Q: Can you tell us what exactly is contained in the prostate fluid so that we can also understand the composition of the substances in it.
A: Actually, don’t look at that little bit of prostate fluid, there are a lot of components in it. In simple terms, normal prostate fluid is milky white, the daily secretion is 0.5-2ml, is weakly acidic, PH value 6.5 – 6.8, contains total lipids 2.8g/L, of which phospholipids account for 65G, within the lecithin vesicles mainly. In addition, it also contains potassium, sodium, chloride, glucose, vitamin C, acid phosphatase, lysozyme and a few epithelial cells and leukocytes, etc.
Q: When there is an inflammatory lesion, there is an abnormal composition of the prostate fluid, right?
A: That’s very true. Generally, prostatic fluid obtained by doing prostate massage should be immediately examined microscopically. Normal prostate fluid contains white blood cells 0~10/high magnification field of view, lecithin vesicles are evenly distributed and nearly full field of view. When the prostate gland has inflammatory lesions, the lecithin in the prostate fluid is significantly reduced or disappeared because macrophages have swallowed a large amount of lipid substances, therefore, lecithin particles are seen to be reduced and unevenly distributed under the microscope.
Q: If this is the case, how can I analyze the prostate fluid test results?
A: This is a very specialized question, which is not easy to explain. In fact, prostatitis begins in the periurethral glands or in the prostate gland that passes into the paracolic sulcus, and there are 64 glandular ducts that pass into the paracolic sulcus. Normally, only 1 to 2 glands or periurethral glands become infected, so the fluid obtained after prostate massage is actually a mixture of normal and infected fluid. When urethral inflammation, strictures, warts, or diverticula can cause a large number of white blood cells to appear in the prostate fluid; when there is sexual intercourse within 72 hours prior to prostate massage, an increase in white blood cells within the prostate fluid is also seen due to ejaculation and arousal; prostate stones without infection may also cause an increase in white blood cells in the prostate fluid. In addition, the number of white blood cells in the prostate fluid may be affected by different levels of prostate massage, or by the insertion of fingers that are too deep and massage into the seminal vesicles. So, the amount of white blood cells in the prostate does not necessarily coincide with the degree of prostate inflammation, and a normal test result cannot easily rule out the possibility of prostate inflammation. The fact that you can occasionally see an increase in white blood cells when you recheck your prostate fluid during treatment may not necessarily mean that the treatment is not working.
A: The PH value of normal prostate fluid is 6.5 to 6.8, which is acidic. The PH value of prostate fluid in patients with chronic prostatitis can increase to 8.0~8.2, which tends to be alkaline. The study confirmed that the change in the PH of the prostate fluid is closely related to the local inflammatory response and not to the presence or absence of bacteria. The more severe the inflammatory response, the higher the PH value, and when the inflammation disappears, the PH value will gradually return to normal. It is worth noting that as we age, the PH of the prostate fluid will also increase to varying degrees. In addition, the importance of elevated prostate fluid PH in patients with chronic prostatitis is that it can affect the diffusion of antibiotic drugs into the prostate tissue.
Q: What is the immune response of the prostate? What is the significance of having an immunological examination of the prostate fluid to differentiate between acute and chronic prostatitis?
A: The immune response of the prostate refers to the specific immune changes that occur when there is some kind of lesion in the prostate, mainly related to bacterial infection of the prostate. In patients with acute and chronic bacterial prostatitis, both IgG and IgA of the prostate fluid are elevated; IgG declines slowly over 6 to 12 months in patients with acute prostatitis, and IgA begins to decline after 12 months; whereas IgA in chronic bacterial prostatitis can remain elevated for nearly 2 years, and IgG remains elevated for nearly 6 months. In patients with refractory bacterial prostatitis, IgG and IgA remain continuously elevated. Therefore, measuring the antigen-specific IgG and IgA levels in prostate fluid is not only helpful for diagnosis, but also for determining the actual effectiveness of treatment in patients with bacterial prostatitis.
Q: What is “prostate fluid bacterial culture four-stage sampling test”?
A: The most accurate way to locate and diagnose prostate infection is the four-stage prostate fluid bacterial culture sampling method (Meares method), which means that quantitative bacterial cultures of urine, bladder urine and prostate massage fluid are done simultaneously, and this method can distinguish prostatitis, urethritis or urinary tract infection. The method is as follows.
(1) drink 500ml of water before the examination and do not urinate for 2~4 hours; (2) turn up the foreskin, clean and disinfect the external urethral opening; (3) collect the first 10ml of urine in a sterile test tube for urethral specimen VB1; (4) continue to urinate 200ml and then collect 10ml of urine in the middle section and place it in equal two sterile test tubes, representing the bladder specimen, for VB2; (5) massage prostate fluid in a sterile container, called prostatic fluid; (6) urinate again and collect 10ml in a sterile test tube, which is the specimen of the prostate and posterior urethra, for VB3.
Q: So, how to judge the result of the test?
A: The method of judging the results of the four-stage sampling method of prostate fluid bacterial culture examination is as follows.
(1) VB2 colonies are many and more than 1000/ml for bladder inflammation.
(2) VB1 and VB2 culture negative or less than 3000 / ml, while the prostate fluid or VB3 bacteria count more than 5000 / ml, or VB3 more than VB1 two times, can be diagnosed as chronic bacterial prostatitis.
(3) If prostate fluid cannot be taken, VB3 can be diluted 100 times for calculation. About 0.1ml of prostate fluid is left in the urethra after prostate massage, and it is diluted in 10ml of urine, which means about 100 times dilution. When the number of VB1 and VB2 bacteria decreases and the number of prostate fluid bacteria increases, prostate fluid culture is valuable for diagnosis and can completely exclude contamination of the urethra.
(4) VB1 bacteria count more than 100 colonies/ml, and more than other specimens for urethritis, less than 100 colonies/ml more for contamination.
(5) During treatment, as antibiotics diffuse less into the prostate fluid, if the prostate fluid and VB3 culture is positive, while VB1 and VB2 are negative, it is more confirmed as prostatitis.