At the 2004 American Urological Association meeting, 20 studies of chronic prostatitis were presented in both poster and podium sessions. The studies brought new insight into the possible causes of the syndrome, how not to treat it, what new treatments are on the horizon, and possible diagnostic tests. Researchers in the United States and abroad are also getting a better idea of how common the disease is and how it correlates with other problems. Pain and sexual function are also getting closer study.
TESTING: DIAGNOSIS AND FOLLOW-UP
There has never been an objective diagnostic test for prostatitis, but some of the studies presented this year hint that tests may be on the way. One study not only points to a possible objective test to follow the effects of treatment but also to a potential cause of chronic pelvic pain syndrome (CPPS, that is, nonbacterial or type III prostatitis). (Note that some researchers use the longer term “chronic prostatitis/chronic pelvic pain syndrome type III” or CP/CPPS type III to describe nonbacterial or type III prostatitis. Prostatitis may be a simple infection—type I, a chronic bacterial infection—type II, or chronic and nonbacterial—type III or just CPPS.)
“MAPPING” THE PROSTATE IN CP/CPPS
Jordan D Dimitrakov*, Jean Tchitalov, Plovdiv , Bulgaria
An instrument developed at Medical University in Plovdiv , Bulgaria , uses a transrectal color Doppler ultrasound probe and a finger-glove transducer to map “hotspots” of nerve activity in and around the prostate in the pelvic floor muscles. The “hotspots” indicate areas of nerve damage. These researchers used the instrument on 77 men with definite type III (nonbacterial) chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and in 33 age- and sex-matched controls. The men were selected very carefully to ensure they had no other condition that might affect the prostate, urinary tract, or nervous system. They had imaging done initially, daily for a week, weekly for a month, and biweekly for 6 months. They also had levels chemical markers of nerve damage tested. Unlike the controls, the men with type III CP/CPPS showed areas of damage in the same locations in their prostates and pelvic floor. These CP/CPPS “hotspots” were also very consistent over time. Not only does this technique have potential to be a test for type III CP/CPPS, it may also help demonstrate that the disease and symptoms are real to those who may still doubt it. Further studies in larger groups of patients are needed, however, before this can become a bona fide test.
CYTOKINE PROFILES IN THE URINE OF PATIENTS WITH CHRONIC PELVIC PAIN SYNDROME (CPPS)
Werner W Hochreiter *, Sebastian Zbrun, Fiona C Burkhard, Urs E Studer, Bern , Switzerland
Cytokines are chemicals secreted from white blood cells that are involved in the immune response and inflammation. Levels of cytokines are high in the prostatic secretions of men with CPPS (nonbacterial or type III prostatitis), suggesting that the cytokines may play a role in the development of the disease. Because expressed prostatic fluid is often hard to obtain, these researchers looked for different cytokines in the urine of 90 men with CPPS using the typical “three-glass” specimens (first void, midstream, and after prostate massage). Thirty of the men had inflammatory CPPS (type IIIa, with white blood cells found in the prostate massage urine specimen), 30 had noninflammatory CPPS (type IIIb, with no white blood cells in the specimen), and 30 were men with erectile dysfunction with no white cells who served as controls. The researchers tested for various cytokines and found one in particular—IL-8—was significantly higher in the men with type IIIa CPPS than in the other men. Measuring IL-8 might not only serve as a test for IIIa CPPS but also point to a potential treatment. The researchers think that IL-8 might play a role in causing prostate inflammation and that it may be useful to look for ways to neutralize this cytokine.
INTRAVESICAL POTASSIUM SENSITIVITY TEST IN PATIENTS WITH CHRONIC PELVIC PAIN SYNDROME: A CONTROLLED STUDY
Ugur Yilmaz*, Yung-Wen Liu, Ivan Rothman, Jay C Lee, Claire C Yang, Richard E Berger, Seattle, WA
Potassium sensitivity is a test often used to look for interstitial cystitis (although it has not been validated and can be painful during and after the test). The test is done by comparing the patient’s rating of pain when a potassium chloride solution is instilled into the bladder with the rating when a plain saline (salt water) solution is instilled. These researchers used the test on 40 men with CPPS and 63 healthy men. Although patients with CPPS did have some increase in pain and urgency scores after instillation of the potassium solution, the test scores weren’t significantly different from those of the healthy men. The researchers concluded that this test is not useful clinically for CPPS.
