Chronic pelvic pain syndrome (CPPS) in men is often mistakenly associated with prostate inflammation - prostatitis - leading to unwarranted prescription of anti-inflammatory and antibacterial therapy. However, current evidence points to the complex multifactorial nature of CPPS, where the pain syndrome may be associated with disorders of neurogenic, muscular or visceral origin, not just prostate pathology.
Prostate secretion and post-massage urine (Meares and Stamey test) has traditionally been a key diagnostic tool for the detection of inflammatory changes in the prostate gland.
The aim of this study is to demonstrate that changes in prostate secretion are not the only or reliable criteria for confirming prostate inflammation in patients with CPPS, and that their inappropriate use in clinical practice leads to overdiagnosis and unnecessary treatment.
To determine the frequency and pattern of elevated leukocyte and bacterial counts in prostate secretions in patients with CPPS and to assess the relationship between the presence of changes in prostate secretions, microflora and associated symptoms.

The study included 40 men between the ages of 25 and 55 who had been diagnosed with CPPS for more than 12 months. 
   - All patients in the main group had previously received antibiotic therapy.
   - Control group: 20 healthy men with no evidence of pelvic pain or prostate pathology.
  - Assessment of the presence of associated symptoms such as irritable bowel syndrome, migraine, interstitial cystitis, fibromyalgia, low back pain and other complex regional pain syndromes by questionnaire and clinical examination.
   - Collection of prostatic secretions by prostatic massage.
   - Microscopic analysis of the secretion for leucocytes, erythrocytes, amyloid cells, lecithin granules.
   - Microbiological examination of prostate secretion to detect infectious agents.

1. 60% of patients in the main group had an increased number of leukocytes and bacteria in the prostate secretion, which was significantly higher than in the control group (p < 0.001).
2. The most common changes were
   - Detection of bacteria in the prostate secretion by microbiological analysis - 56% - Increased leukocyte count in the prostate secretion (> 10 in the field of view) - 18% of cases.
   - Decreased number of lecithin grains - 50% of cases.
   - Presence of amyloid bodies - 35% of cases.
3. Patients with a disease duration of more than 3 years had a higher rate of detection of elevated leukocyte and bacterial counts than patients with a shorter duration of symptoms (p = 0.02).
4. Changes in prostate secretion were observed in 68% of patients with comorbid symptoms such as irritable bowel syndrome, migraine, interstitial cystitis, fibromyalgia, low back pain and other complex regional pain syndromes, but these changes did not always correlate with the severity of pelvic pain.

The data obtained support the hypothesis that long-term CPPS is associated with the detection of increased numbers of leukocytes and bacteria in prostate secretions. These changes may be related to both inflammatory processes and changes in the microbiome in patients with CPPS. The high frequency of detection of infectious agents indicates the need for detailed microbiological examination of patients.
However, it is important to note that patients with CPPS may present with symptoms that are not directly related to changes in prostate secretion.

It is important to remember that the detection of elevated leukocyte and bacterial counts in prostate secretions is more likely to reflect changes in the microbiome than pathological processes in the prostate itself. This underlines the need to interpret test results with caution and to limit the use of antibiotics. Repeated courses of antibiotic therapy should be avoided in patients who have previously received antibiotics because of the risk of antibiotic resistance and poor treatment efficacy.