AUA 2009: Highlights for CP/CPPS

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AUA 2009 - Infection/Inflammation of Genitourinary Tract: Prostate and Genitalia - Session Highlights
Sunday, 26 April 2009

CHICAGO, IL, USA (UroToday.com) - The well-attended podium session on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) included several interesting presentations highlighting epidemiologic aspects, treatment, and basic science efforts.

Dr. Dean Tripp and coworkers from Kingston, Ontario asked whether prostatitis symptoms in adolescents are determined by culture. They compared black African Kenyan and white Canadian groups, ruled out possible confounding factors like sexually transmitted disease, and found that symptoms were not related to age, ethnicity, or culture. Whether the impact on quality of life from CPPS symptoms was also cross-cultural could not be determined from the data. Dr. Daniel Shoskes and colleagues from Cleveland discussed clinical phenotyping of CP/CPPS and found that the more domains (urinary, psychosocial, organ specific, infection, neurologic/systemic, and tenderness) that were involved, the higher the symptom score. Only psychosocial and neurologic domains influenced quality of life. Duration of symptoms correlated with increasing involvement of domains. Nickel from Kingston, Ontario discussed work of the Chronic Prostatitis Collaborative Research Network, comparing symptoms in newly-diagnosed patients to those with chronic-refractory symptoms. The longer symptoms persist, the worse the pain, mental quality of life, anxiety and depression. Duration was not associated with urinary, physical, or sexual functioning. The study did not compare patients over time, but looked at separate populations, and the data needs to be viewed in that context.

Several presentations on therapy were highlighted by results of the randomized placebo-controlled multicenter trial of pregabalin for CP/CPPS presented by Michel Pontari from Philadelphia on behalf of the Chronic Prostatitis Collaborative Research Network. Six weeks of therapy were not superior to placebo, but secondary endpoints suggested the drug may have some efficacy in selected patients. Dimitrakov and colleagues reported what was described as an “old” Bulgarian study evaluating the efficacy of memantine (NamendaR), a noncompetitive NMDA receptor blocker for CP/CPPS in a one year placebo-controlled unregistered trial of 170 men. Six month results were nothing short of spectacular with a 77% response rate compared to 16% response in the placebo group based on the NIH-CPSI pain domain scale primary endpoint. At 12 months, 80 patients on 20mg of memantine daily were compared with 81 patients on placebo. In the active treatment group NIHCPSI pain domain dropped by 7 points versus 2 points on the placebo. The data will need to be examined more carefully when the paper appears in the literature. Side effects were minimal.

Dr. Mi Mi Oh and colleagues from Korea reported on a placebo controlled prospective randomized 2:1 (n=30) trial comparing pelvic floor radiofrequency therapy with sham therapy in 30 men. Twice weekly 30 minute applications at a frequency of 0.5megaherz were employed. Pain related symptoms responded in the treatment group with no significant change in the sham group. In another trial from Korea, Tag Keun Yoo and associates used a portable transrectal thermal therapeutic device (URO-DrTM) and compared it to medical therapy alone and combination thermal and medical therapy in 120 men. They found that a combination of antimicrobials and nonsteroidal anti-inflammatory agents with thermal therapy was more effective for CP/CPPS than either modality alone.

Dr. Xiaoyong Zeng and coinvestigators from Wuhan, China studied the feasibility and efficacy of extracorporeal shock wave treatment for CP/CPPS in a 2:1 active vs. sham design in 60 patients. Patients were treated in 10 sessions over 2 weeks and results were assessed 4 weeks later. There was significant improvement in CPSI score in both arms of the study. The active group had significantly more perceptible and clinically significant improvement than the sham group. No adverse events were noted, and Dr. Zeng suggested that a large, multicenter trial was warranted.

Drs. David Duong and Rodney Anderson from Stanford, California reported on the clinical impact of leukocytes in prostatic fluid in chronic abacterial prostatitis. They found none. Marconi and co-investigators from Giessen, Germany studied 258 infertile men looking to identify NIH type 2 (chronic bacterial) and 3a (nonbacterial, inflammatory ) category CP/CPPS. Using the MAGI (male accessory gland infection/inflammation) criteria of the World Health Organization classification underestimated the percentage of infectious and inflammatory prostatitis in this population from 24% by NIH criteria to 9% by WHO criteria.

Dr. Anthony Schaeffer presented work from his group in Chicago with regard to brain activity associated with spontaneous fluctuations of pain in CP/CPPS. Using functional magnetic imaging techniques, it appears the spontaneous pain of CPPS has a unique temporal variability property that can be localized to the anterior insula and anterior cingulate and can be differentiated from other types of pain. Cognitive deficits related to CP/CPPS and BPS/IC were also demonstrated. Drs. Carlos Perez Martinez and Irma Vargas Diaz from Chihuahua, Mexico used skin surface electromyography in patients and case-matched controls, and believe that this noninvasive technique may be an alternative for electromyography in this patient group that often has a hypertonic pelvic floor.

It may well be that synergism between phenotyping, new therapies, and basic science research techniques will move the study of chronic prostatitis/chronic pelvic pain syndrome into a new era.


Presented at the Annual Meeting of the American Urological Association (AUA) - April 25 - 30, 2009 - McCormick Place Convention Center - Chicago, Illinois, USA