Acta Medica Mediterranea, 2013, 29: 551
*Abant Izzet Baysal University hospital, Department of Internal Medicine, Bolu, Turkey - **Hisar Intercontinental Hospital,
Department of Urology, Istanbul, Turkey - ***Abant Izzet Baysal University hospital, Department of General Surgery, Bolu, Turkey
****Abant Izzet Baysal University hospital, Department of Urology, Bolu, Turkey
Background: Chronic prostatitis is a widespread urological disease, however, underlying pathophysiology is poorly understood and it is usually characterized with recurrences. Platelets take in charge in hemostasis, tissue repairment and inflammation.
Mean platelet volume (MPV), is considered as a marker of platelet activation. The aim of present study is to find out the possible
association between MPV and chronic prostatitis.
Methods: A total of 40 patients with chronic prostatitis and 45 healthy controls enrolled to the study. Laboratory data of chronic prostatitis patients and healthy controls obtained from the computerized databases of the hospitals and platelet count (PLT) and
mean platelet volume (MPV) values of the participants recorded.
Results: There was no statistically significant difference between groups in terms of mean age and PLT count. However,
patients with chronic prostatitis had significantly increased MPV compared to controls (p=0.004).
Conclusion: Increased MPV should help the diagnosis of chronic prostatitis but, more studies with larger study population are
needed to confirm our results.
Key words: Mean platelet volume, chronic prostatitis, platelet activation.
Received June 28, 2013; Accepted July 24, 2013
Chronic prostatitis is a common urological
disease characterized by recurrences that affect
about 10% of men and often causes hospital admissions. Patients with chronic prostatitis are usually
symptomatic for a long time and many patients do
not receive optimal treatment. The underlying
pathophysiology is poorly understood. The diagnosis of chronic prostatitis is based on the history and
physical examination, but there is no characteristic
finding or laboratory test specific to chronic prostatitis.
Platelets are anucleate blood cells that act in
hemostasis and tissue repair(1). Activated platelets
also play a significant role in inflammation. The
mean platelet volume (MPV) is considered a mark-
er of platelet activation and the rate of platelet production(2). It is associated with various inflammatory processes including subclinical inflammation in
coronary ischemia, stroke, and preeclampsia, or
overt inflammation in rheumatoid arthritis and
inflammatory bowel disease(3-8). To our knowledge,
no study has analyzed the correlation between the
MPV and chronic prostatitis.
Since there is no optimal diagnostic test for
chronic prostatitis, we conducted this study to
examine the possible association between MPV and
chronic prostatitis.
Materials and methods
Patients with chronic prostatitis admitted to
the Urology Department of Hisar Intercontinental
Hospital and non-prostatitis subjects admitted to the
Department of Internal Medicine at Abant Izzet
Baysal University Hospital were included in the
study. The patients with chronic prostatitis generally complained of pain in the perineal, suprapubic,
and penile regions that spread to the testicles, groin,
and waist, pain during and after ejaculation,
urgency, strained and intermittent micturition, and
an aversion to sex for 3 months. To confirm the
diagnosis of chronic prostatitis, the hemogram, urinalysis, urine and semen cultures, Meares–Stamey
four-glass test, prostate-specific antigen, and urinary ultrasound were performed. Patients with thyroid disorders, malignancies, autoimmune conditions, and chronic respiratory disorders (chronic
obstructive pulmonary disease or asthma) were
excluded from the study. Patients known to have
platelet disorders or on medications that affect
platelet function were also excluded. The healthy
controls were subject to the same exclusion criteria.
Subsequently, 40 patients with chronic prostatitis and 45 healthy controls were enrolled in the
The laboratory data of the chronic prostatitis
patients and healthy controls obtained from the hospital computerized databases, including the platelet
count (PLT) and mean platelet volume (MPV) of
the participants, were recorded.
The data were analyzed using SPSS 15.0
(SPSS; Chicago, IL, USA). Results are expressed
as the mean ± SD. Variables were compared with
the independent samples t-test and Mann–Whitney
U-test. Statistical significance was set at a p-value <
0.05. The study was approved by the ethics committee of Abant Izzet Baysal University.
All of the participants were male. The mean
ages of the patients with chronic prostatitis and
controls were 46.1 ± 12 and 43 ± 7.4 years, respectively. There was no significant difference between
the groups (p=0.15).
