In recent years we have witnessed increasing interest for the role of microbiota in the pathophysiology and management of prostatic diseases. However, there are several aspects to comprehend. Here, we aim to assess the gut microbiota composition and faecal microbiota-derived short-chain fatty acids production (SCFAs) in the pathogenesis of CP/CPPS. All patients with CP/CPPS attending our urology centre, were enrolled in this study, and underwent urological examination, microbiological evaluation, intestinal microbiota analysis and measurement of interleukins in semen. A cohort of subjects who had undergone intestinal microbiota investigation for various reasons but did not exhibit any symptoms of urological disease, was used as control group. Laboratory data from the two groups were analysed in terms of gut microbiota composition and levels of SCFAs. We enrolled 37 patients and 45 controls. In the CP/CPPS patient group, the mean levels of interleukins were: IL-8 934 pg/ml, IL-10 64 pg/ml, IL-6 871 pg/ml. In this patient group, we found higher levels of Bifidobacteriaceae and Bacteroidaceae and lower levels of Prevotella and Lactobacillus with a Firmicutes/Bacteroides mean ratio at 0.27. The control group had a normal Firmicutes/Bacteroides mean ratio (1.6). The two groups showed a significant difference in total SCFAs levels (p = 0.001) and in particular regarding indole-3-propionic acid (p = 0.003) and butyric acid (p < 0.001). A statistically significant correlation was found between the levels of IL-8 and a decreasing SCFAs production (p < 0.001). A difference in gut microbiota between patients with CP/CPPS and controls, together with a reduction in faecal levels of microbiota-derived short-chain fatty acids and decreased IL-8 levels in semen, might be part of the pathophysiological mechanism in CP/CPPS.

Prostatic calculi are frequently detected on transrectal ultrasound (TRUS) and computed tomography (CT), yet their clinical relevance in prostatitis remains uncertain. To systematically evaluate the association between prostatic calculi and prostatitis-related outcomes in adult men. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review was conducted. PubMed, Ovid Embase, CINAHL, and Google Scholar were searched for studies published between January 1, 2015 and October 31, 2025. Eligible studies assessed prostatic calculi by presence, burden, location, or density and compared outcomes with men without calculi or with lower burden. Outcomes included prostatitis diagnoses, validated symptom measures (National Institutes of Health-chronic prostatitis symptom index [NIH-CPSI], International Prostate Symptom Score [IPSS], International Index of Erectile Function - 5), inflammatory markers, and treatment response. Risk of bias was assessed using the Critical Appraisal Skills Programme tool. A total of 198 records were identified, of which 10 studies were included. Most were cross-sectional, with one prospective CP/chronic pelvic pain syndrome cohort. Greater calcification burden and peri-urethral distribution were associated with higher NIH-CPSI and IPSS scores and less favorable symptom improvement following medical therapy. CT-based cohorts reported associations between higher-density calculi and worse lower urinary tract symptoms, erectile dysfunction, pelvic pain, and reduced quality of life. A prostatectomy series demonstrated bacterial biofilm within calcifications, providing biological plausibility. Prostatic calculi - particularly when extensive or peri-urethral - are associated with increased symptom burden and may identify men with more refractory disease. However, current evidence is observational and heterogeneous, with incomplete confounder control. Standardized imaging classifications and prospective studies are required to clarify causal relationships and inform management strategies.

Acute and chronic bacterial prostatitis are clinically significant entities that can be difficult to diagnose and appropriately treat. Herein, we review when to suspect these clinical conditions, how to diagnose them, and how to effectively treat them based on the extant literature. Our aim was to equip the practicing clinician with the ability to proficiently diagnose and manage acute and chronic bacterial prostatitis, particularly in older patients.

Purple urine bag syndrome (PUBS) is an infrequent and generally asymptomatic condition characterized by the purple coloration of urine in patients with a urinary catheter, secondary to bacterial metabolism of tryptophan and the production of pigments. We describe the case of an 82-year-old male with a history of benign prostatic hyperplasia, arterial hypertension, and chronic Foley catheter use, who presented for a preoperative consultation without symptoms, exhibiting purple urine of 48 hours' duration. The urine culture showed growth of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. Given the absence of urinary or systemic symptoms, it was decided not to administer antibiotics and to only replace the urinary drainage system. The patient progressed favorably, with resolution of the color change. PUBS, although striking, is a benign finding associated with asymptomatic bacteriuria, and its management should avoid unnecessary antibiotic use.

