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Chronic Prostatitis/Chronic Pelvic Pain Syndrome in Elderly Men

Toward Better Understanding and Treatment

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Abstract

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most common of the prostatitis syndromes. It is characterised by pelvic pain, with or without voiding symptoms. CP/CPPS accounts for 2 million office visits in the US alone. Recent epidemiological studies have shown that CP/CPPS can affect men at any age, including those in their 80s. The aetiology is unknown but proposals include infectious, autoimmune, neurologic and psychiatric causes. Men with CP/CPPS are much more likely to have had a past medical history of cardiovascular, neurologic, psychiatric or infectious disease (particularly sinusitis) as compared with asymptomatic individuals. Although leucocytes are commonly found in the prostatic fluid of these men, they do not correlate with the symptoms.

The clinical evaluation now includes a validated, self administered symptom score, the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), which was designed as an outcome measure for treatment trials. This can aid in diagnosis and follow-up of patients’ response to therapy.

Treatment for CP/CPPS is empiric and limited by a lack of randomised, placebo-controlled clinical trials. Antimicrobials are commonly used to treat the symptoms of CP/CPPS. However, the finding that asymptomatic men have equal or greater numbers of bacteria which localise to the prostatic fluid, compared with men with CP/CPPS, has raised doubts about the contribution of infection to the symptoms. Other commonly used drugs include α-adrenoceptor antagonists, anti-inflammatory drugs, tricyclic antidepressants and anticholinergic agents. The adverse effects of these medications are a concern in older men with CP/CPPS. Other therapies available include minimally invasive procedures such as microwave thermotherapy and transurethral needle ablation, and now neuromodulation devices.

Although much progress has been made, particularly in the last 7 years, considerable work still remains to be done to determine the aetiology and pathogenesis of CP/CPPS, and to develop mechanism based therapy that is shown to be effective in controlled trials.

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References

  1. Drach GW, Fair WR, Meares EM, et al. Classification of benign diseases associated with prostatic pain: prostatitis or prostatodynia? [letter]. J Urol 1978; 120(2): 266

    PubMed  CAS  Google Scholar 

  2. Krieger JN, Nyberg Jr L, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999; 282(3): 236–7

    Article  PubMed  CAS  Google Scholar 

  3. de la Rosette JJ, Hubregtse MR, Meuleman EJ, et al. Diagnosis and treatment of 409 patients with prostatitis syndromes. Urology 1993; 41(4): 301–7

    Article  PubMed  Google Scholar 

  4. Krieger J, Jacobs RR, Ross SO. Does the chronic prostatitis/pelvic pain syndrome differ from nonbacterial prostatitis and prostatodynia? J Urol 2000; 164: 1554–8

    Article  PubMed  CAS  Google Scholar 

  5. Krieger JN, Egan KJ, Ross SO, et al. Chronic pelvic pains represent the most prominent urogenital symptoms of “chronic prostatitis”. Urology 1996; 48(5): 715–21

    Article  PubMed  CAS  Google Scholar 

  6. Schaeffer AJ, Landis JR, Knauss JS, et al. Demographic and clinical characteristics of men with chronic prostatitis: the national institutes of health chronic prostatitis cohort study. J Urol 2002; 168(2): 593–8

    Article  PubMed  Google Scholar 

  7. Collins MM, Meigs JB, Barry MJ, et al. Prevalence and correlates of prostatitis in the health professionals follow-up study cohort. J Urol 2002; 167: 1363–6

    Article  PubMed  Google Scholar 

  8. Roberts RO, Lieber MM, Rhodes T, et al. Prevalence of a physician-assigned diagnosis of prostatitis: the Olmsted County study of urinary symptoms and health status among men. Urology 1998; 51: 578–84

    Article  PubMed  CAS  Google Scholar 

  9. Nickel CJ, Downey J, Hunter D, et al. Prevalence of prostatitislike symptoms in a population based study using the National Institutes of Health Chronic Prostatitis Symptom Index. J Urol 2001; 165: 842–5

    Article  PubMed  CAS  Google Scholar 

  10. Roberts RO, Jacobson DJ, Girman CJ, et al. Prevalence of prostatitis-like symptoms in a community based cohort of older men. J Urol 2002; 168: 2467–71

    Article  PubMed  Google Scholar 

  11. Collins MM, Stafford RS, O’Leary MP, et al. How common is prostatitis?: a national survey of physician visits. J Urol 1998; 159(4): 1224–8

