Skip to main content

Advertisement

SpringerLink
Log in

Etiology of chronic prostatitis/chronic pelvic pain syndrome: psychoimmunoneurendocrine dysfunction (PINE syndrome) or just a really bad infection?

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To review the etiology and pathogenesis of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Methods

A literature review for the years 1985–2012 was performed using the MEDLINE database of the United States National Library of Medicine.

Results

The evidence for ongoing infection in men with CP/CPPS is lacking. However, men with CP/CPPS are twice as likely to have had a sexually transmitted disease (STD), and bacteria from men with CP/CPPS may be phenotypically different from those that cause cystitis or acute prostatitis. Evidence continues to support an alteration in both the afferent and efferent autonomic nervous systems. Functional brain imaging suggests changes in the gray matter as well as the importance of the anterior insula and anterior cingulated gyrus in pain processing. Neural function can be modulated by immune and endocrine factors. Alterations in cytokine function and autoimmunity appear to play a role in the immune dysfunction. Alterations in the hypothalamic–pituitary–adrenal axis can mediate the endocrine effects, similar to many other chronic pain conditions. Genetics may play a role in who may develop chronic pain after an initial insult. Finally, any biological changes must then be processed through the psychosocial environment, including the tendency to catastrophize, and degree of spousal support, to produce a given individual patient’s pain experience.

Conclusions

Infection with atypical bacteria or sequelae of an STD may lead to CP/CPPS in some men. Such a biological insult in the context of alterations in psychoimmunoneurendocrine factors produces the chronic pain experience.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Krieger JN, Nyberg L Jr, Nickel JC (1999) NIH consensus definition and classification of prostatitis. JAMA 282:236–237

    Article  PubMed  CAS  Google Scholar 

  2. Schaeffer AJ, Landis JR, Knauss JS, Propert KJ, Alexander RB, Litwin MS, Nickel JC, O’Leary MP, Nadler RB, Pontari MA, Shoskes DA, Zeitlin SI, Fowler JE Jr, Mazurick CA, Kishel L, Kusek JW, Nyberg LM, Chronic Prostatitis Collaborative Research Network Group (2002) Demographic and clinical characteristics of men with chronic prostatitis: the national institutes of health chronic prostatitis cohort study. J Urol 168:593–598

    Article  PubMed  Google Scholar 

  3. Nickel JC, Alexander RB, Schaeffer AJ, Landis JR, Knauss JS, Propert KJ, Chronic Prostatitis Collaborative Research Network Study Group (2003) Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls. J Urol 170:818–822

    Article  PubMed  Google Scholar 

  4. Leskinen MJ, Vainionp R, Syrjnen S, Leppilahti M, Marttila T, Kylml T, Tammela TL (2003) Herpes simplex virus, cytomegalovirus, and papillomavirus DNA are not found in patients with chronic pelvic pain syndrome undergoing radical prostatectomy for localized prostate cancer. Urology 61:397–401

    Article  PubMed  Google Scholar 

  5. Leskinen MJ, Rantakokko-Jalava K, Manninen R, Leppilahti M, Marttila T, Kylmala T, Tammela TL (2003) Negative bacterial polymerase chain reaction (PCR) findings in prostate tissue from patients with symptoms of chronic pelvic pain syndrome (CPPS) and localized prostate cancer. Prostate 55:105–110

    Article  PubMed  Google Scholar 

  6. Shoskes DA, Shahed AR (2000) Detection of bacterial signal by 16S rRNA polymerase chain reaction in expressed prostatic secretions predicts response to antibiotic therapy in men with chronic pelvic pain syndrome. Tech Urol 6:240–242

    PubMed  CAS  Google Scholar 

  7. Karatas OF, Turkay C, Bayrak O, Cimentepe E, Unal D (2010) Helicobacter pylori seroprevalence in patients with chronic prostatitis: a pilot study. Scand J Urol Nephrol 44:91–94

    Article  PubMed  CAS  Google Scholar 

  8. Wood HM, Shoskes DA (2006) The role of nanobacteria in urologic disease. World J Urol 24:51–54

    Article  PubMed  Google Scholar 

  9. Geramoutsos I, Gyftopoulos K, Perimenis P, Thanou V, Liagka D, Siamblis D, Barbalias G (2004) Clinical correlation of prostatic lithiasis with chronic pelvic pain syndromes in young adults. Eur Urol 45:333–337

