Economic impact of chronic prostatitis

There are four types of prostatitis, including type I (acute bacterial prostatitis), type II (chronic bacterial prostatitis), type III (chronic prostatitis/chronic pelvic pain syndrome, or CP/CPPS), and type IV (asymptomatic inflammatory prostatitis). These prostatitis conditions account for approximately 2 million office visits each year to primary care physicians and urologists. The annual cost to treat prostatitis is approximately $84 million. Compared with control subjects, men with prostatitis incur significantly greater costs, predominantly due to increased outpatient visits and pharmacy expenses. CP/CPPS is the most common type of prostatitis. The condition is characterized by chronic, idiopathic pelviperineal pain. Due to the lack of effective treatments for CP/CPPS, the per-person costs associated with the condition are substantial and are similar to those reported for peripheral neuropathy, low back pain, fibromyalgia, and rheumatoid arthritis. Costs appear to be higher in men with more severe symptoms. Indirect costs (eg, work and productivity loss) are incurred by many patients with CP/CPPS. Identification of effective treatments for CP/CPPS would be expected to substantially reduce the costs associated with the condition.     

Sexual dysfunction in chronic prostatitis/chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), or NIH category III prostatitis, is a common clinical syndrome characterized by genital/pelvic pain and lower urinary tract symptoms in the absence of urinary tract infection. There is also growing recognition of the association of sexual dysfunction with CP/CPPS including erectile dysfunction, ejaculatory pain, and premature ejaculation. In this review, we discuss the association between CP/CPPS and sexual dysfunction, potential mechanisms for sexual dysfunction, and treatment strategies for erectile dysfunction in CP/CPPS.     

Role of bacteria in chronic prostatitis/ chronic pelvic pain syndrome

Throughout the past century, we have refined our understanding of prostatitis, moving from using a primarily clinical definition to considering it as a complex inflammatory condition. The inconsistency in identifying uropathogens in patients with symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has led to controversy in therapeutic management. There is compelling evidence that the normal prostate has minimal inflammation and no bacteria. Clinicians using the Meares/Stamey criteria identified uropathogens localized to the prostate in only 6% to 8% of CP/CPPS patients. This suggests that bacteria may have a role in less than 10% of men with CP/CPPS. That some patients respond to antimicrobials could suggest that eradication of bacteria reduces symptoms. However, the beneficial effect of antimicrobial drugs may not be due to their antibacterial action, but to their anti-inflammatory action. The normal prostate shows minimal inflammation, but only 50% of CP/CPPS patients exhibit prostatic leukocytosis. Prudence demands that we examine the function of the white blood cells—the cytokines produced. Several basic science advances allowed new avenues of research regarding the detection of molecular evidence of causative uropathogens. New research brings new controversy and unexpected findings, but further refines our understanding of the immune system and the CP/CPPS disease process.     

Mechanisms in prostatitis/chronic pelvic pain syndrome

PURPOSE: We reviewed the current literature on mechanisms involved in the pathogenesis of prostatitis/chronic pelvic pain syndrome (CPPS). MATERIALS AND METHODS: A literature review for the years 1966 to 2003 was performed using the MEDLINE database of the United States National Library of Medicine. RESULTS: National Institutes of Health categories I and II prostatitis result from identifiable prostatic infections, whereas patients with category IV are asymptomatic. The majority of symptomatic cases are category III or chronic prostatitis (CP)/CPPS. The etiology of CP/CPPS is unknown. The traditional marker of inflammation, namely white blood cells in prostatic fluids, does not correlate with the predominant symptom of pelvic pain. An imbalance toward increased proinflammatory and decreased anti-inflammatory cytokines has been implicated and a few studies have shown some correlation of this with pelvic pain. The imbalance in some men may result from polymorphisms at the cytokine loci. An autoimmune process may be involved and experimental evidence indicates that this can be under hormonal influence. Recent findings include possible defects in the androgen receptor. The prostate may not even be the source of the symptoms. Pelvic pain also correlates with the neurotrophin nerve growth factor implicated in neurogenic inflammation and central sensitization. Finally, psychological stress may produce measurable biochemical changes and influence the other processes. The role of normal prostatic bacterial flora in inciting the inflammatory response has also been reconsidered. CONCLUSIONS: The symptoms of CP/CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological and endocrine systems.     

