Prevalence of prostatitis-like symptoms in a community based cohort of older men

Clinical characterization of the prostatitis patient in Italy: a prospective urology outpatient study

A prospective multi-center Italian urology outpatient survey, undertaken to determine the prevalence of prostatitis in Italy, provided an ideal opportunity to identify and characterize the typical prostatitis patient presenting to Italian urologists. A total of 70 urologists, representing a cross section of urologic centers in Italy, counted and recorded the overall total male patients reported in the clinic and the overall total patients diagnosed with prostatitis over a 5 week period in late 2001. Data on demographics, previous diagnoses, symptoms (frequency and severity), quality of life, physical examination and laboratory data were prospectively collected. A total of 1,148 patients were identified with prostatitis (12.8%). Of these, 1,074 patients had complete data and could be included in this characterization analysis. The mean age of the prostatitis patients was 47.1 years (range 16-83); two thirds had experienced their first symptom within the last year. A family history of prostatitis was reported by 20.4%. The most common urinary diseases were benign prostatic hyperplasia (17.4%), recurrent urinary tract infection (11.2%) and urinary calculogenesis (11.1%), while the most common concurrent diseases were diabetes (7.2%) and depression (6.8%). The most frequently reported and most severe symptoms at the time of evaluation were irritative voiding symptoms, perineal and suprapubic pain and discomfort. Over three quarters of the patients were dissatisfied with their quality of life. Bacteria were cultured in 15.6%, 17.7% and 14.0% of expressed prostatic secretions, urine specimens after prostatic massage and semen specimens, respectively. Prostatitis is a common outpatient diagnosis, comprising over 10% of male outpatient visits to urologists in Italy. This comprehensive characterization of the typical prostatitis patient diagnosed in routine urological outpatient practice can be employed to generate hypothesis-driven studies in diagnosis and treatment.

Chronic prostatitis and sensory urgency: Whose pain is it?

Difficulties encountered in diagnosing and effectively treating chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is frustrating for clinicians and patients. Scientific evidence cannot establish an exact relationship between the prostate and the symptoms of CP/CPPS, and the prostate continues to be the diagnosis of convenience in this complex syndrome in men. However, if the pain is not the prostate's, whose pain is it? A heterogeneous group of insults can result in a common neurogenic pain response, resulting in recurring pain and voiding or sexual dysfunction. To add to this dilemma, certain life-threatening diagnoses, such as carcinoma-in-situ, is in the differential diagnosis and must be excluded. Urodynamics may be useful in evaluating and treating patients whose voiding symptoms predominate. However, many patients with CP/CPPS will not have measurable abnormalities by conventional methods and likely suffer from a functional somatic syndrome that is best treated with a multimodality approach.

Influence of pain and urinary symptoms on quality of life in young men with chronic prostatitis-like symptoms

BACKGROUND

Our aims in the present study were to estimate the influences of pain and urinary symptoms on quality of life, and to determine which of these two variables has the most predictive power with respect to quality of life in young men with chronic prostatitis-like symptoms.

METHODS

Chronic prostatitis-like symptoms were measured by the National Institutes of Health-Chronic Prostatitis Symptom Index. Of the 28,841 men aged 20 years who lived in the study community, 18,495 men (a response rate 64.1%) agreed to participate in the study. A total of 1057 men who complained of symptoms indicative of chronic prostatitis were included in the study. The influences of pain and urinary symptoms on quality of life were determined using logistic regression analysis. The receiver operating characteristic (ROC) curve was used to estimate the predictive ability of each of these variables with respect to quality of life.

RESULTS

Results from multivariate analysis showed that both pain and urinary symptoms were associated with an increased likelihood of impaired quality of life, although pain contributed more to a reduced quality of life than urinary symptoms. Relative to men who experienced mild pain, men who experienced moderate pain had a 3.9-fold risk of poor quality of life (odds ratio [OR], 3.87; 95% confidence interval [CI], 2.86-5.23; P < 0.001) and those who experienced severe pain had a 15.7-fold risk of reduced quality of life (OR, 15.68; 95% CI, 6.59-37.35; P < 0.001). Moderate urinary symptoms were associated with a 1.4-fold risk of bother (OR, 1.41; 95% CI, 1.01-1.99; P < 0.001) and severe urinary symptoms were associated with 2.4-fold risk (OR, 2.39; 95% CI, 1.37-4.12; P < 0.001), relative to mild urinary symptoms. Comparison of the effects of pain and urinary symptoms showed that pain severity had the most predictive power for bother, quality of life, and quality-of-life impact. The areas under the ROC curves for bother, quality of life, and quality-of-life impact were 71.3%, 69.3% and 72.5%, respectively.

CONCLUSION

Urinary symptoms and pain might be associated with an increased likelihood of impaired quality of life in young men with chronic prostatitis-like symptoms. In addition, our findings suggest that pain severity is the most influential variable for determining quality of life in this population.