Although researchers are still looking for a possible infectious cause of CPPS (among others), a large trial of antibiotics showed that this most commonly prescribed therapy doesn’t help men with longstanding, refractory CPPS. And the second most commonly prescribed type of therapy—alpha blockers—don’t help in these men either. Urologists treating these men should help them look for alternatives. Researchers are already on a search for more treatment options, with some encouraging results for corticosteroids, physical therapy for the pelvic floor, and transurethral needle ablation (TUNA) of the prostate (used today for benign prostatitic hyperplasia or BPH). Results were also encouraging, although modest, with a standardized saw palmetto extract. Indications are that men with CPPS may also need to undergo more than one therapy at a time for the best results.
A RANDOMIZED TRIAL OF CIPROFLOXACIN AND TAMSULOSIN IN MEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME
Richard B Alexander*, Baltimore, MD; Kathleen J Propert, Philadelphia, PA; Anthony J Schaeffer, Chicago, IL; J Richard Landis, Philadelphia, PA; John W Kusek, Bethesda, MD; Mark S Litwin, Los Angeles, CA
Antibiotics and alpha blockers are the most commonly prescribed treatments for CP/CPPS patients. Physicians often prescribe antibiotics, such as ciprofloxacin (Cipro), even to men who have had symptoms for a long time when tests show no bacteria. The reason may be that the physicians believe that there may still be some hidden infection that treatment just hasn’t gotten rid of. Physicians also commonly prescribe alpha blockers, such as tamsulosin (Flomax), because they can help ease the lower urinary tract symptoms of BPH (prostate enlargement), so physicians assume these drugs might do the same for CP/CPPS patients. For the first time, this study put these treatments to a rigorous test in men who didn’t show any evidence of infection and who had had symptoms for a long time (an average of about 6 years) and had undergone unsuccessful treatments. The 196 men took one or the other active drug or a dummy pill. The researchers looked at whether the men improved by having them fill out the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaire at six weeks of treatment. The scores actually improved somewhat for all the men, but there were no differences between the scores of the men who got ciprofloxacin versus no ciprofloxacin or tamsulosin versus no tamsulosin. The researchers concluded that these treatments aren’t appropriate for men with nonbacterial (type III) prostatitis who have had their disease for a long time and who have moderate to severe symptoms. These men should try other therapies.
EFFICACY AND SAFETY OF CORTICOSTEROIDS IN THE TREATMENT OF CP/CPPS: A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL
Jordan D Dimitrakov*, Jean Tchitalov, Plovdiv , Bulgaria ; Dorian Dikov, Lagny-sur-Marne , France
Basic research supports a variety of potential causes of type III CP/CPPS—autoimmune, inflammatory, chemical, neuromuscular, and infectious. But since antibiotics don’t work for men with longstanding symptoms, these researchers decided to try another treatment—steroids—which are commonly used for autoimmune and inflammatory diseases. They tested methylprednisolone (also known as Medrol or Methylpred) in 133 men with category III CP/CPPS who were randomly assigned to get either 0.5 mg, 1 mg, or 5 mg per kg of body weight or a dummy pill (placebo) for seven days, with rapid tapering off of the active drug. The investigators looked at whether the NIH-CPSI scores improved, at the levels of cytokines in the expressed prostatic fluid and postprostatic massage urine, and also at the side effects the men reported. With the drug, scores improved 67 to 77 percent at one month, compared with 27 percent for placebo. At one year, the improvement had tapered off to 0 for the placebo and to 5 percent for the low dose. Improvement dropped much less—to 70 percent—for the high dose one year later. The levels of cytokines, which indicate inflammation, decreased significantly in all the men receiving active drug compared with the levels in men taking placebo. Side effects occurred in 30 percent of the men taking the highest dose, 21 percent of those taking the middle dose, and 5 percent of those taking the lowest dose. These researchers think that steroids might be a valuable treatment for type III CP/CPPS, but the benefit needs to be weighed against the side effects, and further large-scale studies need to be done.
