Treatment of chronic prostatitis

Evaluation of a modification of the UPOINT clinical phenotype system for the chronic pelvic pain syndrome

OBJECTIVE

. To evaluate the recently presented six-domain UPOINT phenotype system for the chronic abacterial prostatitis/chronic pelvic pain syndrome (CPPS) and to correlate it with clinically relevant parameters such as ejaculatory pain, pain localization, erectile dysfunction, cold sensitivity and the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI).

MATERIAL AND METHODS

Fifty men with CPPS were classified in each of the six UPOINT domains. A CPPS focused history was obtained and the men were asked to complete the NIH-CPSI, the International Index of Erectile Function (IIEF-5) and the Coping Strategies Questionnaire (CSQ).

RESULTS

The mean age was 46 years (range 26-71 years). The percentage positive for each domain was 26 (52%) for urinary, 18 (36%) for psychosocial, 19 (38%) for organ specific, 19 (38%) for infection, 18 (36%) for neurological/systemic and 16 (32%) for pelvic muscle tenderness. Mean NIH-CPSI was 23+/-7. The number of positive domains and the NIH-CPSI [correlation coefficient (r) = 0.478, p=0.002] and its quality of life section (r=0.432, p=0.003) were linked; there was, however, no correlation between the number of positive domains and IIEF-5, ejaculatory pain, painful micturition, cold sensitivity or pain localization (except for scrotal pain). The link between catastrophizing and NIH-CPSI was marked (r=0.61, p<0.001).

CONCLUSIONS

The correlation between the UPOINT score and NIH-CPSI was verified. A weak or lacking correlation with the studied clinical parameters suggests that further development is required before UPOINT can be considered an optimal phenotyping instrument.

New treatments for chronic prostatitis/chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition among men of a wide age range, with detrimental effects on quality of life. The etiology, pathogenesis, and optimal treatment of CP/CPPS remain unknown, although progress has been made in these domains in recent years. A wide variety of pharmacologic and nonpharmacologic therapies have been studied in clinical trials, but most have shown limited efficacy in symptom alleviation. CP/CPPS is increasingly viewed as a condition that involves variable degrees of neuropathic pain. Medications such as gabapentin, pregabalin, memantine, and tricyclic antidepressants are often used in other neuropathic pain conditions and, therefore, are considered potential treatments for CP/CPPS. Few studies of these agents in patients with CP/CPPS have been reported, but future clinical trials should help to determine their utility and to characterize the pathogenetic mechanisms of pain in CP/CPPS. Combining treatment trials with biomarker, genomic, and imaging studies, in addition to epidemiologic and symptom-based assessments, will maximize the ability to probe disease etiology and pathogenesis, as well as identify effective treatment.

Chronic prostatitis/chronic pelvic pain syndrome: Symptoms are aggravated by cold and become less distressing with age and time

OBJECTIVES

To evaluate how age and the duration of the condition influence the distress caused by the chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and to study how heat and cold influence the symptoms associated with CP/ CPPS as reported by patients afflicted with the condition.

MATERIAL AND METHODS

Forty-eight men (median age 50 years; age range 27-70 years) who had suffered from CP/CPPS for a duration ranging from 18 months to 40 years were included in the study. The evaluation included determination of the serum prostate-specific antigen level, the National Institutes of Health's Chronic Prostatitis Symptom Index (NIH-CPSI) and the International Prostate Symptom Score (IPSS).

RESULTS

The mean NIH-CPSI score was 23.0 +/- 4.8. The mean IPSS was 14.3 +/- 7.2. Dysuria was reported by 30 men (63%) and ejaculatory pain by 22 (48%). Men with dysuria had painful ejaculations more often (60%) than men without (22%) (p <0.01). There was a strong negative correlation between age and the NIH-CPSI quality of life (QOL) score (correlation coefficient 0.646; p < 0.001). Independent of age, the duration of the disease also correlated with the NIH-CPSI QOL score (correlation coefficient -0.48; p < 0.02). The total NIH-CPSI score did not correlate with either age or the duration of the disease. Nearly every other man stated that the disease had started in association with a specific event, which for 15 men (31%) included exposure to cold. Forty men (83%) reported that cold caused symptom aggravation and/or induced a relapse. Thirty men (63%) stated that taking a hot bath and 22 (46%) reported that spending time in a hot climate decreased the symptoms.