Chronic prostatitis/chronic pelvic pain syndrome in elderly men: toward better understanding and treatment

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most common of the prostatitis syndromes. It is characterised by pelvic pain, with or without voiding symptoms. CP/CPPS accounts for 2 million office visits in the US alone. Recent epidemiological studies have shown that CP/CPPS can affect men at any age, including those in their 80s. The aetiology is unknown but proposals include infectious, autoimmune, neurologic and psychiatric causes. Men with CP/CPPS are much more likely to have had a past medical history of cardiovascular, neurologic, psychiatric or infectious disease (particularly sinusitis) as compared with asymptomatic individuals. Although leucocytes are commonly found in the prostatic fluid of these men, they do not correlate with the symptoms. The clinical evaluation now includes a validated, self administered symptom score, the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), which was designed as an outcome measure for treatment trials. This can aid in diagnosis and follow-up of patients' response to therapy. Treatment for CP/CPPS is empiric and limited by a lack of randomised, placebo-controlled clinical trials. Antimicrobials are commonly used to treat the symptoms of CP/CPPS. However, the finding that asymptomatic men have equal or greater numbers of bacteria which localise to the prostatic fluid, compared with men with CP/CPPS, has raised doubts about the contribution of infection to the symptoms. Other commonly used drugs include alpha-adrenoceptor antagonists, anti-inflammatory drugs, tricyclic antidepressants and anticholinergic agents. The adverse effects of these medications are a concern in older men with CP/CPPS. Other therapies available include minimally invasive procedures such as microwave thermotherapy and transurethral needle ablation, and now neuromodulation devices.Although much progress has been made, particularly in the last 7 years, considerable work still remains to be done to determine the aetiology and pathogenesis of CP/CPPS, and to develop mechanism based therapy that is shown to be effective in controlled trials.

Low Agreement Between Previous Physician Diagnosed Prostatitis and National Institutes of Health Chronic Prostatitis Symptom Index Pain Measures

PURPOSE

We evaluate the agreement between self-reported physician diagnosed prostatitis and pain questions from the National Institutes of Health Chronic Prostatitis Symptom Index (CPSI).

MATERIALS AND METHODS

A randomly selected cohort of white men 47 to 90 years old from Olmsted County, Minnesota completed a study questionnaire on a history of physician diagnosed prostatitis in the preceding 2 years, including the CPSI questions. The medical records were also reviewed for physician diagnosis of chronic prostatitis during the preceding 10 years.

RESULTS

Of 1,543 men 27 (1.7%) reported a physician diagnosis of prostatitis in the preceding 2 years. There were strong associations between self-reported prostatitis and pain at the tip of the penis (OR 6.3, 95% CI 1.4, 28.5), ejaculatory (5.9, CI 1.3, 26.6) and testicular (3.6, 1.2, 10.8) pain. The chance corrected agreement between self-reported prostatitis and pain symptoms was low at 0.01 (pubic pain) to 0.07 (pain at the tip of the penis, ejaculatory pain and testicular pain). Agreement in positive responses was also low at 3.7% (perineal pain) to 8% (pain at the tip of the penis, ejaculatory pain and testicular pain). The predictive value of the modified total CPSI score for prostatitis was 0.67, which was better than chance (0.5). Associations based on medical record ascertainment of prostatitis during followup were weak, and the area under the curve was 0.57, which was no better than chance.

CONCLUSIONS

These findings demonstrate low agreement between CPSI-like pain measures and self-reported physician diagnosed prostatitis. The stronger associations between pain symptoms and self-reported diagnosed prostatitis, and the moderate predictive ability of the modified total CPSI score measures for self-reported prostatitis compared to medical record ascertainment demonstrate the sensitivity of the CPSI to prevalent symptoms. Thus, the tool may be best used to evaluate the severity of current symptoms rather than to assess the presence or absence of prostatitis.

Prevalence, diagnosis and treatment of prostatitis in Italy: a prospective urology outpatient practice study

OBJECTIVE

To report a prospective, multicentre descriptive study designed to determine the prevalence of the diagnosis of prostatitis in male outpatients examined by urologists in Italy, and to further examine the diagnostic evaluation and treatment of patients identified with a clinical diagnosis of prostatitis.

PATIENTS AND METHODS

Between July 2001 and October 2001, 70 urologists, representing a cross-section of urological centres in Italy, counted and recorded the overall total of men reported in the clinic and that of patients diagnosed with prostatitis over a 5-week period. Data on demographics, previous diagnoses, symptoms, physical examination, laboratory data and therapy instituted were collected. Patients with a diagnosis of prostatitis completed questionnaires on symptom frequency and severity, and quality of life.

RESULTS

In all, 8503 patients were included in the primary outcome analysis; 1148 were identified with prostatitis (12.8%; mean age 47.1 years, range 16-83) with all age ranges equally represented, and 68% had had their first symptom within the last year. The most common presenting symptoms were severe, bothersome urinary frequency, obstructive voiding symptoms, perineal, suprapubic and penile pain or discomfort. The self-administered questionnaire confirmed that the most frequently reported and most severe symptoms at the time of evaluation were irritative voiding symptoms, perineal and suprapubic pain and discomfort. Over three-quarters of the patients were dissatisfied with their quality of life. While 98% of the patients had a digital rectal examination and expressed prostatic secretion was successfully recovered in 44%, < 3% of the patients had the traditional Meares-Stamey four-glass test. The most common treatment prescribed was drug therapy (not antibiotic).

CONCLUSION

The prevalence of a clinical diagnosis of prostatitis in urology outpatient practice in Italy was 12.8%. The prevalence, diagnosis, evaluation and treatment of prostatitis reported in this prospective study was very similar to that reported in other retrospective series from other countries.