    Article  PubMed  CAS  Google Scholar 

  12. Wenninger K, Heiman JR, Rothman I, et al. Sickness impact of chronic nonbacterial prostatitis and its correlates. J Urol 1996; 155(3): 965–8

    Article  PubMed  CAS  Google Scholar 

  13. McNaughton Collins M, Pontari MA, O’Leary MP, et al. Quality of life is impaired in men with chronic prostatitis: the Chronic Prostatitis Collaborative Research Network. J Gen Intern Med 2001; 16(10): 656–62

    Article  PubMed  CAS  Google Scholar 

  14. Ware JE, Kosinski M, Keller SD. A twelve item short form health survey-construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34: 220–3

    Article  PubMed  Google Scholar 

  15. Calhoun E, Collins MM, Pontari M, et al. What is the economic impact of chronic prostatitis [abstract]. J Urol 2001; 165Suppl. 5: 25

    Google Scholar 

  16. Weidner W, Schiefer HG, Krauss H, et al. Chronic prostatitis: a thorough search for etiologically involved microorganisms in 1461 patients. Infection 1991; 19Suppl. 3: S119–25

    Article  PubMed  Google Scholar 

  17. Roberts RO, Lieber MM, Bostwick DG, et al. A review of clinical and pathological prostatitis syndromes. Urology 1997; 49(6): 809–21

    Article  PubMed  CAS  Google Scholar 

  18. Berger RE, Krieger JN, Rothman I, et al. Bacteria in the prostate tissue of men with idiopathic prostatic inflammation. J Urol 1997; 157(3): 863–5

    Article  PubMed  CAS  Google Scholar 

  19. Ponniah S, Arah I, Alexander RB. PSA is a candidate self-antigen in autoimmune chronic prostatitis/chronic pelvic pain syndrome. Prostate 2000; 44(1): 49–54

    Article  PubMed  CAS  Google Scholar 

  20. Zermann DH, Ishigooka M, Doggweiler R, et al. Neurourological insights into the etiology of genitourinary pain in men. J Urol 1999; 161(3): 903–8

    Article  PubMed  CAS  Google Scholar 

  21. Mehik A, Hellstrom P, Sarpola A, et al. Fears, sexual disturbances and personality features in men with prostatitis: a population-based cross-sectional study in Finland. BJU Int 2001; 88(1): 35–8

    Article  PubMed  CAS  Google Scholar 

  22. Pontari MA, Litwin MS, O’Leary MP, et al. A case-control study of epidemiological factors in men with chronic pelvic pain syndrome [abstract]. J Urol 2002; 167Suppl. 4: 24

    Google Scholar 

  23. Mehik A, Hellstrom P, Lukkarinen O, et al. Epidemiology of prostatitis in Finnish men: a population-based cross-sectional study. BJU Int 2000; 86(4): 443–8

    Article  PubMed  CAS  Google Scholar 

  24. Ohkawa M, Yamaguchi K, Tokunaga S, et al. Ureaplasma urealyticum in the urogenital tract of patients with chronic prostatitis or related symptomatology. Br J Urol 1993; 72(6): 918–21

    Article  PubMed  CAS  Google Scholar 

  25. Doble A, Thomas BJ, Walker MM, et al. The role of Chlamydia trachomatis in chronic abacterial prostatitis: a study using ultrasound guided biopsy. J Urol 1989; 141(2): 332–3

    PubMed  CAS  Google Scholar 

  26. Weidner W, Schiefer HG, Brahler E. Refractory chronic bacterial prostatitis: a re-evaluation of ciprofloxacin treatment after a median follow-up of 30 months. J Urol 1991; 146(2): 350–2

    PubMed  CAS  Google Scholar 

  27. Weidner W, Schiefer HG, Krauss H. Role of Chlamydia trachomatis and mycoplasmas in chronic prostatitis: a review. Urol Int 1988; 43(3): 167–73

    Article  PubMed  CAS  Google Scholar 

  28. Weidner W, Schiefer HG. Re: Isolation of Chlamydia trachomatis from the prostatic cells in patients affected by nonacute abacterial prostatitis [letter]. J Urol 1986; 136(3): 690

    PubMed  CAS  Google Scholar 

  29. Relman D, Schmidt T, MacDermott R, et al. Identidification of the uncultured bacillus of Whipple’s Disease. N Engl J Med 1992; 327: 293–301