CONCLUSIONS

Age, as well as the duration of the condition, influenced the distress induced by CP/CPPS, suggesting an improved coping ability with time as well as age. The ambient temperature appears to play a role as cold was frequently reported as causing symptom aggravation and heat was often reported to be ameliorating. The mechanisms behind this association between CP/CPPS and temperature as well as the correlation between ejaculatory pain and dysuria require further study.

Adrenocortical hormone abnormalities in men with chronic prostatitis/chronic pelvic pain syndrome

OBJECTIVES

To identify adrenocortical hormone abnormalities as indicators of endocrine dysfunction in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

METHODS

We simultaneously measured the serum concentrations of 12 steroids in patients with CP/CPPS and controls, using isotope dilution liquid chromatography, followed by atmospheric pressure photospray ionization and tandem mass spectrometry.

RESULTS

We evaluated 27 patients with CP/CPPS and 29 age-matched asymptomatic healthy controls. In the mineralocorticoid pathway, progesterone was significantly greater, and the corticosterone and aldosterone concentrations were significantly lower, in the patients with CP/CPPS than in the controls. In the glucocorticoid pathway, 11-deoxycortisol was significantly lower and the cortisol concentrations were not different between the patients and controls. In the sex steroid pathway, the androstenedione and testosterone concentrations were significantly greater in those with CP/CPPS than in the controls. The estradiol, dehydroepiandrosterone, and dehydroepiandrosterone sulfate concentrations were not different between the patients and controls. The National Institutes of Health-Chronic Prostatitis Symptom Index total and pain domain scores correlated positively with the 17-hydroxyprogesterone and aldosterone (P <0.001) and negatively with the cortisol (P <0.001) concentrations.

CONCLUSIONS

Our results suggest reduced activity of CYP21A2 (P450c21), the enzyme that converts progesterone to corticosterone and 17-hydroxyprogesterone to 11-deoxycortisol. Furthermore, these results provide insights into the biologic basis of CP/CPPS. Follow-up studies should explore the possibility that patients with CP/CPPS meet the diagnostic criteria for nonclassic congenital adrenal hyperplasia and whether the hormonal findings improve or worsen in parallel with symptom severity.

Chronic abacterial prostatitis and cold exposure: an explorative study

OBJECTIVE

Chronic abacterial prostatitis/pelvic pain syndrome (CP/CPPS) is characterized by pain, voiding and sexual dysfunction persisting fo r> 3 months. The symptoms tend to occur in relapses of varying length. To evaluate what causes a relapse and what precautions patients with CP/CPPS undertake to avoid a relapse and/or aggravation of symptoms, individual semi-structured interviews were performed.

MATERIAL AND METHODS

Information was obtained from semi-structured in-depth interviews with 10 selected men with CP/CPPS (mean age 44 years; 30-62 years). The interviews were transcribed and analysed according to Girorgi's phenomenological method as modified by Malterud.

RESULTS

CP/CPPS tended to start in connection with a specific event involving cold exposure, suggesting cold as an initiating stimulus for CP/CPPS. The informants also reported that cold exposure caused aggravation of symptoms and provoked their relapse. Sitting on cold objects, spending time in cold, damp or windy surroundings and walking on a cold floor were provocative and thus were avoided. The exposure did not have to be either prolonged or intense. Heat applied to the perineum, as well as spending time in a warmer climate, gave relief from symptoms.

CONCLUSIONS

It appears that cold is one of the factors that can trigger a process resulting in CP/CPPS. The fact that cold also causes aggravation of symptoms and can initiate a relapse was evident, as was the fact that symptoms could be relieved by heat. The connection between cold and symptom aggravation is well known among clinicians but has not previously been studied in a systematic way. The fact that cold, in a susceptible man, can initiate a process resulting in CP/CPSS has not been reported before. Studies aimed at elucidating the mechanisms behind this phenomenon are warranted. Reflex vasoconstriction in a susceptible individual is a possible cause.