Xiangbin Kong et al., 2024: The role of gut microbiota involved in prostate microenvironment and symptoms improvement in chronic prostatitis/chronic pelvic pain syndrome patients treated with low-intensity extracorporeal shock wave

Thursday, 07 November 2024

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Xiangbin Kong, Zhilong Dong, Weiwei Hu, Jun Mi, Jie Xiao, Yiran Wang, Wenfang Chen, Zixu Pei, Zongyao Hao , Chaozhao Liang, Qi Wang, Zhiping Wang
1Department of Urology/Research Institute of Urology/Gansu Clinical Medical Research Center for Urological Diseases/Clinical Center of Gansu Province for Urological Diseases, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou City, Gansu Province, China.
2Department of Nephrology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou City, Gansu Province, China.
3The Second Clinical Medical School, Lanzhou University, Lanzhou City, Gansu Province, China.
4Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
5Cuiying Biomedical Research Center, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou City, Gansu Province, China.

Abstract

Background: Low-intensity extracorporeal shockwave therapy (Li-ESWT) is emerging as a promising and safe treatment for Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). In this study, we aimed to investigate the role of the gut microbiota involved in the prostate microenvironment and symptom improvement during the Li-ESWT for CP/CPPS patients.

Methods: CP/CPPS patients not taking antibiotics or other treatments were included. NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5) were used to evaluate the effectiveness of Li-ESWT at the end of treatment. Visual analogue scale/score was used to evaluate the pain during procedure. Stool and semen samples were collected before and after Li-ESWT. Shotgun metagenomics analyzed gut microbiota, while ELISA and other diagnostic kits detected biochemical changes in seminal plasma.

Result: Of the 60 enrolled patients, 52 completed treatment. Li-ESWT response rate was 78.8% (41/52) at end of treatment. Among responders, the subitems of the NIH-CPSI; IPSS; and IIEF-5 scores improved significantly, and the seminal plasma analysis showed decreased TNF-a and MDA levels and increased SOD and Zn2+ levels posttreatment. Gut microbiome analysis indicated that posttreatment, both α and β diversity increased, and the abundance of certain specific species significantly increased. Fifty-eight pathways significantly enriched posttreatment, notably in branched-chain amino acid synthesis and butyrate synthesis. The abundance of several specific species was found to be significantly higher in non-responders than responders. Among responders, at the species level, some bacteria associated with NIH-CPSI and its subscales, IPSS, IIEF-5, and prostate microenvironment markers (TNF-a, MDA, Zn2+, and SOD) were identified.

Conclusions: Our study demonstrates for the first time that Li-ESWT improves the prostate microenvironment and gut microbiota in CP/CPPS patients. Treatment nonresponse may be associated with a high abundance of specific pathogens before treatment. The gut microbiota could have a significant impact on Li-ESWT response and the prostate microenvironment.

Prostate. 2024 Sep 22. doi: 10.1002/pros.24794. Online ahead of print. PMID: 39308020