细胞因子及热休克蛋白在慢性前列腺炎患者精浆中的含量及其临床意义

目的:探讨慢性细菌性前列腺炎以及慢性前列腺炎/慢性骨盆疼痛综合症(CP/CPPS)患者精浆中肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)以及热休克蛋白70(HSP70)的含量及临床意义。方法:采用酶联免疫吸附测定法(ELISA)对36例慢性细菌性前列腺炎(Ⅱ型)、43例炎症型慢性非细菌性前列腺炎即炎症型慢性骨盆疼痛综合征(ⅢA型)、46例非炎症型慢性非细菌性前列腺炎即非炎症型慢性骨盆疼痛综合征(ⅢB型)患者及25例健康志愿者精浆中TNF-α、IL-1β以及HSP70含量进行测定分析,并将HSP70的表达与慢性前列腺炎症状评分进行相关性分析。结果:慢性细菌性前列腺炎患者精浆中细胞因子(TNF-α、IL-1β)以及HSP70含量明显高于CP/CPPS患者及正常对照组。CP/CPPSⅢA型患者精浆中IL-1β的含量明显高于CP/CPPSⅢB型患者及正常对照组。CP/CPPS患者精浆中HSP70的含量明显低于正常对照组。慢性细菌性前列腺炎患者精浆中HSP70的含量与CPSI评分呈显著负相关。结论:精浆中HSP70的含量能够作为评价慢性细菌性前列腺炎病情程度的分子生物学指标。IL-1β能够作为CP/CPPS分型诊断指标。对于慢性细菌性前列腺炎患者,HSP70具有细胞保护功能。CP/CPPS患者精浆中HSP70表达的抑制可能与T细胞功能受损有关。     

Role of alpha1-blockers in chronic prostatitis syndromes

Category III chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most commonly diagnosed prostatitis syndrome. CP/CPPS is characterized by lower urinary tract symptoms (LUTS) of which pain (particularly perineal pain and pain on ejaculation) and dysfunctional voiding cause the greatest morbidity and poor quality of life. There is no standard treatment for CP/CPPS. Patients report only transient relief of symptoms from currently available therapies and are frequently required to change treatments. The origin of LUTS and possibly the pelvic pain (e.g. on ejaculation) is thought to be prolonged smooth muscle contraction in the bladder and prostate, caused by alpha(1)-adrenoceptor activation. alpha(1)-Blockers are not indicated in the treatment of CP/CPPS but clinical experience suggests that they might be of benefit, possibly by promoting smooth muscle relaxation. Encouraging results of three phase II, randomized, placebo-controlled trials evaluating (using a validated instrument) the efficacy of alfuzosin, tamsulosin and terazosin in alpha(1)-blocker-na?ve patients with CP/CPPS, support this hypothesis. The National Institute of Health and the National Institute of Diabetes and Digestive and Kidney Diseases are currently conducting a large phase III trial in 272 newly diagnosed and alpha(1)-blocker-na?ve CP/CPPS patients randomized to received alfuzosin 10 mg once daily or placebo for 12 weeks.     

Acupuncture for chronic prostatitis/ chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/ CPPS) is prevalent in urological practice and has a significant impact on quality of life. Standard therapies often fail to achieve sustainable amelioration of symptoms. This article attempts to show that neuromodulatory treatment in the form of electroacupuncture can be a minimally invasive and effective treatment for CP/CPPS that is refractory to standard therapies. This neuromodulatory therapy lends support to the hypothesis that the end stage of CP/CPPS may be a neuropathic pain syndrome.     