The platelet levels of the patients with chronic
prostatitis and controls were 258,000 ± 61,000 and
242,000 ± 53,000 in mm3, respectively. The difference did not reach statistical significance (p=0.20).
The chronic prostatitis patients had a significantly
(p=0.004) higher MPV than the controls (8.45 ± 1.1
vs. 7.76 ± 1, respectively). Table I summarizes the
general characteristics and laboratory data of the
study subjects.
Gulali Aktas, Basri Cakiroglu et Al
Prostatitis group
Control Group
P value
Mean age (years)
46.1 ± 12
43 ± 7.4
PLT (/mm3)
258000 ± 61000
242000 ± 53000
MPV (fL)
8.45 ± 1.1
7.76 ± 1
Table I: General characteristics and laboratory data of
the patients and controls.
Of the 40 patients with chronic prostatitis, 13
grew bacteria in urine or semen cultures. The mean
age (p=0.20), PLT (p=0.99), and MPV (p=0.35) did
not differ significantly between the culture-positive
(n=13) and -negative (n=27) groups. Table II shows
the general characteristics and laboratory data of
the chronic prostatitis patients with and without
bacterial growth.
Prostatitis group
with bacterial
Prostatitis group
without bacterial
P value
Mean age
42.5 ± 10.1
47.9 ± 13.1
258000 ± 64000
258000 ± 61000
8.71 ± 1.26
8.32 ± 1.02
Table II: General characteristics and laboratory data of
the chronic prostatitis patients with and without bacterial
We found that patients with chronic prostatitis
have a higher MPV, as compared to the healthy
population. This is the first study to identify an
association between MPV and chronic prostatitis.
This association was independent of whether bacterial growth accompanied the disease.
The MPV is associated with various infectious
and inflammatory diseases (7-13) . Infection and
inflammation play important roles in the pathogenesis of chronic prostatitis. Therefore, our results are
not surprising.
Sit et al. studied the hemogram parameters of
33 patients with hepatic hydatid cysts before and
after surgery and found that while PLT did not
change, the MPV of the patients decreased significantly postoperatively (10) . Kucukbayrak et al.
obtained the same results in 72 patients with pulmonary hydatid cysts, i.e., MPV decreased significantly after pulmonary cyst hydatid surgery, while
Mean Platelet Volume: A simple indicator of Chronic Prostatitis
PLT did not(14). Similarly, in our study, MPV was
increased significantly in patients with chronic prostatitis, as compared to healthy controls.
Why does MPV increase in chronic prostatitis? Initially, we considered the role of platelets in
infection, and inflammation. Platelets are the first
cells encountered by bacteria in the vascular system(15). They are activated after bacterial induction(16)
and play an important role in the defense against
Activated platelets contain microbicidal peptides, such as chemokines, fibrinopeptides, thymosin, and defensin-1. When platelets are activated, they release these peptides, which help leukocytes counter bacteria(18-20). Furthermore, a recent
study reported that platelet activation suppresses
human immunodeficiency virus (HIV) infection of
T lymphocytes(21). MPV is considered a marker of
platelet activation(2,22). Therefore, as infection is an
underlying pathological factor in chronic prostatitis,
MPV might be increased in this condition as a
marker of platelet activation.
As well as hemostasis, platelets are involved
in inflammatory reactions(23). MPV is associated
with several inflammatory diseases (5,8,13,24). Since
inflammation is an underlying mechanism in chronic prostatitis, an increased MPV should indicate this
disease. As MPV is associated with numerous
inflammatory and infectious diseases, it is not specific to chronic prostatitis.
The retrospective design of our work and
small study population are limitations. Prospective
studies with a larger cohort might contribute better
to understanding the association between chronic
prostatitis and MPV.
In conclusion, an increased MPV should help
support the diagnosis of chronic prostatitis,
although studies with more subjects are needed to
confirm our results.
Polinska B, Matowicka-Karna J, Kemona H.
Assessment of the influence of the inflammatory process
on the activation of blood platelets and morphological
parameters in patients with ulcerative colitis (colitis
ulcerosa). Folia histochemica et cytobiologica / Polish
Academy of Sciences, Polish Histochemical and
Cytochemical Society. 2011; 49(1): 119-124.
Briggs C. Quality counts: new parameters in blood
cell counting. International journal of laboratory
hematology. Jun 2009; 31(3): 277-297.
Bath PM, Butterworth RJ. Platelet size: measurement,
physiology and vascular disease. Blood coagulation &
fibrinolysis: an international journal in haemostasis
and thrombosis. Mar 1996; 7(2): 157-161.