Comments 1

Jens Rassweiler on Thursday, 07 November 2024 10:00

This study investigates how gut microbiota influence treatment outcomes in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) undergoing low-intensity extracorporeal shock wave therapy (Li-ESWT). CP/CPPS, a common urological disorder affecting up to 16% of men globally, causes significant pelvic pain, urinary issues, and sometimes sexual dysfunction, impairing quality of life. Treatment is challenging due to its complex causes, though Li-ESWT has shown promise by reducing inflammation, promoting blood flow, and alleviating pain through localized effects.
The study explores the role of gut microbiota in Li-ESWT efficacy, hypothesizing that gut microbiota variations might affect the prostate's local microenvironment and overall symptom improvement.
Sixty patients were treated weekly with Li-ESWT and evaluated for changes in symptoms, prostate health markers, and gut microbiota diversity. Results indicated a higher response rate (78.8%) among patients, with improvements in pain, urinary symptoms, and quality of life scores, without adverse effects.
Results include
Prostate Microenvironment: Among responders, levels of inflammatory markers (TNF-α, MDA) significantly decreased post-treatment, and antioxidant levels (SOD, Zn²⁺) increased. Non-responders showed no significant biochemical changes.
Gut Microbiota Diversity: Responders had increased gut microbial diversity, particularly in beneficial species like Faecalibacterium prausnitzii and Alistipes putredinis, associated with reduced inflammation. Conversely, non-responders retained higher levels of pathogenic species, potentially hindering treatment efficacy.
Symptom Correlations: Positive treatment response was linked with specific microbiota changes, including enriched pathways in amino acid and butyrate synthesis, which are associated with improved gut and immune function. Specific gut bacteria negatively correlated with inflammation and prostate health markers, suggesting a gut-prostate connection that impacts CP/CPPS symptoms.
Discussion: The authors interpret their findings that gut microbiota alterations may be integral to the treatment response for CP/CPPS patients undergoing Li-ESWT. They highlight that Li-ESWT not only improved symptoms and prostate microenvironment markers (such as decreased inflammatory factors and increased antioxidants) but also positively shifted the diversity and composition of gut microbiota in responders. This change suggests a relationship between gut health and symptom alleviation, particularly for inflammatory and pain pathways in the prostate.
Key points from the discussion include:
1. Gut-Prostate Axis: The authors propose that the "gut-prostate axis" could play a vital role in CP/CPPS, where gut microbiota influence inflammatory and immune responses in the prostate. This axis could help explain why Li-ESWT was more effective in patients with certain microbial profiles before treatment.
2. Symptom and Microbiota Correlation: The study observed that specific gut bacteria were associated with reduced symptoms. For example, species such as Faecalibacterium prausnitzii were more abundant in responders and are known for their anti-inflammatory properties, which may contribute to alleviating CP/CPPS symptoms. The authors speculate that enhancing the presence of beneficial species might improve treatment outcomes by fostering a healthier immune response and reducing oxidative stress in the prostate.
3. Pathogenic Microbes in Non-Responders: Non-responders had higher levels of pathogenic bacteria, which could inhibit recovery. This imbalance may create a pro-inflammatory environment, preventing effective symptom relief. The authors suggest that a disrupted gut microbiota might be a marker of poor response to Li-ESWT and that addressing gut health before or during treatment could potentially improve outcomes.
4. Potential for Microbiota-Based Therapies: The findings imply that gut microbiota modulation—through probiotics, dietary adjustments, or other interventions—could be a future approach to enhance CP/CPPS treatments. By improving the gut microbiome, patients might experience better results from therapies like Li-ESWT.
Conclusions: This research suggests that gut microbiota composition could play a role in Li-ESWT response for CP/CPPS patients. Monitoring and potentially modifying gut microbiota might enhance Li-ESWT effectiveness, offering new avenues for treating CP/CPPS. The authors call for further research to explore gut microbiota as both a predictive marker and therapeutic target in this condition.

Jens Rassweiler

This study investigates how gut microbiota influence treatment outcomes in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) undergoing low-intensity extracorporeal shock wave therapy (Li-ESWT). CP/CPPS, a common urological disorder affecting up to 16% of men globally, causes significant pelvic pain, urinary issues, and sometimes sexual dysfunction, impairing quality of life. Treatment is challenging due to its complex causes, though Li-ESWT has shown promise by reducing inflammation, promoting blood flow, and alleviating pain through localized effects.
The study explores the role of gut microbiota in Li-ESWT efficacy, hypothesizing that gut microbiota variations might affect the prostate's local microenvironment and overall symptom improvement. 
Sixty patients were treated weekly with Li-ESWT and evaluated for changes in symptoms, prostate health markers, and gut microbiota diversity. Results indicated a higher response rate (78.8%) among patients, with improvements in pain, urinary symptoms, and quality of life scores, without adverse effects.
Results include
Prostate Microenvironment: Among responders, levels of inflammatory markers (TNF-α, MDA) significantly decreased post-treatment, and antioxidant levels (SOD, Zn²⁺) increased. Non-responders showed no significant biochemical changes.
Gut Microbiota Diversity: Responders had increased gut microbial diversity, particularly in beneficial species like Faecalibacterium prausnitzii and Alistipes putredinis, associated with reduced inflammation. Conversely, non-responders retained higher levels of pathogenic species, potentially hindering treatment efficacy.
Symptom Correlations: Positive treatment response was linked with specific microbiota changes, including enriched pathways in amino acid and butyrate synthesis, which are associated with improved gut and immune function. Specific gut bacteria negatively correlated with inflammation and prostate health markers, suggesting a gut-prostate connection that impacts CP/CPPS symptoms.
Discussion: The authors interpret their findings that gut microbiota alterations may be integral to the treatment response for CP/CPPS patients undergoing Li-ESWT. They highlight that Li-ESWT not only improved symptoms and prostate microenvironment markers (such as decreased inflammatory factors and increased antioxidants) but also positively shifted the diversity and composition of gut microbiota in responders. This change suggests a relationship between gut health and symptom alleviation, particularly for inflammatory and pain pathways in the prostate.
Key points from the discussion include:
1.	Gut-Prostate Axis: The authors propose that the "gut-prostate axis" could play a vital role in CP/CPPS, where gut microbiota influence inflammatory and immune responses in the prostate. This axis could help explain why Li-ESWT was more effective in patients with certain microbial profiles before treatment.
2.	Symptom and Microbiota Correlation: The study observed that specific gut bacteria were associated with reduced symptoms. For example, species such as Faecalibacterium prausnitzii were more abundant in responders and are known for their anti-inflammatory properties, which may contribute to alleviating CP/CPPS symptoms. The authors speculate that enhancing the presence of beneficial species might improve treatment outcomes by fostering a healthier immune response and reducing oxidative stress in the prostate.
3.	Pathogenic Microbes in Non-Responders: Non-responders had higher levels of pathogenic bacteria, which could inhibit recovery. This imbalance may create a pro-inflammatory environment, preventing effective symptom relief. The authors suggest that a disrupted gut microbiota might be a marker of poor response to Li-ESWT and that addressing gut health before or during treatment could potentially improve outcomes.
4.	Potential for Microbiota-Based Therapies: The findings imply that gut microbiota modulation—through probiotics, dietary adjustments, or other interventions—could be a future approach to enhance CP/CPPS treatments. By improving the gut microbiome, patients might experience better results from therapies like Li-ESWT.
Conclusions: This research suggests that gut microbiota composition could play a role in Li-ESWT response for CP/CPPS patients. Monitoring and potentially modifying gut microbiota might enhance Li-ESWT effectiveness, offering new avenues for treating CP/CPPS. The authors call for further research to explore gut microbiota as both a predictive marker and therapeutic target in this condition.

