That is the million-dollar question! It is possible that several different conditions, still to define/discover, are the underlying cause to CP/CPPS symptoms. It is also questionable if the prostate is involved. Research “is dominated by hypotheses, all of which lack a substantial evidential standing”. “Ethiogenic theories vary from the abstruse to the fashionable… and sadly often of confusion in medical thinking” (P. Hanno (1)). CPPS is most likely both under- and over-diagnosed.
“Patients with chronic pelvic pain syndrome (2) demonstrate no evidence of inflammation. They do not have urethritis, urogenital cancer, urethral stricture, or neurological disease involving the bladder. Indeed, they exhibit no overt renal tract disease.” What is known is that the men categorized with this label present with fairly similar symptoms and problems, that the condition is more common the more north you live and that it shows a relapsing (flare) and remitting (improvement) pattern superimposed on a seasonal pattern with wintertime exacerbations.
“If I knew how to really cure CPPS I would be world famous, make millions, afford an apartment over-looking Central Park, one in Aspen and one in Miami and only need to work three months a year” (Anonymous).
“We must break down the difference between the urologist, gynecologist and gastroenterologist and treat the pelvic floor as a single unit” (GR Sant).
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb
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(1) IC Epidemiology Task Force Report of the Bethesda Oct 29, 2003 meeting. Draft 1/6/2004.
(2) A syndrome is, according to the Oxford Concise Medical Dictionary, “a combination of signs and/or symptoms that forms a distinct clinical picture indicative of a particular disorder” but is not necessarily of a related etiology. That is why the word “syndrome” is used in CPPS. Unfortunately in the case of CPPS it is rather a label to “a combination of signs and/or symptoms”. Period.
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General references. Yes, there is an astoundingly prolific production of prostatitis reviews and related material despite little new data of import.
ReplyDelete(1) Nickel CL. Prostatitis syndromes: an update for urologic practice. Can J Urol. 2000 Oct;7(5):1091-8.
(2) Habermacher GM, Chason JT, Schaeffer AJ. Prostatitis/chronic pelvic pain syndrome. Annu Rev Med 57:195-206, 2006.
(3) Hochreiter WW, Madersbacher S, Temml C., Zbrun S., Wolfensberger P. Studer U.E., Prevalence of prostatitis symptoms and lower urinary tract symptoms (luts) in 1759 men using validated questionnaires. Paper presented at the Chronic Pelvic Pain Syndrome (CPPS or Chronic Nonbacterial Prostatitis) in Men at the European Association of Urology Meeting Istanbul, Turkey, March 2005
(4) Jack SJ, Zeitlin SI Confronting Prostatitis: is your management strategy up to date?, Contemporary Urology nov 2004 p. 24-35 and www.prostate-usa.com
(5) Krieger JN, Ross SO, Riley DE. Chronic prostatitis: epidemiology and role of infection. Urology. 2002 Dec;60(6 Suppl):8-12
(6) Krieger JN, Riley DE, Cheah PY, Liong ML, Yuen KH. Epidemiology of prostatitis: new evidence for a world-wide problem. World J Urol. 2003 Jun;21(2):70-4.
(7) Krieger JN. Classification, epidemiology and implications of chronic prostatitis in North America, Europe and Asia. Minerva Urol Nefrol. 2004 Jun;56(2):99-107.
(8) Daniels NA, Link CL, Barry MJ, McKinlay JB for the BACH Survey Investigators. Are Past Urinary Tract Infections Associated with Current Symptoms of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Results from the Boston Area Community Health (BACH) Survey. Journal of the National Medical Association May 2007;99:509-516.
(9) CJ Nickel, various works
(10) Collins MM, Stafford RS, O'Leary MP, Barry MJ. How common is prostatitis?, J Urol, 159:1224-1228, 1998 and Collins MM, Meigs JB, Barry MJ, Walker Corkery E, Giovannucci E, Kawachi I. Prevalence of correlates of prostatitis in the health professionals follow-up study cohort. J Urol 167:1363-1366, 2002
(11) Schaeffer AJ, Datta NS, Fowler JE et al. Overview summary statement-diagnosis and management of CP/CPPS. Urology 60(6):1-4, 2002
(12) Dimitrakov J, Diemer T, Ludwig M, Weidner W. Recent developments in diagnosis and therapy of the prostatitis syndromes. Cur Opin Urol, 11:87-91, 2001
(13) The Chronic Prostatitis Collaborative Research Network Group…”, J Urol, 168:593, 2002
(14) www.prostate-usa.com
(15) Bergman J, Zeitlin SI. Prostatitis and chronic prostatitis/chronic pelvic pain syndrome. Expert Rev Neurother 7(3):301-307, 2007.
(16) See “Guidelines on Chronic Pelvic Pain” at www.uroweb.org/files/uploaded_files/guidelines/chronicpelvicpain.pdf.
(17) Prezioso D, Naber KG, Lobel B, Weidner W, Algaba F, Denis LJ, Griffiths K. Changing concepts on prostatitis. Arch Med Sci 2(2):71-84, 2006.
(18) Weidner W, Anderson RU. Evaluation of acute and chronic bacterial prostatitis and diagnostic management of CPPS… Int J Antimicrob Agents 31(suppl):91-95, 2008.
(19) Krieger JN, Lee SW, Jeon J, Cheah PY, Liong ML, Riley DE. Epidemiology of prostatitis. Int J Antimicrob Agents. 31 Suppl 1:S85-90, 2008.
Just read these too:
ReplyDelete(20) Jonsson K, Hedelin H. Chronic abacterial prostatitis: living with atroublesome disease affecting many aspects of life. Scand J Urol Nephro 42(6):545-550, 2008.
(21) Hedelin H, Fall M. Controversies in chronic abacterial prostatitis. Scand J Urol Nephro 42(6):198-204, 2008.