    Article  PubMed  Google Scholar 

  10. Shoskes DA, Thomas KD, Gomez E (2005) Anti-nanobacterial therapy for men with chronic prostatitis/chronic pelvic pain syndrome and prostatic stones: preliminary experience. J Urol 173:474–477

    Article  PubMed  Google Scholar 

  11. Zhou Z, Hong L, Shen X, Rao X, Jin X, Lu G, Li L, Xiong E, Li W, Zhang J, Chen Z, Pan J, Song B (2008) Detection of nanobacteria infection in type III prostatitis. Urology 71:1091–1095

    Article  PubMed  Google Scholar 

  12. Collins MM, Meigs JB, Barry MJ, Walker Corkery E, Giovannucci E, Kawachi I (2002) Prevalence and correlates of prostatitis in the health professionals follow-up study cohort. J Urol 167:1363–1366

    Article  PubMed  Google Scholar 

  13. Weidner W, Schiefer HG, Krauss H, Jantos C, Friedrich HJ, Altmannsberger M (1991) Chronic prostatitis: a thorough search for etiologically involved microorganisms in 1,461 patients. Infection 19:S119–S125

    Article  PubMed  Google Scholar 

  14. Pontari MA, McNaughton-Collins M, O’leary MP, Calhoun EA, Jang T, Kusek JW, Landis JR, Knauss J, Litwin MS, CPCRN Study G (2005) A case-control study of risk factors in men with chronic pelvic pain syndrome. BJU Int 96:559–565

    Article  PubMed  Google Scholar 

  15. Johnson JR (2003) Microbial virulence determinants and the pathogenesis of urinary tract infection. Infect Dis Clin North Am 17:261–278

    Article  PubMed  Google Scholar 

  16. Ivanov IB, Gritsenko VA, Kuzmin MD (2010) Phenotypic differences between coagulase-negative staphylococci isolated from seminal fluid of healthy men and men suffering from chronic prostatitis syndrome. Int J Androl 33:563–567

    Article  PubMed  CAS  Google Scholar 

  17. Ivanov IB, Gritsenko VA, Kuzmin MD (2009) Phenotypic differences between coryneform bacteria isolated from seminal fluid of healthy men and men with chronic prostatitis syndrome. Asian J Androl 11:517–520

    Article  PubMed  CAS  Google Scholar 

  18. Ivanov IB, Gritsenko VA, Kuzmin MD (2008) Distribution of secretory inhibitor of platelet microbicidal protein among urethral isolates with its correlation with prostatitis. Asian J Androl 10:189–192

    Article  PubMed  Google Scholar 

  19. Ivanov IB, Gritsenko VA, Kuzmin MD (2006) Staphylococcal secretory inhibitor of platelet microbicidal protein is associated with prostatitis source. J Med Microbiol 55:1645–1648

    Article  PubMed  CAS  Google Scholar 

  20. Ivanov IB, Kuzmin MD, Gritsenko VA (2009) Microflora of the seminal fluid of healthy men and men suffering from chronic prostatitis syndrome. Int J Androl 32:462–467

    Article  PubMed  Google Scholar 

  21. Rudick CN, Berry RE, Johnson JR, Johnston B, Klumpp DJ, Schaeffer AJ, Thumbikat P (2011) Uropathogenic Escherichia coli induces chronic pelvic pain. Infect Immun 79:628–635

    Article  PubMed  CAS  Google Scholar 

  22. Kikutani H, Makino S (1992) The murine autoimmune diabetes model: NOD and related strains. Adv Immunol 51:285–322

    Article  PubMed  CAS  Google Scholar 

  23. True LD, Berger RE, Rothman I, Ross SO, Krieger JN (1999) Prostate histopathology and the chronic prostatitis/chronic pelvic pain syndrome: a prospective biopsy study. J Urol 162:2014–2018

    Article  PubMed  CAS  Google Scholar 

  24. Nickel JC, Roehrborn CG, O’Leary MP, Bostwick DG, Somerville MC, Rittmaster RS (2008) The relationship between prostate inflammation and lower urinary tract symptoms: examination of baseline data from the reduce trial. Eur Urol 54:1379–1384

    Article  PubMed  Google Scholar 

  25. Schaeffer AJ, Knauss JS, Landis JR, Propert KJ, Alexander RB, Litwin MS, Nickel JC, O’Leary MP, Nadler RB, Pontari MA, Shoskes DA, Zeitlin SI, Fowler JE Jr, Mazurick CA, Kusek JW, Nyberg LM, Chronic Prostatitis Collaborative Research Network Study Group (2002) Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: the national institutes of health chronic prostatitis cohort study. J Urol 168:1048–1053