CHRONIC PELVIC PAIN SYNDROME TYPE 3 SUCCESFULLY TREATED WITH BIOFEEDBACK PHYSICAL THERAPY
Erik B Cornel*, Hengelo , Netherlands ; Ernst P van Haarst, Amsterdam , Netherlands
Physical therapy for the pelvic floor can help improve symptoms in some men with CPPS (nonbacterial or type III prostatitis). This group of researchers tested the effectiveness of pelvic floor therapy by looking at their NIH-CPSI scores, measurements of pelvic floor muscle tone, and urinary function before and after therapy. (Men with CPPS often have high tone. In other words, the muscles don’t relax.) The physical therapy technique involved biofeedback to teach the men to relax these muscles. Two of the 23 men enrolled couldn’t be trained well and didn’t show improvement. But for the other 21 men, the NIH-CPSI score fell significantly from a mean of 26 (range 11 to 33) down to 8 (range 1 to 19) after treatment. Muscle tone also improved (that is, the muscles became more relaxed). In healthy men, the measurement of muscle tone in the pelvic floor should be 1 mev, but the average before treatment in the men with CPPS was 5 (range 2.5-100), which decreased significantly to 1.4 (range 0.5-2.8) after treatment. These researchers believe that physical therapy for the pelvic floor should play a role in CPPS treatment.
PROSPECTIVE PLACEBO-CONTROLLED MULTICENTER TRIAL ON SAFETY AND EFFICACY OF PHYTOTHERAPY IN THE TREATMENT OF CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME
Andreas Reissigl*, Bregenz, Austria; Bob Djavan, Vienna, Austria; Josef Pointner, Jurgen Brunner, Stefan Obwexer, Bregenz, Austria; Michael Marberger, Vienna, Austria
This study looked at a standardized extract of saw palmetto, called Permixon (available in Europe ) as a treatment for CPPS (type III or nonbacterial prostatitis). Of 142 men with CPPS, 72 got Permixon and 70 got a placebo. The response to therapy was measured at 6 and 12 weeks and 6, 12, and 18 months after treatment based on elements of the Patients’ Subjective Global Assessment (SGA) and the total NIH-CPSI scores. PSA and prostate volume were also checked. At least mild (35 to 50 percent) improvement was apparent at 12 months in 76.4 percent of men taking the drug and in 71.8 percent at 18 months compared with 24.3 percent at 12 months and 18.5 percent at 18 months for the men taking placebo. The proportion reporting moderate to marked (at least 50 percent) improvement with the drug was 55.7 percent at 12 months and 52.6 at 18 months compared with 18.8 percent and 14.7 percent, respectively, for the placebo group. At 18 months, 68.4 percent, 56.6 percent, and 54.7 percent of patients in the Permixon group demonstrated a 50 percent or better improvement in their international prostate symptom score, peak urine flow, and quality of life score, respectively, compared with 15.2 percent, 9.1 percent, and 11.6 percent, respectively, in the placebo group. Overall, the men who received Permixon had a 30 percent reduction in their NIH-CPSI score compared with 6.3 percent in the placebo group. Prostate volume did not change significantly in either group. PSA, however, decreased by 18 percent in the Permixon group at 18 months, whereas there was no change in the placebo group. (This decrease hasn’t been seen in men with BPH). The researchers concluded that Permixon may be a beneficial treatment for CPPS.
FAILURE OF A MONOTHERAPY STRATEGY FOR THE TREATMENT OF DIFFICULT CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME PATIENTS
J Curtis Nickel*, Joe Downey, Dale Ardern, Janet Clark, Kyle Nickel, Kingston , ON , Canada
Just one treatment may not be enough for CP/CPPS. This team tried treatments in a systematic way, but one at a time in sequence, in 100 men who had had previous treatment fail. If the men were taking a therapy that did help, they continued it. For others, when a treatment didn’t work, that therapy was stopped an another one begun. Depending on symptoms, the first-line therapies were alpha blockers, anti-inflammatory medications, and prostate massage. After 6 to 12 weeks, if a patient didn’t improve, he was switched to a different first-line therapy or one of the secondary therapies, including finasteride (Proscar), pentosan polysulfate (Elmiron), quercetin (an over-the-counter anti-inflammatory supplement often used for allergy), and other types of physical therapy. After one year, the improvements in NIH-CPSI scores were real but generally modest. Only 19 percent had at least a 50 percent improvement in their score. The researchers think their results indicate that trying one therapy after the other may not be useful and that patients likely need to undergo more than one therapy at a time.