    Article  PubMed  CAS  Google Scholar 

  30. Shoskes DA, Mazurick CA, Landis JR, et al. Bacterial cultures of urine, prostatic fluid and semen of men with chronic pelvic pain syndrome: role of culture for 2 vs 5 days [abstract]. J Urol 2000; 163Suppl. 4: 24

    Google Scholar 

  31. Jarvi K, Wang W, Korithoski B, et al. Identification of unusual bacteria in the semen and urine of men with NIH type III prostatitis [abstract]. J Urol 2001; 165Suppl. 5: 27

    Google Scholar 

  32. Shoskes DA, Shahed AR. 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 2000; 6(3): 240–2

    PubMed  CAS  Google Scholar 

  33. Hochreiter WW, Duncan JL, Schaeffer AJ. Evaluation of the bacterial flora of the prostate using a 16S rRNA gene based polymerase chain reaction. J Urol 2000; 163(1): 127–30

    Article  PubMed  CAS  Google Scholar 

  34. Keay S, Zhang C, Baldwin BR, et al. Polymerase chain reaction amplification of bacterial 16s rRNA genes in prostate biopsies from men without chronic prostatitis. Urology 1999; 53: 487–91

    Article  PubMed  CAS  Google Scholar 

  35. Krieger JN, Riley DE, Vesella RL, et al. Bacterial dna sequences in prostate tissue from patients with prostate cancer and chronic prostatitis. J Urol 2000; 164(4): 1221–8

    Article  PubMed  CAS  Google Scholar 

  36. Nickel JC, Alexander RB, Schaeffer AJ, et al. Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls. J Urol 2003; 170(3): 818–22

    Article  PubMed  Google Scholar 

  37. Shahed AR, Shoskes DA. Oxidative stress in prostatic fluid of patients with chronic pelvic pain syndrome: correlation with gram positive bacterial growth and treatment response. J Androl 2000; 21(5): 669–75

    PubMed  CAS  Google Scholar 

  38. John H, Barghorn A, Funke G, et al. Noninflammatory chronic pelvic pain syndrome: immunological study in blood, ejaculate and prostate tissue. Eur Urol 2001; 39: 72–8

    Article  PubMed  CAS  Google Scholar 

  39. Schaeffer AJ, Knauss JS, Landis JR, et al. 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 2002; 168(3): 1048–53

    Article  PubMed  Google Scholar 

  40. Hochreiter WW, Nadler RB, Koch AE, et al. Evaluation of the cytokines interleukin 8 and epithelial neutrophil activating peptide 78 as indicators of inflammation in prostatic secretions. Urology 2000; 56(6): 1025–9

    Article  PubMed  CAS  Google Scholar 

  41. Nadler RB, Koch AE, Calhoun EA, et al. IL-1beta and TNF-alpha in prostatic secretions are indicators in the evaluation of men with chronic prostatitis. J Urol 2000; 164(1): 214–8

    Article  PubMed  CAS  Google Scholar 

  42. Alexander R, Ponniah S, Hasday J, et al. Elevated levels of proinflammatory cytokines in the semen of patients with chronic prostatitis/chronic pelvic pain syndrome. Urology 1998; 52: 744–9

    Article  PubMed  CAS  Google Scholar 

  43. Ruggieri M, Braverman AS, Pontari MA. Biochemical markers for inflammation and glands that contribute to the semen in patients with chronic prostatitis/chronic pelvic pain syndrome [abstract]. J Urol 2000; 163Suppl. 4: 26

    Google Scholar 

  44. Hochreiter W, Nadler RB, Koch AE. Diagnostic value of serial cytokine changes in expressed prostatic secretions [abstract]. J Urol 2000; 163Suppl. 4: 24

    Google Scholar 

  45. Miller LJ, Fischer KA, Goralnick SJ, et al. Interleukin-10 levels in seminal plasma: implications for chronic prostatitis-chronic pelvic pain syndrome. J Urol 2002; 167 (2 Pt 1): 753–6

    Article  PubMed  CAS  Google Scholar 

  46. Lalani I, Bhol K, Ahmed AR. Interleukin-10: biology, role in inflammation and autoimmunity. Ann Allergy Asthma Immunol 1997; 79: 469–83