    Article  PubMed  Google Scholar 

  26. Schenk JM, Kristal AR, Neuhouser ML, Tangen CM, White E, Lin DW, Kratz M, Thompson IM (2010) Biomarkers of systemic inflammation and risk of incident, symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial. Am J Epidemiol 171:571–582

    Article  PubMed  Google Scholar 

  27. Nadler RB, Koch AE, Calhoun EA, Campbell PL, Pruden DL, Bennett CL, Yarnold PR, Schaeffer AJ (2000) IL-1beta and TNF-alpha in prostatic secretions are indicators in the evaluation of men with chronic prostatitis. J Urol 164:214–218

    Article  PubMed  CAS  Google Scholar 

  28. Hochreiter WW, Nadler RB, Koch AE, Campbell PL, Ludwig M, Weidner W, Schaeffer AJ (2000) Evaluation of the cytokines interleukin 8 and epithelial neutrophil activating peptide 78 as indicators of inflammation in prostatic secretions. Urology 56:1025–1029

    Article  PubMed  CAS  Google Scholar 

  29. Desireddi NV, Campbell PL, Stern JA, Sobkoviak R, Chuai S, Shahrara S, Thumbikat P, Pope RM, Landis JR, Koch AE, Schaeffer AJ (2008) Monocyte chemoattractant protein-1 and macrophage inflammatory protein-1alpha as possible biomarkers for the chronic pelvic pain syndrome. J Urol 179:1857–1861

    Article  PubMed  Google Scholar 

  30. Thumbikat P, Shahrara S, Sobkoviak R, Done J, Pope RM, Schaeffer AJ (2010) Prostate secretions from men with chronic pelvic pain syndrome inhibit proinflammatory mediators. J Urol 184:1536–1542

    Article  PubMed  Google Scholar 

  31. Rudick CN, Schaeffer AJ, Thumbikat P (2008) Experimental autoimmune prostatitis induces chronic pelvic pain. Am J Physiol Regul Integr Comp Physiol 294:R1268–R1275

    Article  PubMed  CAS  Google Scholar 

  32. Done JD, Rudick CN, Quick ML, Schaeffer AJ, Thumbikat P (2012) Role of mast cells in male chronic pelvic pain. J Urol 187:1473–1482

    Article  PubMed  CAS  Google Scholar 

  33. Alexander RB, Brady F, Ponniah S (1997) Autoimmune prostatitis: evidence of T cell reactivity with normal prostatic proteins. Urology 50:893–899

    Article  PubMed  CAS  Google Scholar 

  34. Motrich RD, Maccioni M, Riera CM, Rivero VE (2007) Autoimmune prostatitis: state of the art. Scand J Immunol 66:217–227

    Article  PubMed  CAS  Google Scholar 

  35. Kouiavskaia DV, Southwood S, Berard CA, Klyushnenkova EN, Alexander RB (2009) T-cell recognition of prostatic peptides in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol 182:2483–2489

    Article  PubMed  CAS  Google Scholar 

  36. Hou DS, Long WM, Shen J, Zhao LP, Pang XY, Xu C (2012) Characterisation of the bacterial community in expressed prostatic secretions from patients with chronic prostatitis/chronic pelvic pain syndrome and infertile men: a preliminary investigation. Asian J Androl 14:566–573

    Article  PubMed  CAS  Google Scholar 

  37. Miller LJ, Fischer KA, Goralnick SJ, Litt M, Burleson JA, Albertsen P, Kreutzer DL (2002) Nerve growth factor and chronic prostatitis/chronic pelvic pain syndrome. Urology 59:603–608

    Article  PubMed  Google Scholar 

  38. Birder L, de Groat W, Mills I, Morrison J, Thor K, Drake M (2010) Neural control of the lower urinary tract: peripheral and spinal mechanisms. Neurourol Urodyn 29:128–139

    Article  PubMed  CAS  Google Scholar 

  39. Watanabe T, Inoue M, Sasaki K, Araki M, Uehara S, Monden K, Saika T, Nasu Y, Kumon H, Chancellor MB (2011) Nerve growth factor level in the prostatic fluid of patients with chronic prostatitis/chronic pelvic pain syndrome is correlated with symptom severity and response to treatment. BJU Int 108:248–251