TRANSURETHRAL NEEDLE ABLATION FOR CHRONIC NON BACTERIAL PROSTATITIS: A 3-YEAR FOLLOW-UP STUDY
Xenophon Giannakopoulos, Ioannina, Greece; Kim Entezari, Claude Schulman, Brussels, Belgium; Nikolaos Sofikitis, Ioannina, Greece; Alexandre Zlotta*, Brussels, Belgium
TUNA is a treatment used for BPH. It has been tested for chronic nonbacterial prostatitis (type III) in a small, short term study. These researchers, however, have longer-term follow up (three years) in 29 patients. All these patients had type IIIa prostatitis, that is, no evidence of infection and no white blood cells in the postprostatic massage urine specimen. All the patients had had their symptoms for at least 36 months and weren’t helped by any conventional therapy. They had their symptoms and quality of life assessed by questionnaires before and after surgery. The researchers also looked at semen quality and sperm motility and morphology. They also looked for white blood cells before and after surgery. TUNA was done under local anesthesia, and assessments were made at 1, 3, 6, 12, 24, and 36 months after treatment. Two patients were lost to follow up, but for the others, quality of life and symptom scores improved significantly at 3 years. Thirty-one patients (84 percent) had improvements in symptom scores of at least 50 percent. Improvements in the number of white blood cells in prostatic fluid and postprostatic massage urine samples were also significant compared with pretreatment values. There was no change in sperm morphology, numbers, or motility. Side effects included transient perineal discomfort (one week). Acute urinary retention occurred in 12 patients (31 percent) but resolved spontaneously in all cases within one week. The research team said its study supports TUNA as a possible effective treatment but also said that randomized studies should be encouraged.
Pain is a major feature of CPPS that deserves more study. One study showed that men with CPPS who have persistent postejaculatory do worse than other men with CPPS. Pain levels also seemed to correlate with how bad the urinary symptoms were and with depression and feelings of being out of control.
IMPACT OF POST-EJACULATORY PAIN IN MEN WITH CATEGORY III CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CPPS)
Daniel Shoskes*, Weston, FL; J Richard Landis, Yanlin Wang, Philadelphia, PA; J Curtis Nickel, Kingston, ON, Canada; Scott Zeitlin, Los Angeles, CA; Robert B Nadler, Chicago, IL
Ejaculation eases symptoms of CPPS for some men but worsens them in others. This group of researchers looked at ejaculatory pain and whether it was associated with other symptoms or risk factors in 486 men in the NIH Chronic Prostatitis Cohort Study at three monthly follow-up visits. Similar numbers of men never had pain, didn’t have pain at the start of the study but did at least once later, had pain at the start of the study but then didn’t at least once later, or always had it. Symptom scores increased progressively through that sequence of subgroups. Men who had ejaculatory pain all the time were more likely to live alone, have lower income, and a greater variety of sexual practices (sexual orientation was not a factor). They were also less likely to show at least a 50 percent improvement in their symptoms. In general, men with persistent ejaculatory pain did worse than others, were less likely to improve over time, and had more pain and poorer quality of life.
PHYSICAL AND PSYCHOSOCIAL PREDICTORS OF PAIN EXPERIENCE IN CP/CPPS
Dean Tripp*, J Curtis Nickel, Kingston , ON , Canada ; J Richard Landis, Yanlin Wang, Philadelphia , PA
In men with CP/CPSS, pain is commonly associated with poor quality of life, no matter a man’s age, urinary symptoms, or whether he has depressive symptoms. These researchers looked at what physical and psychological factors might be associated with pain by using the NIH-CPSI to assess urinary symptoms and other standard questionnaires to check for depressive symptoms, anxiety, social support, perceived control over pain, coping with chronic pain, and catastrophizing their pain. The researchers concluded that CP/CPPS pain is multifaceted, with both urinary and psychological variables as influential factors. Helplessness pain catastrophizing and urinary symptom score, coping, and feelings of control over pain were highly predictive of the level of pain, as was the depression score.