    Article  PubMed  CAS  Google Scholar 

  47. Pasqualotto FF, Sharma RK, Potts JM, et al. Seminal oxidative stress in patients with chronic prostatitis. Urology 2000; 55(6): 881–5

    Article  PubMed  CAS  Google Scholar 

  48. Siegel S, Paszkiewicz E, Kirkpatrick C, et al. Sacral nerve stimulation in patients with chronic intractable pelvic pain. J Urol 2001; 166(5): 1742–5

    Article  PubMed  CAS  Google Scholar 

  49. Lowe E, Anand P, Terengh G, et al. Increased nerve growth factor levels in the urinary bladder of women with sensory urgency and interstitial cystitis. Br J Urol 1997; 79: 572–7

    Article  PubMed  CAS  Google Scholar 

  50. Anand P. Nerve growth factor regulates nociception in human health and disese. Br J Anaesthesiol 1995; 75: 201–8

    Article  CAS  Google Scholar 

  51. Horigome K, Bullock E, Johnson E. Effects of nerve growth factor on rat peritoneal mast cells: survival promotion and immediate-early gene induction. J Biol Chem 1994; 269: 2695–702

    PubMed  CAS  Google Scholar 

  52. Miller LJ, Fischer KA, Goralnick SJ, et al. Nerve growth factor and chronic prostatitis/chronic pelvic pain syndrome. Urology 2002; 59(4): 603–8

    Article  PubMed  Google Scholar 

  53. Pontari M, Maerten SF, Ruggieri MR. Nerve growth factor is elevated in seminal plasma of men with chronic prostatitis/chronic pelvic pain syndrome (CPPS) [abstract]. J Urol 2002; 167Suppl. 4: 25

    Google Scholar 

  54. Dimitrakov J. Increased nerve growth factor levels in the postprostatic massage urine of patients with chronic abacterial prostatitis [abstract]. J Urol 2000; 163Suppl. 4: 25

    Google Scholar 

  55. Ku JH, Kim ME, Lee NK, et al. Influence of environmental factors on chronic prostatitis-like symptoms in young men: results of a community-based survey. Urology 2001; 58(6): 853–8

    Article  PubMed  CAS  Google Scholar 

  56. Potts J, Moritz N, Everson D, et al. Chronic abacterial prostatitis: a functional somatic syndrome? [abstract]. J Urol 2001; 165Suppl. 4: 25

    Google Scholar 

  57. Alighiri M, Chottinger S, Ratner V, et al. Interstitial cystitis: unexplained associations with other chronic disease and pain syndromes. Urology 1997; 49 Suppl. 5A: 52–7

    Article  Google Scholar 

  58. Curhan GC, Speizer FE, Hunter DJ, et al. Epidemiology of interstitial cystitis: a population based study. J Urol 1999; 161(2): 549–52

    Article  PubMed  CAS  Google Scholar 

  59. Simon L, Landis J, Erickson D, et al. The Interstitial Cystitis Data Base Study: concepts and preliminary baseline descriptive statistics. Urology 1997; 49 Suppl. 5A: 64–75

    Article  PubMed  CAS  Google Scholar 

  60. Forrest JB, Vo Q. Observations on the presentation, diagnosis, and treatment of interstitial cystitis in men. Urology 2001; 57 Suppl. 6A: 26–9

    Article  PubMed  CAS  Google Scholar 

  61. Novicki DE, Larson TR, Swanson SK. Interstitial cystitis in men. Urology 1998; 52: 621–4

    Article  PubMed  CAS  Google Scholar 

  62. Koziol JA, Clark DC, Gittes RF, et al. The natural history of interstitial cystitis: a survey of 374 patients. J Urol 1993; 149(3): 465–9

    PubMed  CAS  Google Scholar 

  63. Berger RE, Miller JE, Rothman I, et al. Bladder petechiae after cystoscopy and hydrodistension in men diagnosed with prostate pain. J Urol 1998; 159(1): 83–5

    Article  PubMed  CAS  Google Scholar 

  64. Waxman JA, Sulak PJ, Kuehl TJ. Cystoscopic findings consistent with interstitial cystitis in normal women undergoing tubal ligation. J Urol 1998; 160(5): 1663–7

