MEAN PLATELET VOLUME: A SIMPLE INDICATOR OF CHRONIC PROSTATITIS
Acta Medica Mediterranea, 2013, 29: 551 MEAN PLATELET VOLUME: A SIMPLE INDICATOR OF CHRONIC PROSTATITIS GULALI AKTAS*, BASRI CAKIROGLU**, MUSTAFA SIT***, UGUR UYETURK****, AYTEKIN ALCELIK*, HALUK SAVLI*, ERAY KEMAHLI**** *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 ABSTRACT 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 Introduction 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 552 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 study. 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. Results 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 0.15 PLT (/mm3) 258000 ± 61000 242000 ± 53000 0.20 MPV (fL) 8.45 ± 1.1 7.76 ± 1 0.004 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 growth Prostatitis group without bacterial growth P value Mean age (years) 42.5 ± 10.1 47.9 ± 13.1 0.20 PLT (/mm3) 258000 ± 64000 258000 ± 61000 0.99 MPV (fL) 8.71 ± 1.26 8.32 ± 1.02 0.35 Table II: General characteristics and laboratory data of the chronic prostatitis patients with and without bacterial growth. Discussion 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 bacteria(17). 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. 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