CPPS has a terrible effect on a man’s sexual function, no matter what his ethnicity.
SEXUAL FUNCTION IN ETHNICALLY DIVERSE MEN WITH CATEGORY III PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME
Zeph Okeke, Konstantin Walmsley, Alexis E Te, Steven A Kaplan*, New York , NY
No matter what race you are, CP/CPPS has profound effects on sexual function. These researchers looked at sexual function in 51 men with CP/CPPS, age 23 to 58 years (mean about 40); 57 percent were Caucasian, 27 percent were Hispanic, and 16 percent were African American. All three groups had significant decrease in sexual function and satisfaction and painful ejaculation, which was not related to the NIH-CPSI score. These investigators encourage diagnosis and treatment of rectile and ejaculatory function in men with CP/CPPS.
CAUSES OF PROSTATITIS
Although some researchers are still looking for bacteria as a possible cause of “nonbacterial” prostatitis, other researchers are taking a closer look at inflammatory and immune system processes, with some intriguing results.
CORRELATION OF SYSTEMIC CYTOKINE PRODUCTION WITH SEMINAL OXIDATIVE STRESS AND TREATMENT RESPONSE IN CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME
Daniel Shoskes*, Chantale Lapierre, Weston , FL
Similar to the study that looked at the cytokine IL-8 as a possible disease marker and something that might play a role in causing CPPS, this study looked at levels of other cytokines (IL-1, IL-2, IFN-gamma, IL-10, and TNF) that might be players. Cytokines are chemicals secreted from white blood cells that are involved in the immune response and inflammation. This group of researchers found that, in 35 CPPS patients, some cytokine levels are higher than normal, whereas others are lower. Specifically, cytokine-producing cells in the bloodstream of CPPS patients produce significantly less IL-1, more IL-2, and less IL-10. Because there is some speculation that CPPS may be an autoimmune disease with prostate-specific antigen (PSA) as the target, the researchers also looked at levels of cytokines with and without stimulation by PSA antigen. That did not, however, increase cytokine production, except in one patient who turned out to have an infection. The researchers also looked at levels of isoprostanes, a measure of oxidative stress (free-radical damage), but cytokine levels did not correlate with them, nor did they correlate with NIH-CPSI scores. A smaller group of CP/CPPS patients was treated with quercetin, an over-the-counter anti-inflammatory supplement often used for allergy, for at least a month and found that these men had significant reductions in isoprostane levels. The researchers pointed particularly to the lack of production of the anti-inflammatory cytokine IL-10 as typical of CPPS patients, especially those with longstanding symptoms.
HIGH BACTERIAL DNA LEVELS IN A SUBSET OF CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME PATIENTS
Donald E Riley*, John N Krieger, David Miner, Susan Ross, Seattle , WA
Could some CP/CPPS patients have infections that may not be apparent and still amenable to antibiotic treatment? These researchers attempted to find out by looking for the DNA of bacteria in prostate biopsy specimens (using a test called polymerase chain reaction) in 111 CP/CPPS patients and 71 prostate cancer patients. The research team found that the CP/CPPS patients had levels of bacterial DNA in their prostates that was three times higher than levels in the prostate cancer patients. This was mainly because about 20 percent of the CP/CPPS patients had extremely high levels of bacterial DNA indicating they might have an active infection. These patients might respond to antibiotics. These results may mean that studies need to have larger groups of patients to find out if there are some who will respond to antibiotics.