    Article  PubMed  CAS  Google Scholar 

  40. Nickel JC, Atkinson G, Krieger JN, Mills IW, Pontari M, Shoskes DA, Crook TJ (2012) Preliminary assessment of safety and efficacy in proof-of-concept, randomized Clinical trial of tanezumab for chronic prostatitis/chronic pelvic pain syndrome. Urology 80:1105–1110

    Article  PubMed  Google Scholar 

  41. Lee JC, Yang CC, Kromm BG, Berger RE (2001) Neurophysiologic testing in chronic pelvic pain syndrome: a pilot study. Urology 58:246–250

    Article  PubMed  CAS  Google Scholar 

  42. Yang CC, Lee JC, Kromm BG, Ciol MA, Berger RE (2003) Pain sensitization in male chronic pelvic pain syndrome: why are symptoms so difficult to treat? J Urol 170:823–826

    Article  PubMed  Google Scholar 

  43. Yilmaz U, Liu YW, Berger RE, Yang CC (2007) Autonomic nervous system changes in men with chronic pelvic pain syndrome. J Urol 177:2170–2174

    Article  PubMed  Google Scholar 

  44. Cho DS, Choi JB, Kim YS, Joo KJ, Kim SH, Kim JC, Kim HW (2011) Heart rate variability in assessment of autonomic dysfunction in patients with chronic prostatitis/chronic pelvic pain syndrome. Urology 78:1369–1372

    Article  PubMed  Google Scholar 

  45. Yilmaz U, Ciol MA, Berger RE, Yang CC (2010) Sensory perception thresholds in men with chronic pelvic pain syndrome. Urology 75:34–37

    Article  PubMed  Google Scholar 

  46. Yilmaz U, Rothman I, Ciol MA, Yang CC, Berger RE (2005) Toe spreading ability in men with chronic pelvic pain syndrome. BMC Urol 5:11

    Article  PubMed  Google Scholar 

  47. Shoskes DA, Prots D, Karns J, Horhn J, Shoskes AC (2011) Greater endothelial dysfunction and arterial stiffness in men with chronic prostatitis/chronic pelvic pain syndrome—a possible link to cardiovascular disease. J Urol 186:907–910

    Article  PubMed  Google Scholar 

  48. Zermann DH, Ishigooka M, Doggweiler R, Schmidt RA (1999) Neurourological insights into the etiology of genitourinary pain in men. J Urol 161:903–908

    Article  PubMed  CAS  Google Scholar 

  49. Blaivas JG, Sinha HP, Zayed AA, Labib KB (1981) Detrusor-external sphincter dyssynergia. J Urol 125:542–544

    PubMed  CAS  Google Scholar 

  50. Hetrick DC, Glazer H, Liu YW, Turner JA, Frest M, Berger RE (2006) Pelvic floor electromyography in men with chronic pelvic pain syndrome: a case-control study. Neurourol Urodyn 25:46–49

    Article  PubMed  Google Scholar 

  51. Berger RE, Ciol MA, Rothman I, Turner JA (2007) Pelvic tenderness is not limited to the prostate in chronic prostatitis/chronic pelvic pain syndrome (CPPS) type IIIA and IIIB: comparison of men with and without CP/CPPS. BMC Urol 7:17

    Article  PubMed  Google Scholar 

  52. Farmer MA, Chanda ML, Parks EL, Baliki MN, Apkarian AV, Schaeffer AJ (2011) Brain functional and anatomical changes in chronic prostatitis/chronic pelvic pain syndrome. J Urol 186:117–124

    Article  PubMed  Google Scholar 

  53. Baliki MN, Schnitzer TJ, Bauer WR, Apkarian AV (2011) Brain morphological signatures for chronic pain. PLoS ONE [Electronic Resource] 6:e26010

  54. Baliki MN, Geha PY, Apkarian AV (2009) Parsing pain perception between nociceptive representation and magnitude estimation. J Neurophysiol 101:875–887

    Article  PubMed  CAS  Google Scholar 

  55. Mordasini L, Weisstanner C, Rummel C, Thalmann GN, Verma RK, Wiest R, Kessler TM (2012) Chronic pelvic pain syndrome is associated with reduction of relative gray matter volume in the anterior cingulate cortex compared to healthy controls. J Urol 188:2233–2237