Choi CU, Seo HS, Kim YK, et al. Can mean platelet
volume predict coronary vasospasm? Platelets. 2011;
22(3): 173-178.
Gasparyan AY, Stavropoulos-Kalinoglou A, Toms TE,
Douglas KM, Kitas GD. Association of mean platelet
volume with hypertension in rheumatoid arthritis.
Inflammation & allergy drug targets. Mar 2010; 9(1):
Ha S-I, Choi D-H, Ki Y-J, et al. Stroke prediction using
mean platelet volume in patients with atrial fibrillation.
Platelets. 2011; 22(6): 408-414.
Järemo P, Lindahl T, Lennmarken C, Forsgren H. The
use of platelet density and volume measurements to estimate the severity of pre‐eclampsia. European journal of
clinical investigation. 2000; 30(12): 1113-1118.
Kapsoritakis AN, Koukourakis MI, Sfiridaki A, et al.
Mean platelet volume: a useful marker of inflammatory
bowel disease activity. The American journal of gastroenterology. Mar 2001; 96(3): 776-781.
Küçükbayrak A, Taş T, Tosun M, et al. Could thrombocyte parameters be an inflammatory marker in the brucellosis? Med Glas. 2012.
Sit M, Aktas G, Yilmaz EE, Hakyemez IN, Alcelik A,
Kucukbayrak A. Platelet parameters in hepatic hydatid
cysts. International journal of inflammation.
Bath P, Algert C, Chapman N, Neal B. Association of
mean platelet volume with risk of stroke among 3134
individuals with history of cerebrovascular disease.
Stroke. 2004; 35(3): 622-626.
Yuksel O, Helvaci K, Basar O, et al. An overlooked
indicator of disease activity in ulcerative colitis: mean
platelet volume. Platelets. Jun 2009; 20(4): 277-281.
Jaremo P, Sandberg-Gertzen H. Platelet density and size
in inflammatory bowel disease. Thrombosis and
haemostasis. Apr 1996; 75(4): 560-561.
Kucukbayrak A, Oz G, Findik G, et al. Evaluation of
platelet parameters in patients with pulmonary hydatid
cyst. Mediterranean journal of hematology and infectious diseases. 2010; 2(1): e2010006.
Durack D. Experimental bacterial endocarditis. IV.
Structure and evolution of very early lesions. The
Journal of pathology. 1975; 115(2): 81-89.
Fitzgerald JR, Foster TJ, Cox D. The interaction of bacterial pathogens with platelets. Nature reviews.
Microbiology. Jun 2006; 4(6): 445-457.
Kraemer BF, Campbell RA, Schwertz H, et al. Novel
anti-bacterial activities of β-defensin 1 in human
platelets: suppression of pathogen growth and signaling
of neutrophil extracellular trap formation. PLoS
pathogens. 2011; 7(11): e1002355.
Yeaman MR, Puentes SM, Norman DC, Bayer AS.
Partial characterization and staphylocidal activity of
thrombin-induced platelet microbicidal protein.
Infection and immunity. Mar 1992; 60(3): 1202-1209.
Yeaman MR, Tang YQ, Shen AJ, Bayer AS, Selsted
ME. Purification and in vitro activities of rabbit platelet
microbicidal proteins. Infection and immunity. Mar
1997; 65(3): 1023-1031.
Tang YQ, Yeaman MR, Selsted ME. Antimicrobial peptides from human platelets. Infection and immunity. Dec
2002; 70(12): 6524-6533.
Gulali Aktas, Basri Cakiroglu et Al
Solomon Tsegaye T, Gnirss K, Rahe-Meyer N, et al.
Platelet activation suppresses HIV-1 infection of T cells.
Retrovirology. 2013; 10: 48.
Park Y, Schoene N, Harris W. Mean platelet volume as
an indicator of platelet activation: methodological
issues. Platelets. 2002; 13(5-6): 301-306.
Bazzoni G, Dejana E, Del Maschio A. Platelet-neutrophil interactions. Possible relevance in the pathogenesis of thrombosis and inflammation. Haematologica.
Nov-Dec 1991; 76(6): 491-499.
Kisacik B, Tufan A, Kalyoncu U, et al. Mean platelet
volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone
Spine. 2008; 75(3): 291-294.
Request reprints from
Abant Izzet Baysal University Hospital
Department of Internal Medicine