The role of cytokines in prostatitis

There is substantiating evidence to support the role of the immune system in the pathogenesis of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Inflammation of the prostate is mediated through the cytokine-induced expression of several factors such as chemokines, inducible nitric oxide synthase, and cyclooxygenase-2. The balance between the effects of proinflammatory and anti-inflammatory cytokines determines the outcome of the inflammatory process. Several proinflammatory and anti-inflammatory cytokines have been identified in CPPS patients, their roles characterized, and their inter-relationships defined. Study of this system will provide further insights into the etiology of CP/CPPS, and lead the way for the development of novel therapeutic approaches for this morbid condition.     

Quercetin for chronic prostatitis/chronic pelvic pain syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition with a heterogeneous origin that responds best to multimodal therapy. The bioflavonoid quercetin has antioxidant and antiinflammatory effects that have proven useful for treating this condition. Using the clinical phenotype system UPOINT, quercetin can be helpful for those with organ-specific complaints (bladder or prostate) and pelvic floor spasm. This article discusses the current understanding of CP/CPPS and how treatment with quercetin can be used alone or as part of multimodal therapy.     

The NIH Consensus concept of chronic prostatitis/chronic pelvic pain syndrome compared with traditional concepts of nonbacterial prostatitis and prostatodynia

The new National Institutes of Health (NIH) consensus classification identifies chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) based on the presence or absence of leukocytes in expressed prostatic secretions (EPS), postprostatic massage urine (VB3), or seminal fluid analysis. The purpose of this review is to determine the effect of the new classification on the proportion of symptomatic patients diagnosed with inflammation. We compare and contrast the new consensus classification with the traditional classification of prostatitis syndromes, then review how these changes effect patient classification in our clinical practice. Thorough clinical and microbiologic examination of 140 patients attending the University of Washington Prostatitis Clinic included evaluation of first void urine, mid-stream urine, EPS, VB3, and semen specimens. Inflammation was documented in 111 (26%) of 420 samples including 39 EPS samples, 32 VB3 samples, and 40 SFA specimens. Of the 140 patients, 73 (52%) had inflammatory CP/CPPS according to the NIH consensus criteria, but only 39 (28%) had nonbacterial prostatitis according to traditional EPS criteria (P < 0.001). The new NIH consensus concept of inflammatory CP/CPPS includes almost twice as many patients as the traditional category of nonbacterial prostatitis.     

Herbal nutraceutical treatment of chronic prostatitis–chronic pelvic pain syndrome: a literature review

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most frequent form of prostatitis, and has a serious impact on patients’ quality of life, and causes severe symptoms. The pain in the pelvic, perineal and penile areas, lower abdominal pain, and pain during urination or ejaculation are the main complaints of CP/CPPS. The underlying complex and unknown pathophysiology of this syndrome have made the management of CP/CPPS and the availability of monotherapy challenging. To identify an effective monotherapy, a plethora of clinical trials failed due to its puzzling etiology. Antibiotics, anti-inflammatory, and a-blockers have been commonly used for the treatment of CP/CPPS, but the desired and complete effects have not been gotten yet. The patients and clinicians are attracted to alternative therapies because of their multi-targeted effects. Attention toward natural compounds effectiveness and safety, supporting the development of a new nutraceutical science. In the alternative remedies for the treatment of prostatic diseases, medicinal herbs, in the form of herb parts or extracts, are getting attention due to their positive effects on prostatic diseases. At present, there is no available detailed literature review about the efficacy of medicinal herbs in the treatment of CP/CPPS. This review aimed to explore the useful medicinal herbs in the treatment of CP/CPPS from different perspectives and their possible mechanism of action in managing CP/CPPS.