    Article  PubMed  Google Scholar 

  56. Seminowicz DA, Labus JS, Bueller JA, Tillisch K, Naliboff BD, Bushnell MC, Mayer EA (2010) Regional gray matter density changes in brains of patients with irritable bowel syndrome. Gastroenterology 139(48–57):e2

    PubMed  Google Scholar 

  57. Luu P, Posner MI (2003) Anterior cingulate cortex regulation of sympathetic activity. Brain 126:2119–2120

    Article  PubMed  Google Scholar 

  58. Seminowicz DA, Wideman TH, Naso L, Hatami-Khoroushahi Z, Fallatah S, Ware MA, Jarzem P, Bushnell MC, Shir Y, Ouellet JA, Stone LS (2011) Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function. J Neurosci 31:7540–7550

    Article  PubMed  CAS  Google Scholar 

  59. Woolf CJ (1983) Evidence for a central component of post-injury pain hypersensitivity. Nature 306:686–688

    Article  PubMed  CAS  Google Scholar 

  60. Woolf CJ (2011) Central sensitization: implications for the diagnosis and treatment of pain. Pain 152:S2–S15

    Article  PubMed  Google Scholar 

  61. Ishigooka M, Zermann DH, Doggweiler R, Schmidt RA (2000) Similarity of distributions of spinal c-Fos and plasma extravasation after acute chemical irritation of the bladder and the prostate. J Urol 164:1751–1756

    Article  PubMed  CAS  Google Scholar 

  62. Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233

    Article  PubMed  Google Scholar 

  63. McNaughton Collins M, Pontari MA, O’Leary MP, Calhoun EA, Santanna J, Landis JR, Kusek JW, Litwin MS, Chronic Prostatitis Collaborative Research Network (2001) Quality of life is impaired in men with chronic prostatitis: the chronic prostatitis collaborative research network. J Gen Intern Med 16:656–662

    Article  PubMed  CAS  Google Scholar 

  64. Tripp DA, Curtis Nickel J, Landis JR, Wang YL, Knauss JS, CPCRN Study G (2004) Predictors of quality of life and pain in chronic prostatitis/chronic pelvic pain syndrome: findings from the national institutes of health chronic prostatitis cohort study. BJU Int 94:1279–1282

    Article  PubMed  Google Scholar 

  65. Tripp DA, Nickel JC, Wang Y, Litwin MS, McNaughton-Collins M, Landis JR, Alexander RB, Schaeffer AJ, O’Leary MP, Pontari MA, Fowler JE Jr, Nyberg LM, Kusek JW, National Institutes of Health-Chronic Prostatitis Collaborative Research Network (NIH-CPCRN) Study Group (2006) Catastrophizing and pain-contingent rest predict patient adjustment in men with chronic prostatitis/chronic pelvic pain syndrome. J Pain 7:697–708

    Article  PubMed  Google Scholar 

  66. Nickel JC, Tripp DA, Chuai S, Litwin MS, McNaughton-Collins M, Landis JR, Alexander RB, Schaeffer AJ, O’Leary MP, Pontari MA, White P, Mullins C, Nyberg L, Kusek J, NIH-CPCRN Study G (2008) Psychosocial variables affect the quality of life of men diagnosed with chronic prostatitis/chronic pelvic pain syndrome. BJU Int 101:59–64

    PubMed  Google Scholar 

  67. Hsieh AY, Tripp DA, Ji LJ, Sullivan MJ (2010) Comparisons of catastrophizing, pain attitudes, and cold-pressor pain experience between Chinese and European Canadian young adults. J Pain 11:1187–1194

    Article  PubMed  Google Scholar 

  68. Seminowicz DA, Davis KD (2006) Cortical responses to pain in healthy individuals depends on pain catastrophizing. Pain 120:297–306

    Article  PubMed  Google Scholar 

  69. Ullrich PM, Turner JA, Ciol M, Berger R (2005) Stress is associated with subsequent pain and disability among men with nonbacterial prostatitis/pelvic pain. Ann Behav Med 30:112–118

    Article  PubMed  Google Scholar 

  70. Hu JC, Link CL, McNaughton-Collins M, Barry MJ, McKinlay JB (2007) The association of abuse and symptoms suggestive of chronic prostatitis/chronic pelvic pain syndrome: results from the boston area community health survey. J Gen Intern Med 22:1532–1537

