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

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 Zn 2+ 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, Zn 2+ , 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.