Prostatitis is an inflammatory disease of the prostate gland that can present with lower abdominal pain, urinary incontinence, and sexual dysfunction. The diagnosis of prostatitis encompasses two main conditions: acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP). Urinary dysfunction is a key factor in the pathogenesis of chronic prostatitis. Overactive contraction of the urinary sphincter can cause bladder outlet obstruction and residual urine, which can lead to urinary reflux into the prostate. Alpha-1-adrenergic receptor antagonists (alpha blockers) are a class of drugs that inhibit smooth muscle contraction in the prostate and bladder neck. Tamsulosin is the first selective 1-adrenergic receptor antagonist, primarily the 1A and 1D subtypes, which are found in the smooth muscle of the prostate, bladder neck, and prostatic urethra. Blockade of these receptors reduces smooth muscle tone in these structures, which, in turn, improves urine flow from the bladder. We carried out a systematic review of the literature to evaluate the efficacy of tamsulosin in the treatment of acute and chronic bacterial and abacterial prostatitis, as well as chronic pelvic pain syndrome (CPPS). A search for clinical trials was carried out in the PubMed database, the clinical trials registry clinicaltrials.gov, and the Russian electronic library elibrary.ru by two independent researchers using keywords describing treatments that potentially included tamsulosin. The search yielded information on 21 publications, 20 of which were included in the systematic review. Five studies were non-comparative, meaning they analyzed only patients receiving tamsulosin in addition to background therapy. The remaining studies had different comparison groups and could include active strategies such as antibacterial, analgesic, anti-inflammatory, herbal (urological) medications, and others. Treatment duration ranged from 4 to 52 weeks. The prescribed dose of tamsulosin was 0.4 mg orally once daily. Most studies used the NIH-CPSI (National Institute of Health Chronic Prostatitis Symptom Index) scores to evaluate outcomes. The average age of the participants ranged from 28.9 to 59.1 years. The quality of the included studies was highly variable. Of the 20 studies included in this review, 19 examined the use of tamsulosin in patients with CP/CPPS. Positive treatment outcomes were observed in all studies using tamsulosin. Increases in maximum urinary flow rate, significant symptom regression, as measured by standardized scales, and improvements in quality of life were observed. The greatest differences in symptom regression were observed early in treatment, up to 45 days. This is likely due to the fact that urinary dysfunction, pain, and decreased quality of life become more prominent early in the disease course. The safety of the treatment was assessed in 15 of the 20 studies. No standardized scales were used to assess safety. The safety of tamsulosin was assessed based on the reporting of adverse reactions. The development of serious adverse reactions (defined in Roszdravnadzor Order No. 1071 of February 15, 2017) was reported in two studies, but it was not possible to reliably link them to tamsulosin use. CONCLUSION: The results of this systematic review confirm that tamsulosin is an effective drug for inclusion in combination treatment regimens for various forms of prostatitis, including CBP, chronic abacterial prostatitis, and CPPS. Its use significantly reduces symptoms such as pain and dysuria, which in turn improves patients' quality of life.

The human microbiome is increasingly recognized as a dynamic element in cancer biology. Studies across breast, prostate, lung, colorectal, and cervical tumors reveal that microbial communities influence carcinogenesis, immune regulation, and treatment outcomes. When the balance of these microorganisms is altered, inflammation becomes chronic, metabolism is disrupted, and signaling pathways such as NF-κB, IL6-STAT3, and β-catenin are activated. Bacterial metabolites and genotoxins, including colibactin and bile acids, may damage DNA and reshape the epigenetic landscape. Distinct microbial profiles have been linked to prognosis and to patient responses to chemotherapy and immunotherapy. The presence of beneficial taxa, such as Akkermansia muciniphila and Ruminococcus, has been associated with improved response to immune checkpoint inhibitors. At the same time, antibiotic-induced depletion of gut microbiome can reduce therapeutic efficacy. Strategies that help restore microbial balance, including probiotics, dietary interventions, and fecal microbiota transplantation, are being explored as complementary therapies. Although methodological differences and contamination remain challenges, the growing body of evidence indicates that the microbiome is a measurable and modifiable component of tumor ecosystems with strong potential for diagnostic, prognostic, and therapeutic applications in precision oncology.

Gallic acid (GA), also known as 3,4,5-trihydroxybenzoic acid, is a polyphenolic bioactive component in pomegranates, grapes, tea leaves, and gallnuts. This study employed LC-MS/MS to systematically analyze the pharmacokinetic and tissue distribution of GA in rats. Our findings demonstrated that GA accumulated most prominently in kidney and prostate tissues. Based on these targeted distribution characteristics, chronic bacterial prostatitis (CBP) was chosen as a target tissue inflammatory model to explore the anti-inflammatory effects of GA. The results showed that GA exerted a direct anti-inflammatory effect by inhibiting the activation of the NF-κB inflammatory signaling pathway and reducing the release of pro-inflammatory cytokines such as IL-6, IL-1β, and TNF-α in both lipopolysaccharide (LPS)-induced RWPE-1 cell model and CBP rats. Untargeted prostate tissue metabolomics identified 43 metabolites in the prostate as metabolic markers associated with CBP rats. Additionally, mass spectrometry imaging (MSI) was used to visualize the heterogeneous distribution of these metabolites in prostate tissue and reveal the anti-inflammatory metabolic mechanism of GA, which was related to arginine metabolism, linoleic acid metabolism, and the downregulation of arachidonic acid metabolism. In conclusion, GA improves the physiological disorders associated with CBP by exerting anti-inflammatory effects and regulating metabolic homeostasis. These findings may shed new light on our understanding of the application value of natural polyphenols in food function and nutrition.

Treatment of extensively drug-resistant (XDR) organisms is complicated by pharmacodynamic and pharmacokinetic (PK) limitations of current antimicrobial agents. Prostatitis is an infection that is historically difficult to treat with beta-lactams given poor tissue penetration as compared to fluoroquinolones and sulfamethoxazole-trimethoprim. Cefiderocol is a novel cephalosporin that is often used to treat a wide variety of gram-negative bacteria that have extensive resistance to other antibiotics. Cefiderocol remains stable against many β-lactamases and shows enhanced bacterial cell entry as a result of siderophore uptake. However, its penetration into prostatic tissue has not been studied. This review presents the use of cefiderocol in a patient with complicated urinary tract infection and prostatitis caused by XDR Klebsiella pneumoniae resistant to almost all tested antibiotics, including novel beta-lactam/beta-lactamase combinations. Although PK data suggest that cefiderocol may achieve therapeutic concentrations in prostatic tissue, further studies are needed to confirm its efficacy in treating prostatitis, particularly in cases of chronic or complicated infection. This case highlights cefiderocol as a potential therapeutic option for XDR Enterobacterales prostatitis, though additional research is required to fully understand its prostate penetration and clinical outcomes.