     

Chronic prostatitis/chronic pelvic pain syndrome: role of alpha blocker therapy

INTRODUCTION: This article reviews the rationale and data supporting alpha blocker therapy for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), the most common and difficult prostatitis syndrome. METHODS: Systematic review identified ten clinical trials evaluating alpha blocker therapy for patients with CP/CPPS, including five open-label or small prospective studies and five double-blinded and placebo-controlled clinical trials. RESULTS: Encouraging results in uncontrolled and small clinical trials led to the development of reasonably powered, double-blinded, placebo-controlled, randomized clinical trials evaluating terazosin, doxazosin, tamsulosin, and alfuzosin. CONCLUSIONS: Current data suggest that treatment-na?ve and/or newly diagnosed patients appear more likely to respond than long-term, chronic refractory patients. Longer courses of treatment (12 weeks to 6 months) appear superior to shorter courses, and less selective agents appear superior to more selective alpha1 blockers. These observations outline important questions that must be answered to define optimal treatment strategies for patients with CP/CPPS.     

Management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): the studies, the evidence, and the impact

Introduction

The development of an accepted clinical definition, classification system and validated outcome questionnaire for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has led to a flurry of clinical trial activity over the last 15 years.

Methods

Twenty-four of these studies enrolled a homogeneous population of CP/CPPS patients, were prospective randomized placebo or sham controlled, and employed the National Institutes of Health chronic prostatitis symptom index (CPSI) as an outcome parameter.

Results

This review of the evidence and clinical impact from these studies suggests that physician’s strict adherence to a rigid evidence-based approach for the treatment of a CP/CPPS patient will result in disappointed patients as well as disappointed physicians.

Conclusions

There is no one particular treatment that shows significant clinical efficacy to be recommended as a mono-therapy for CP/CPPS. Therefore, the physician must adapt his knowledge and interpretation of the evidence from randomized placebo- and sham-controlled trials to determine what therapy or therapies are best indicated for each individual patient.     

Phenotypic approach to the Management of chronic prostatitis/chronic pelvic pain syndrome

There is no one unifying etiological mechanism or specific curative therapy for chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS). However, there is sufficient evidence to suggest that each of the proposed mechanisms may be important in some patients, and that many of our evaluated treatments do in fact work in subgroups of patients. We hypothesize that CP/CPPS patients are not a homogenous group suffering from a single disease entity. Rather, CP/CPPS patients are actually unique individuals with differing clinical phenotypes based on various etiological mechanisms with distinctive symptom complexes and progression trajectories. We call this the “Snow Flake Hypothesis.” We propose the UPOINT (urinary, psychosocial, organ-specific, infection, neurologic/systemic, and tenderness domains) clinical phenotyping classification; we have validated the concept in a CP/CPPS cohort and have suggested that phenotypically directed therapy will improve our clinical treatment outcomes.     

Phenotypic approach to the management of the chronic prostatitis/chronic pelvic pain syndrome

? Our traditional approach to managing the chronic prostatitis (CP) syndromes has not been very successful for many of our patients. ? Our developing understanding of CP/chronic pelvic pain syndrome (CP/CPPS) as a heterogeneous syndrome rather than a homogenous disease has allowed us to develop treatment strategies based on individual patient characteristics. ? By considering each patient as a unique individual and tailoring treatments to a specific patient's clinical 'phenotype' we improve our therapeutic outcomes.     

Development of an evidence-based cognitive behavioral treatment program for men with chronic prostatitis/chronic pelvic pain syndrome

Objectives Psychosocial factors reported by patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) promote greater pain, disability, and ultimately poorer quality of life (QOL). We targeted those parameters in the development of a cognitive-behavioral (CB) program designed specifically for CP/CPPS. Methods and materials Five NIH sponsored biopsychosocial studies examined predictors of pain, disability, and QOL in CP/CPPS men. Pain, urinary symptoms, QOL, depressive symptoms, catastrophic thinking about pain, perceived control over pain, pain-contingent resting as a pain coping measure, social support and interaction, sexual functioning, and relationship issues were assessed. These data showed that CB intervention for pain catastrophizing, pain contingent rest, social support and depressive symptoms is warranted for men with CP/CPPS Results An evidence based 8-week CB program was developed. The content of the CB sessions are defined in an instructional patient workbook for each of the weekly 1-h sessions. The CB program guides patients in examining the relationship between their symptom-based distress, their thinking at such times and the emotions linked with those thoughts, and their behavioral responses to their particular thinking style (e.g., illness vs. wellness focused). Patients complete such analyses by using a Reaction Record format, which also delineates new thinking/behavioral responses. Conclusions The CB program developed for CP/CPPS is the first comprehensive attempt to target specific evidence supported biopsychosocial variables for both symptom and QOL improvement in CP/CPPS and is expected to provide a useful tool for the clinical management of this chronic condition.     