POLYMERASE CHAIN REACTION AND SEQUENCING ANALYSIS OF BACTERIAL DNA IN MEN WITH CHRONIC PROSTATITIS SYNDROME: PRELIMINARY RESULT OF MULTICENTER STUDY
Woo-Chul Moon*, Choong Hee Noh, Moon Soo Park, Chung Ho Cho, Ho Young Kang, Seoul, Republic of Korea
These researchers used the polymerase chain reaction assay to look for bacterial DNA in postprostatic massage urine and the expressed prostate secretions of 247 men with CPPS (nonbacterial or type III prostatitis) and 85 healthy men. In addition, the team did PCR analyses to find out whether certain kinds of bacterial DNA were present, including Escherichia coli (which commonly causes urinary tract infections), and four major causative organisms of sexually transmitted diseases (STDs), including gonorrhea and chlamydia. They also analyzed products from the PCR assays to help determine further what other kinds of bacteria might be present. More than half the samples (53.8 percent) showed bacterial DNA, with the most common being for enterobacteria, a group that includes E coli. The team also found DNA from novel bacteria in 14.7 percent of cases. DNA of various STD organisms was also present at low levels. In contrast, somewhat less than a third of the samples (30.6 percent) from the healthy men showed bacterial DNA but rarely showed the presence of DNA from E coli or any STD organism. PCR by itself, the researchers commented, has a high false positive rate (21.1 percent). They concluded that E coli is a causative organism in chronic prostatitis and called for further studies to look at the role of the novel bacteria and the value of extensive molecular bacteriologic study in this disease.
EFFECT OF PROSTATIC CALCULI IN TREATMENT OF INFLAMMATORY CHRONIC PELVIC PAIN SYNDROME
Yong-Hyun Cho, Seung-Ju Lee*, Usyn Ha, Sae Woong Kim, Moon Soo Yoon, Seoul , Republic of Korea
One theory holds that inflammation in prostatitis is caused by films of infectious organisms thought to be on the surface of prostate stones. Among 82 patients with CPPS treated at the Korean clinic, 22 had stones. The team used a polymerase chain reaction assay to check for the presence of bacterial DNA. There was no difference in NIH-CPSI scores between the group with stones and the group without stones and no significant difference in the levels of bacterial DNA between the groups. There were differences between the groups, however, in terms of white blood cell counts in prostate secretions after treatment, which included antibiotics, anti-inflammatory agents, and alpha blockers. Of those who did not have stones, 69.5 percent had white blood cell counts respond to treatment compared with 36.4 percent of those with stones. This team thinks that these prostate stones may play a role in inflammation that persists despite proper treatment.
Prostatitis is fairly common in older men and might correlate with BPH and prostate cancer, but more study is needed.
PREVALENCE AND CORRELATES OF PROSTATITIS IN A LARGE COMMUNITY-BASED COHORT OF OLDER MEN
Nicholas A Daniels*, Susan K Ewing, San Francisco, CA; Joseph M Zmuda, Pittsburgh, PA; Timothy J Wilt, Minneapolis, MN; Douglas C Bauer, San Francisco, CA
Prostatitis is fairly common in older men, and it seems to be associated with and increased risk of BPH and prostate cancer. In addition, many older men were unsatisfied with prostatitis treatment, especially African Americans. In this study, the researchers asked 1,439 older men, age 65 to 100 years, who were in a study of osteoporosis about their history of “prostatitis.” They didn’t have the men try to distinguish bacterial and nonbacterial prostatiitis. Of that total, 25 percent reported a history of prostatitis, which ocurred at similar rates in Caucasian, African American, and Asian men. The prevalence rose with age, from 19 percent for those under age 70 to 33 percent for those older than 80. Men who said they had prostatitis were more likely to report they had prostate cancer than other men (25 percent versus 7 percent) and BPH (83 percent versus 38 percent). A higher percentage of men with a history of prostatitis reported being mostly unsatisfied with their urinary condition or worse than men without a history of prostatitis (21 percent versus 11 percent), with the highest percentage among African American men with a history of prostatitis. Men with a history of prostatitis also had higher prostate symptom scores, with African American men having the highest. Controlling for BPH and age did not alter the results. This research team called for more research with more objective criteria into the relationship between the conditions.
European researchers are beginning to study how common prostatitis is in their countries and how urologists treat it. They are finding that prevalence, diagnosis, and treatment are not that different from the United States , but there’s still a long way to go with education and therapy everywhere. Meanwhile, there are now useful Chinese and Malay versions of the NIH-CPSI.