    Article  PubMed  CAS  Google Scholar 

  65. Siroky MB, Goldstein I, Krane RJ. Functional voiding disorders in men. J Urol 1981; 126(2): 200–4

    PubMed  CAS  Google Scholar 

  66. Steinkohl WB, Leach GE. Urodynamic findings in interstitial cystitis. Urology 1989; 34(6): 399–401

    Article  PubMed  CAS  Google Scholar 

  67. Mayo ME, Ross SO, Krieger JN. Few patients with “chronic prostatitis” have significant bladder outlet obstruction. Urology 1998; 52(3): 417–21

    Article  PubMed  CAS  Google Scholar 

  68. Schmidt RA, Vapnek JM. Pelvic floor behavior and interstitial cystitis. Semin Urol 1991; 9(2): 154–9

    PubMed  CAS  Google Scholar 

  69. Duncan JL, Schaeffer AJ. Do infectious agents cause interstitial cystitis? Urology 1997; 49(5A Suppl.): 48–51

    Article  PubMed  CAS  Google Scholar 

  70. Keay S, Zhang CO, Baldwin BR, et al. Polymerase chain reaction amplification of bacterial 16S rRNA genes in interstitial cystitis and control patient bladder biopsies. J Urol 1998; 159(1): 280–3

    Article  PubMed  CAS  Google Scholar 

  71. Potts JM, Ward AM, Rackley RR. Association of chronic urinary symptoms in women and Ureaplasma urealyticum. Urology 2000; 55(4): 486–9

    Article  PubMed  CAS  Google Scholar 

  72. Parsons CL, Lilly JD, Stein P. Epithelial dysfunction in nonbacterial cystitis (interstitial cystitis). J Urol 1991; 145(4): 732–5

    PubMed  CAS  Google Scholar 

  73. Jones EG, Harper ME. Studies on the proliferation, secretory activities, and epidermal growth factor receptor expression in benign prostatic hyperplasia expiant cultures. Prostate 1992; 20(2): 133–49

    Article  PubMed  CAS  Google Scholar 

  74. Moldwin RM. Similarities between interstitial cystitis and male chronic pelvic pain syndrome. Curr Urol Rep 2002; 3(4): 313–8

    Article  PubMed  Google Scholar 

  75. Wesselmann U. Interstitial cystitis: a chronic visceral pain syndrome. Urology 2001; 57 (6 Suppl. 1): 32–9

    Article  PubMed  CAS  Google Scholar 

  76. Hohenfellner M, Nunes L, Schmidt RA, et al. Interstitial cystitis: increased sympathetic innervation and related neuropeptide synthesis. J Urol 1992; 147(3): 587–91

    PubMed  CAS  Google Scholar 

  77. Pang X, Marchand J, Sant GR, et al. Increased number of substance P positive nerve fibres in interstitial cystitis. Br J Urol 1995; 75(6): 744–50

    Article  PubMed  CAS  Google Scholar 

  78. Elbadawi A. Interstitial cystitis: a critique of current concepts with a new proposal for pathologic diagnosis and pathogenesis. Urology 1997; 49(5A Suppl.): 14–40

    Article  PubMed  CAS  Google Scholar 

  79. Spanos C, Pang X, Ligris K, et al. Stress-induced bladder mast cell activation: implications for interstitial cystitis. J Urol 1997; 157(2): 669–72

    Article  PubMed  CAS  Google Scholar 

  80. Feltis JT, Perez-Marrero R, Emerson LE. Increased mast cells of the bladder in suspected cases of interstitial cystitis: a possible disease marker. J Urol 1987; 138(1): 42–3

    PubMed  CAS  Google Scholar 

  81. Kastrup J, Hald T, Larsen S, et al. Histamine content and mast cell count of detrusor muscle in patients with interstitial cystitis and other types of chronic cystitis. Br J Urol 1983; 55(5): 495–500

    Article  PubMed  CAS  Google Scholar 

  82. Theoharides TC, Flaris N, Cronin CT, et al. Mast cell activation in sterile bladder and prostate inflammation. Int Arch Allergy Appl Immunol 1990; 92(3): 281–6

    Article  PubMed  CAS  Google Scholar 

  83. Anderson JB, Parivar F, Lee G, et al. The enigma of interstitial cystitis: an autoimmune disease? Br J Urol 1989; 63(1): 58–63

    Article  PubMed  CAS  Google Scholar 

  84. Nickel JC. Clinical evaluation of the man with chronic prostatitis/chronic pelvic pain syndrome. Urology 2002; 60: 20–3