    Article  PubMed  Google Scholar 

  71. Spanos C, Pang X, Ligris K, Letourneau R, Alferes L, Alexacos N, Sant GR, Theoharides TC (1997) Stress-induced bladder mast cell activation: implications for interstitial cystitis. J Urol 157:669–672

    Article  PubMed  CAS  Google Scholar 

  72. Babenko O, Golubov A, Ilnytskyy Y, Kovalchuk I, Metz GA (2012) Genomic and epigenomic responses to chronic stress involve miRNA-mediated programming. PLoS ONE [Electronic Resource] 7:e29441

  73. Rodriguez MA, Afari N, Buchwald DS (2009) National Institute of diabetes and digestive and kidney diseases working Group on urological chronic pelvic, pain. Evidence for overlap between urological and nonurological unexplained clinical conditions. J Urol 182:2123–2131

    Article  PubMed  Google Scholar 

  74. Di Franco M, Iannuccelli C, Valesini G (2010) Neuroendocrine immunology of fibromyalgia. Ann N Y Acad Sci 1193:84–90

    Article  PubMed  Google Scholar 

  75. McEwen BS, Kalia M (2010) The role of corticosteroids and stress in chronic pain conditions. Metab, Clin Exp 59:S9–S15

    Article  CAS  Google Scholar 

  76. Anderson RU, Orenberg EK, Chan CA, Morey A, Flores V (2008) Psychometric profiles and hypothalamic-pituitary-adrenal axis function in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol 179:956–960

    Article  PubMed  Google Scholar 

  77. Dimitrakov J, Joffe HV, Soldin SJ, Bolus R, Buffington CA, Nickel JC (2008) Adrenocortical hormone abnormalities in men with chronic prostatitis/chronic pelvic pain syndrome. Urology 71:261–266

    Article  PubMed  Google Scholar 

  78. Turner DM, Williams DM, Sankaran D, Lazarus M, Sinnott PJ, Hutchinson IV (1997) An investigation of polymorphism in the interleukin-10 gene promoter. Eur J Immunogenet 24:1–8

    Article  PubMed  CAS  Google Scholar 

  79. Kroeger KM, Carville KS, Abraham LJ (1997) The -308 tumor necrosis factor-alpha promoter polymorphism effects transcription. Mol Immunol 34:391–399

    Article  PubMed  CAS  Google Scholar 

  80. Shoskes DA, Albakri Q, Thomas K, Cook D (2002) Cytokine polymorphisms in men with chronic prostatitis/chronic pelvic pain syndrome: association with diagnosis and treatment response. J Urol 168:331–335

    Article  PubMed  CAS  Google Scholar 

  81. Riley DE, Krieger JN (2002) X Chromosomal short tandem repeat polymorphisms near the phosphoglycerate kinase gene in men with chronic prostatitis. Biochim Biophys Acta 1586:99–107

    Article  PubMed  CAS  Google Scholar 

  82. Riley DE, Krieger JN (2001) Short tandem repeat polymorphism linkage to the androgen receptor gene in prostate carcinoma. Cancer 92:2603–2608

    Article  PubMed  CAS  Google Scholar 

  83. Riley DE, Krieger JN (2009) Embryonic nervous system genes predominate in searches for dinucleotide simple sequence repeats flanked by conserved sequences. Gene 429:74–79

    Article  PubMed  CAS  Google Scholar 

  84. Arisan ED, Arisan S, Kiremit MC, Tigli H, Caskurlu T, Palavan-Unsal N, Ergenekon E (2006) Manganese superoxide dismutase polymorphism in chronic pelvic pain syndrome patients. Prostate Cancer Prostatic Dis 9:426–431

    Article  PubMed  CAS  Google Scholar 

  85. von Hehn CA, Baron R, Woolf CJ (2012) Deconstructing the neuropathic pain phenotype to reveal neural mechanisms. Neuron 73:638–652

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Medicine, Temple University, 3401 North Broad Street, Zone C Suite 340, Philadelphia, PA, 19140, USA

    Michel A. Pontari

Authors
  1. Michel A. Pontari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michel A. Pontari.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pontari, M.A. Etiology of chronic prostatitis/chronic pelvic pain syndrome: psychoimmunoneurendocrine dysfunction (PINE syndrome) or just a really bad infection?. World J Urol 31, 725–732 (2013). https://doi.org/10.1007/s00345-013-1061-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-013-1061-z

Keywords

Search

Navigation