disclosures

Transl Androl Urol. 2020;9(5):2218-2226. 

In This Article

Results

The Relationship Between Urine PSEP Level and EPS-WBC Number With "+/−" as an Indicator of Disease Severity

All 372 patients were documented with EPS-WBC numbers in their case report forms (CRFs). This method stratified them from documenting WBCs, as shown in Table 1.

They were divided into distinct groups according to their WBC number in EPS. WBC number less than 9 under the high-power microscope is considered negative or set as ±; WBC number 10–20 is set as +; WBC number 21–30 is set as ++; WBC number 31–40 is set as+++; WBC number >40 is set as ++++. As is shown in Table 1, with the increase of EPS-WBC number, the positive rate of PSEP showed a trend of increase. The mean PSEP concentration appeared to increase. PSEP concentration in urine sample change significantly when we analyze the dataset with the contingency table chi-square test (χ 2=13.200, P=0.01). Spearman's correlation coefficient showed a significant rank correlation between EPS-WBC and PSEP concentration either (rs=0.183, P=0.001). These data suggested that, in the current cohort of 372 patients, there was a statistically significant correlation between the number of WBC and the concentration of PSEP in the urine of CP/CPPS patients.

Relationship Between Urine PSEP Level and EPS-lecithin Corpuscles

Although the vitality EPS examination has been questioned, EPS is still widely used in the clinic because there is no ideal specific diagnostic marker. We, therefore, examined EPS-lecithin corpuscles for all patients. All 372 patients had records of the EPS-lecithin corpuscle in their CRFs. The grade of EPS-lecithin corpuscle density stratified them, as shown in Table 2. In normal EPS, a full field of lecithin corpuscles was observed with a high-power microscope, which was appointed as ++++. The density of EPS-lecithin corpuscles lower than 50% (++) per vision field under the high-power microscope is considered a sign of CP/CPPS in urological clinics. From Table 2, the data showed there was no statistical significance (χ 2=0.003, P=0.999) between the density of lecithin corpuscles and PSEP concentration in the urine of CP/CPPS patients when we analyzed them with contingency tables chi-square test. Also, the Spearman's correlation coefficient showed no significant rank correlation between the two either (rs=0.001, P=0.994).

Relationship Between Urine PSEP Level and NIHCPSI

The CP symptom index developed by the NIH of the United States (NIHCPSI) is an established scoring method to record the symptoms of the patients. According to the severity of symptoms, NIH-CPSI is divided into mild (1–14 points), moderate (15–29 points), or severe (30–43 points).[21] Increases of NIH-CPSI are used as the indication that CP/CPPS becomes more pronounced with more severe symptoms.

From the 372 CP/CPPS patients, 225 patients had NIH-CPSI records. The correlation between urine PSEP level in urine and NIH-CPSI was examined. As shown in Table 3, the rising NIH-CPSI was correlated with the increase of patients with a positive rate of PSEP. We analyzed them with the contingency table chi-square test (χ 2=9.149, P=0.0091). Spearman's correlation coefficient showed a significant rank correlation between NIH-CPSI and PSEP concentration (rs=0.194, P=0.0035). Although the correlation between NIH-CPSI and PSEP is weak, these data suggest an increased PESP concentration in the urine sample is correlated with the severity of symptoms and the advanced stages of CP/CPPS.

We have conducted a power analysis by the G power software to assess the sample size. Power (1 − β) =0.99, which means the power of the test is well, and the sample size is enough to have valid results (Figure 1).

Figure 1.

The power analysis by the G power software.

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