    Article  PubMed  Google Scholar 

  85. Litwin MS, McNaughton Collins M, Fowler Jr FJ, et al. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure: Chronic Prostatitis Collaborative Research Network. J Urol 1999; 162(2): 369–75

    Article  PubMed  CAS  Google Scholar 

  86. Collins MM, O’Leary MP, Calhoun EA, et al. The Spanish National Institutes of Health-Chronic Prostatitis Symptom Index: translation and linguistic validation. J Urol 2001; 166(5): 1800–3

    Article  PubMed  CAS  Google Scholar 

  87. Meares EM, Stamey TA. Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol 1968; 5(5): 492–518

    PubMed  CAS  Google Scholar 

  88. Nickel JC. The Pre and Post Massage Test (PPMT): a simple screen for prostatitis. Tech Urol 1997; 3(1): 38–43

    PubMed  CAS  Google Scholar 

  89. Ludwig M, Schroeder-Printzen I, Ludecke G, et al. Comparison of expressed prostatic secretions with urine after prostatic massage: a means to diagnose chronic prostatitis/inflammatory chronic pelvic pain syndrome. Urology 2000; 55(2): 175–7

    Article  PubMed  CAS  Google Scholar 

  90. de la Rosette JJ, Hubregtse MR, Wiersma AM, et al. Value of urine cytology. Acta Cytol 1993; 37: 710–2

    PubMed  Google Scholar 

  91. Nadler RB, Schaeffer A, Knauss JS, et al. Total prostate specific antigen is elevated and statistically, but not clinically significant in patients with chronic pelvic pain syndrome [abstract]. J Urol 2003; 169Suppl. 4: 27

    Google Scholar 

  92. McNaughton Collins M, MacDonald R, Wilt TJ. Diagnosis and treatment of chronic abacterial prostatitis: a systematic review. Ann Intern Med 2000; 133(5): 367–81

    PubMed  CAS  Google Scholar 

  93. Nickel JC, Nyberg LM, Hennenfent M. Research guidelines for chronic prostatitis: consensus report from the first National Institutes of Health International Prostatitis Collaborative Network. Urology 1999; 54(2): 229–33

    Article  PubMed  CAS  Google Scholar 

  94. Propert KJ, Alexander RB, Nickel JC, et al. Design of a multicenter randomized clinical trial for chronic prostatitis/chronic pelvic pain syndrome. Urology 2002; 59(6): 870–6

    Article  PubMed  Google Scholar 

  95. Bjerklund Johansen TE, Gruneberg RN, Guibert J, et al. The role of antibiotics in the treatment of chronic prostatitis: a consensus statement. Eur Urol 1998; 34(6): 457–66

    Article  PubMed  CAS  Google Scholar 

  96. Nickel JC, Downey J, Johnston B, et al. Predictors of patient response to antibiotic therapy for the chronic prostatitis/chronic pelvic pain syndrome: a prospective multicenter clinical trial. J Urol 2001; 165(5): 1539–44

    Article  PubMed  CAS  Google Scholar 

  97. Barbalias GA, Nikiforidis G, Liatsikos EN. Alpha-blockers for the treatment of chronic prostatitis in combination with antibiotics. J Urol 1998; 159(3): 883–7

    Article  PubMed  CAS  Google Scholar 

  98. Osborn DE, George NJ, Rao PN, et al. Prostatodynia: physiological characteristics and rational management with muscle relaxants. Br J Urol 1981; 53(6): 621–3

    Article  PubMed  CAS  Google Scholar 

  99. de la Rosette JJ, Karthaus HF, van Kerrebroeck PE, et al. Research in ‘prostatitis syndromes’: the use of Alfuzosin (a new alpha-1 receptor blocking agent) in patients mainly presenting with micturition complaints of an irritatvie nature and confirmed urodynamic abnormalities. Eur Urol 1992; 22: 222–7

    PubMed  Google Scholar 

  100. Neal DE, Moon TD. Use of terazosin in prostatodynia and validation of a symptom score questionnaire. Urology 1994; 43: 460–5

    Article  PubMed  Google Scholar 

  101. Narayan P, McKay J, Doyle C. A six-week double-blind pilot study of Tamsulosin versus placebo in patients with chronic non-bacterial prostatitis/chronic pelvic pain [abstract]. J Urol 2002; 167Suppl. 4: 24