慢性前列腺炎/慢性盆腔疼痛综合征与勃起功能障碍的临床预测

目的应用临床指标,预测慢性前列腺炎/慢性盆腔疼痛综合征（CP/CPSS）发生勃起功能障碍（ED）的可能性。方法以90例门诊确诊的慢性前列腺炎/慢性盆腔疼痛综合征患者为研究对象,分为发生ED组（A组）23例,未发生ED组（B组）67例,分别比较两组间在硫酸脱氢表雄酮（DHEAS）、24h尿香草扁桃体酸（VMA）、年龄等观察指标上的差异性,寻找其中能用于预测ED的临床指标。结果A组平均DHEAS值低于B组,VMA值高于B组,年龄方面两组差异无统计学意义。结论可通过DHEAS、VMA来预测慢性前列腺炎/慢性盆腔疼痛综合征患者ED的发生,有利于对慢性前列腺炎/慢性盆腔疼痛综合征发生ED患者的监控和治疗干预。     

The Estonian version of the National Institutes of Health chronic prostatitis symptom index

Our aim was to establish the Estonian version of the National Institutes of Health chronic prostatitis symptom index (NIH-CPSI), and to examine its validity and applicability in chronic prostatitis patients as well as in community-based study. The questionnaire was tested in 54 category III prostatitis patients. In addition, 452 men were enrolled into a community-based study that resulted in 83 completed questionnaires. The discriminatory power, psychometric properties and internal correlations of the questionnaire were tested. The questionnaire demonstrated good internal consistency, with Cronbach's alpha coefficient 0.82. The pain and quality of life domains demonstrated high correlations with each other and with the entire questionnaire. The total score and the scores of pain and quality of life domains of the Estonian NIH-CPSI differed significantly between the chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) patients and the men without CP/CPPS, and so the index proved a good discriminant validity. We can conclude that the Estonian NIH-CPSI is easily understood and reflects accurately the clinical symptoms and the quality of life in patients with chronic prostatitis. The similarity of the psychometric properties of the English and Estonian versions of the NIH-CPSI supports their measurement equivalence.     

The Challenge of Erectile Dysfunction in the Man with Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), also known as NIH category III prostatitis, is common and has significant impact on quality of life through pain and lower urinary tract symptoms. A high proportion of men with CP/CPPS suffer from some form of sexual dysfunction including erectile dysfunction, premature ejaculation, and painful ejaculation. While well described, the pathophysiology of these sexual symptoms has not been well studied. This review will focus on what we know regarding the incidence and potential mechanisms for sexual dysfunction in CP/CPPS and discuss diagnostic and therapeutic options.     

The impact of chronic prostatitis/chronic pelvic pain syndrome on patients

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition, affecting men of all ages. Since mortality and serious complications are extremely uncommon, CP/CPPS is primarily a quality-of-life disease, and, therefore, the patient's perspective is of paramount importance. As with other non-life threatening diseases, the goal of treatment is to maximize quality not quantity of life. Scientifically validated methods to measure patients' health related quality of life have been applied in other urological diseases such as benign prostatic hyperplasia and interstitial cystitis; the same process is now underway in the study of CP/CPPS. Recent studies have shown that CP/CPPS takes a substantial toll on physical and mental health. In addition to examining the health related quality of life of patients with CP/CPPS, future studies should address additional patient-centered outcomes, such as satisfaction with care and the economic burden of the illness, in order to allow a more comprehensive understanding of the impact of this condition on patients.