Jens Rassweiler

This study investigates how gut microbiota influence treatment outcomes in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) undergoing low-intensity extracorporeal shock wave therapy (Li-ESWT). CP/CPPS, a common urological disorder affecting up to 16% of men globally, causes significant pelvic pain, urinary issues, and sometimes sexual dysfunction, impairing quality of life. Treatment is challenging due to its complex causes, though Li-ESWT has shown promise by reducing inflammation, promoting blood flow, and alleviating pain through localized effects. The study explores the role of gut microbiota in Li-ESWT efficacy, hypothesizing that gut microbiota variations might affect the prostate's local microenvironment and overall symptom improvement. Sixty patients were treated weekly with Li-ESWT and evaluated for changes in symptoms, prostate health markers, and gut microbiota diversity. Results indicated a higher response rate (78.8%) among patients, with improvements in pain, urinary symptoms, and quality of life scores, without adverse effects. Results include Prostate Microenvironment: Among responders, levels of inflammatory markers (TNF-α, MDA) significantly decreased post-treatment, and antioxidant levels (SOD, Zn²⁺) increased. Non-responders showed no significant biochemical changes. Gut Microbiota Diversity: Responders had increased gut microbial diversity, particularly in beneficial species like Faecalibacterium prausnitzii and Alistipes putredinis, associated with reduced inflammation. Conversely, non-responders retained higher levels of pathogenic species, potentially hindering treatment efficacy. Symptom Correlations: Positive treatment response was linked with specific microbiota changes, including enriched pathways in amino acid and butyrate synthesis, which are associated with improved gut and immune function. Specific gut bacteria negatively correlated with inflammation and prostate health markers, suggesting a gut-prostate connection that impacts CP/CPPS symptoms. Discussion: The authors interpret their findings that gut microbiota alterations may be integral to the treatment response for CP/CPPS patients undergoing Li-ESWT. They highlight that Li-ESWT not only improved symptoms and prostate microenvironment markers (such as decreased inflammatory factors and increased antioxidants) but also positively shifted the diversity and composition of gut microbiota in responders. This change suggests a relationship between gut health and symptom alleviation, particularly for inflammatory and pain pathways in the prostate. Key points from the discussion include: 1. Gut-Prostate Axis: The authors propose that the "gut-prostate axis" could play a vital role in CP/CPPS, where gut microbiota influence inflammatory and immune responses in the prostate. This axis could help explain why Li-ESWT was more effective in patients with certain microbial profiles before treatment. 2. Symptom and Microbiota Correlation: The study observed that specific gut bacteria were associated with reduced symptoms. For example, species such as Faecalibacterium prausnitzii were more abundant in responders and are known for their anti-inflammatory properties, which may contribute to alleviating CP/CPPS symptoms. The authors speculate that enhancing the presence of beneficial species might improve treatment outcomes by fostering a healthier immune response and reducing oxidative stress in the prostate. 3. Pathogenic Microbes in Non-Responders: Non-responders had higher levels of pathogenic bacteria, which could inhibit recovery. This imbalance may create a pro-inflammatory environment, preventing effective symptom relief. The authors suggest that a disrupted gut microbiota might be a marker of poor response to Li-ESWT and that addressing gut health before or during treatment could potentially improve outcomes. 4. Potential for Microbiota-Based Therapies: The findings imply that gut microbiota modulation—through probiotics, dietary adjustments, or other interventions—could be a future approach to enhance CP/CPPS treatments. By improving the gut microbiome, patients might experience better results from therapies like Li-ESWT. Conclusions: This research suggests that gut microbiota composition could play a role in Li-ESWT response for CP/CPPS patients. Monitoring and potentially modifying gut microbiota might enhance Li-ESWT effectiveness, offering new avenues for treating CP/CPPS. The authors call for further research to explore gut microbiota as both a predictive marker and therapeutic target in this condition. Jens Rassweiler

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