    Google Scholar 

  102. Pfizer. Cardura (doxazosin mesylate) tablets. In: Sifton DW, editor. Physicians’ Desk Reference. 55th ed. Montvale (NJ): Medical Economics Company, 2001: 2473–2477

    Google Scholar 

  103. Wilde MI, McTavish D. Tamsulosin: a review of its pharmacological properties and therapeutic potential in the management of symptomatic benign prostatic hyperplasia. Drugs 1996; 52(6): 883–98

    Article  PubMed  CAS  Google Scholar 

  104. Beduschi MC, Beduschi R, Oesterling JE. Alpha-blockade therapy for benign prostatic hyperplasia: from a nonselective to a more selective alphalA-adrenergic antagonist. Urology 1998; 51(6): 861–72

    Article  PubMed  CAS  Google Scholar 

  105. Rudner XL, Berkowitz DE, Booth JV, et al. Subtype specific regulation of human vascular alpha (l)-adrenergic receptors by vessel bed and age. Circulation 1999; 100(23): 2336–43

    Article  PubMed  CAS  Google Scholar 

  106. Muraro G. Clinical study on the efficacy and safety of seaprose S combined with local prostate hyperthermia in chronic nonbacterial prostatitis: controlled study versus local prostatic hyperthermia. Archivio di Medicina Interna 1995; 47: 73–86

    Google Scholar 

  107. Canale D, Turchi P, Giorgi PM, et al. Treatment of abacterial prostato-vesiculitis with nimesulide. Drugs 1993; 46Suppl. 1: 147–50

    Article  PubMed  Google Scholar 

  108. Nickel JC, Gittleman M, Malek G, et al. Effects of rofecoxib in patients with chronic nonbacterial prostatitis: a placebo controlled pilot study [abstract]. J Urol 2001; 165Suppl. 5: 27

    Google Scholar 

  109. Appleton I, Tomlinson A, Willoughby DA. Induction of cyclooxygenase and nitric oxide synthase in inflammation. Adv Pharmacol 1996; 35: 27–78

    Article  PubMed  CAS  Google Scholar 

  110. Rimarachin JA, Jacobson JA, Szabo P. Regulation of cyclooxygense-2 experssion in aortic smooth muscle cells. Arterioscler Thromb 1994; 14: 1021–31

    Article  PubMed  CAS  Google Scholar 

  111. Lacroix S, Rivest S. Effect of acute systemic inflammatory response and cytokines on the transcription of the genes encoding cyclooxygenase enzymes (COX-1 and COX-2) in the rat brain. J Neurochem 1998; 70: 452–66

    Article  PubMed  CAS  Google Scholar 

  112. Nickel JC, Pontari M, Moon T, et al. A randomized, placebo controlled, multicenter study to evaluate the safety and efficacy of rofecoxib in the treatment of chronic nonbacterial prostatitis. J Urol 2003; 169(4): 1401–5

    Article  PubMed  CAS  Google Scholar 

  113. Wedren H. Effects of sodium pentosanpolysulphate on symptoms related to chronic non-bacterial prostatitis: a double-blind randomized study. Scand J Urol Nephrol 1987; 21(2): 81–8

    Article  PubMed  CAS  Google Scholar 

  114. Nickel JC, Johnston B, Downey J, et al. Pentosan polysulfate therapy for chronic nonbacterial prostatitis (chronic pelvic pain syndrome category IIIA): a prospective multicenter clinical trial. Urology 2000; 56(3): 413–7

    Article  PubMed  CAS  Google Scholar 

  115. Nickel JC, Forrest J, Tomera KM, et al. Effects of pentosanpolysulfate sodium in men with chronic pelvic pain syndrome: a multicenter randomized placebo controlled study: on behalf of the North American PPS-CPPS Investigator Group [abstract]. J Urol 2002; 167Suppl. 4: 63

    Google Scholar 

  116. Downey J, Nickel JC, Pontari MA, et al. Randomized placebo controlled multi-center pilot study to evaluate the safety and efficacy of finasteride in the treatment of male chronic pelvic pain syndrome: Category IIIA CPPS (Chronic nonbacterial prostatitis) [abstract]. J Urol 2002; 167Suppl. 4: 26

    Google Scholar 

  117. McConnell JD, Bruskewitz RC, Walsh P, et al. The effect of finasteride on the risk of urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. N Engl J Med 1998; 338: 557–63