PREVALENCE, CHARACTERIZATION, DIAGNOSIS AND TREATMENT OF THE PROSTATITIS PATIENT IN ITALY : AN OPPORTUNITY TO COMPARE THE EUROPEAN PROSTATITIS PATIENT TO THE NORTH AMERICAN EXPERIENCE
J Curtis Nickel*, Kingston, ON, Canada; Michelangelo Rizzo, Florence, Italy; Federico Marchetti, Verona, Italy; Fabrizio Travaglini, Florence, Italy; Alberto Trinchieri, Milan, Italy
A survey of 70 Italian urologists helped get a handle on how common prostatitis is in Italy and how it is diagnosed and treated there. It also gave researchers the opportunity to compare the results with studies done here in the United States . The Italian study identified 1,148 patients with prostatitis—a prevalence of about 13 percent. The patients’ mean age was 47.1 years (range 16 to 83 years); two thirds had experienced their first symptoms within the last year. Among these men, the most common urinary diseases were BPH (17.4 percent), recurrent urinary tract infection (11.2 percent) and urinary stones (11.1 percent), and the most common concurrent diseases were diabetes (7.2%) and depression (6.8 percent). The most frequently reported and most severe symptoms were irritative voiding symptoms and perineal and suprapubic pain or discomfort. Three quarters of the patients were dissatisfied with their quality of life. Bacteria were cultured in 15.6 percent of expressed prostatic fluid specimens and 17.7 percent of the postprostatic massage urine specimens. Although 98 percent of the patients underwent a digital rectal examination, less than 3 percent underwent the classic Meares-Stamey four-glass test. The most common treatments prescribed were nonantibiotic drug therapy. Comparing these numbers to North American data led the researchers to conclude that diagnosis and treatment of prostatitis in Europe is not very different from that in North America . The team called for international collaborative efforts.
CHRONIC PROSTATITIS—A NATIONWIDE SURVEY OF ALL UROLOGISTS IN SWITZERLAND
Sebastian Zbrun*, Martin Schumacher, Urs E Studer, Werner W Hochreiter , Bern , Switzerland
Swiss researchers sent a survey on prostatitis to all 154 urologists practicing in Switzerland in May 2003 to document the current perception and management of chronic prostatitis urologists there. Seventy six (49 percent) of the urologists responded. They indicated that they see a median of 10 chronic prostatitis patients per month, including 3 newly diagnosed cases. That corresponds to a prevalence of 25 percent and an incidence of 76 per 100,000 inhabitants. Twenty-one percent of the urologists believed that chronic prostatitis is the result of infection, whereas 28 percent did not. For routine diagnostic assessment, the most commonly used tests were digital rectal examination, dipstick urinanalysis, ultrasound for postvoid residual urine volume, and microscopic urine analysis (91, 75 , 73 , and 67 percent of respondents, respectively). Microscopic and microbiologic analysis of postprostatic massage urine as well as symptom assessment by the NIH-CPSI are less frequently used (46, 34, and 12 percent of respondents, respectively). The predominant treatment prescribed for chronic prostatitis is antibiotics (75 percent). Ninety-three percent of respondents who thought infection was the cause of chronic prostatitis routinely used antibiotics as first-line therapy. Surprisingly, 80 percent of respondents who did not believe in an infectious etiology also prescribed antibiotics. When asked about the therapeutic consequences of analysis of postprostatic massage urine, almost half of the respondents said they would prescribe antibiotics even when no white cells were present. Treatments with nonsteroidal anti-inflammatory drugs or alpha blockers are less frequently adopted as first-line therapy (30 percent and 17 percent of respondents, respectively). The mean overall success rates of initial therapy reported (all treatments included) was 60 percent, but the mean recurrence rate after six months was reported to be 48 percent.
RELIABILITY AND VALIDITY OF THE CHINESE, MALAY AND ENGLISH VERSIONS OF THE NATIONAL INSTITUTES OF HEALTH–CHRONIC PROSTATITIS SYMPTOM INDEX IN A MALAYSIAN POPULATION
Phaik Yeong Cheah, Men Long Liong*, Kah Hay Yuen, Jin Rong Yang, Chu Leong Teh, Timothy Khor, Hin Wai Yap, Penang, Malaysia; John N Krieger, Seattle, WA
This team developed Chinese and Malay versions of the NIH-CPSI and tested them for validity in Malaysia , which has an ethnically diverse population. Various tests of validity were used, such as consistency when the test was given again. The tests held up well, except for test-retest validity over the long term, which might reflect variation in patients’ perceptions of symptoms over time. Researchers should be aware of this difference if they use the NIH-CPSI in long-term treatment trials.