    Article  PubMed  CAS  Google Scholar 

  118. McConnell JD, MTOPS Steering Committee. The long term effects of medical therapy on the progression of BPH: Results from the MTOPS trial [abstract]. J Urol 2002; 167Suppl. 4:265

    Google Scholar 

  119. Shoskes DA, Zeitlin SI, Shahed A, et al. Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. Urology 1999; 54(6): 960–3

    Article  PubMed  CAS  Google Scholar 

  120. Galer BS. Neuropathic pain of peripheral origin: advances in pharmacologic treatment. Neurology 1995; 45 (12 Suppl. 9): S17–25

    Article  PubMed  CAS  Google Scholar 

  121. Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet 1999; 353(9168): 1959–64

    Article  PubMed  CAS  Google Scholar 

  122. Abrams P. Tolterodine therapy in men with bladder outlet obstruction and symptomatic detrusor overactivity is not associated with urinary safety concerns [abstract]. J Urol 2002; 167Suppl. 4: 266

    Google Scholar 

  123. Backonja M, Beydoun A, Edwards KR, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA 1998; 280(21): 1831–6

    Article  PubMed  CAS  Google Scholar 

  124. Sasaki K, Smith CP, Chuang YC, et al. Oral gabapentin (neurontin) treatment of refractory genitourinary tract pain. Tech Urol 2001; 7(1): 47–9

    PubMed  CAS  Google Scholar 

  125. Kaplan SA, Te AE, Jacobs BZ. Urodynamic evidence of vesical neck obstruction in men with misdiagnosed chronic nonbacterial prostatitis and the therapeutic role of endoscopic incision of the bladder neck. J Urol 1994; 152 (6 Pt 1): 2063–5

    PubMed  CAS  Google Scholar 

  126. Servadio C, Leib Z. Chronic abacterial prostatitis and hyperthermia: a possible new treatment? Br J Urol 1991; 67(3): 308–11

    Article  PubMed  CAS  Google Scholar 

  127. Montorsi F, Guazzoni G, Bergamaschi F, et al. Is there a role for transrectal microwave hyperthermia of the prostate in the treatment of abacterial prostatitis and prostatodynia? Prostate 1993; 22(2): 139–46

    Article  PubMed  CAS  Google Scholar 

  128. Shah TK, Watson GM, Barnes DG. Microwave hyperthermia in the treatment of chronic abacterial prostatitis and prostatodynia: results of a double-blind placebo controlled trial [abstract]. J Urol 1993; 149Suppl. 4: 405A

    Google Scholar 

  129. Nickel JC, Sorensen R. Transurethral microwave thermotherapy for nonbacterial prostatitis: a randomized double-blind sham controlled study using new prostatitis specific assessment questionnaires. J Urol 1996; 155(6): 1950–4

    Article  PubMed  CAS  Google Scholar 

  130. Choi NG, Soh SH, Yoon TH, et al. Clinical experience with transurethral microwave thermotherapy for chronic nonbacterial prostatitis and prostatodynia. J Endourol 1994; 8(1): 61–4

    Article  PubMed  CAS  Google Scholar 

  131. Lee KC, Jung PB, Park HS, et al. Transurethral needle ablation for chronic nonbacterial prostatitis. BJU Int 2002; 89(3): 226–9

    Article  PubMed  CAS  Google Scholar 

  132. Leskinen MJ, Kilponen A, Lukkarinen O, et al. Transurethral needle ablation for the treatment of chronic pelvic pain syndrome (category III prostatitis): a randomized, sham-controlled study. Urology 2002; 60(2): 300–4

    Article  PubMed  Google Scholar 

  133. Clemens JQ, Nadler RB, Schaeffer AJ, et al. Biofeedback, pelvic floor re-education, and bladder training for male chronic pelvic pain syndrome. Urology 2000; 56(6): 951–5

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

Dr Pontari is a consultant for both Pfizer and Yamanouchi and has been an investigator fo clinical trials for both Merck & Co. and Roche. The authors have provided no information on sources of funding directly relevant to the content of this review.

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  1. Department of Urology, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, Pennsylvania, 19140, USA

    Michel A. Pontari

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Pontari, M.A. Chronic Prostatitis/Chronic Pelvic Pain Syndrome in Elderly Men. Drugs Aging 20, 1111–1125 (2003). https://doi.org/10.2165/00002512-200320150-00004

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