Clinical phenotyping

While symptoms clusters are practical groupings helpful to elucidate disease causes and suggesting treatment options, clinical phenotyping is supposed to be a more precise indication of underlying genetical differences. An attempt to phenotype CPPS sufferers have been made by Shoskes et al (2009) (1-2). In my opinion their approach is more like a mix of symptom clusters, select clinical findings and co-morbidities. They suggest six groups: urologic (essentialy the micturition & genito-urinary symptom clusters), psychosocial (more or less sickness behavior), organ specific (clinical findings about the prostate and ejaculate), infection (clinical findings about bacteria), neurological/systemic (essentially the remaining symptom clusters in my previous posts) and muscle tenderness. Although useful I am of the opinion that their categories are a bit too rough and disparate to be useful for research, but they may be helpful in improving the treatment of patients.

And an evaluation just agreed with me. The author concluded that "a weak or lacking correlation with the studied clinical parameters suggest that further development is required".(3)

Other researchers (Anderson et al, and Dimitrakov et al) have focused on profiling of HPA function and hormonal testing, both of which will be discussed under the findings chapters.

Updated 2009-09-04
Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, klinisk fenotypning
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(1) Shoskes DA, Nickel JC, Rackley RR, Pontari MA. Clinical phenotyping in CP/CPPS and IC: a management strategy for urologic chronic pelvic pain syndromes. Prostate Cancer Prostatic Dis 2008, 7pp.
(2) Shoskes DA, Nickel JC, Dolinga R, Prots D. Clinical phenotyping in CP/CPPS and correlation with symptom severity. Urology 73(3):538-542, 2009.
(3) Hedelin HH. Evaluation of a modification of the UPOINT clinical phenotype system for the CPPS. Scand J Urol Nephrol 9:1-4, aug 2009 (epub ahead of print).

Socio-economic differences and education

No or small differences in incidence due to economic or education level differences have been found, although lower socio-economic status (SES) predict that symptoms will be experienced as worse / more painful (1). Why this difference in experience? Two causes are probable: a) worse nutrition and more stress caused by the lower SES causing an objectively more severe disease, or b) subjectively experiencing being more ill.

Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb
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(1) McNaughton Collins M, Pontari MA, O'Leary MP, Calhoun EA, Santanna J, Landis JR, Kusek JW, Litwin MS,.Quality of life is impaired in men with chronic prostatitis: the Chronic Prostatitis Collaborative Research Network.J Gen Intern Med 16(10):656-662, 2001.

Leukocytes, urates and citrates

Leukocyte (white blood cells) counts and common inflammatory markers have little or no correlation with CP/CPPS. Whether this be in urine (VB3), semen and or prostatic secretions. Cytokines show better correlation. See further discussion below in the sections on micro-organisms and inflammation.

Urates and other compounds typical for urine have been found in the prostate and prostatic calculi indicating reflux.

Added 2009-04-26
Various small studies have found a correlation between expressed prostatic secretion and semen contents of uric acid (urates) and CPPS symptoms. The assumption is that uric acid (urates) cause an inflammatory reaction and that the presence of uric acid is caused by reflux. (1-3)

Reflux, or retrograde flow, is the "backflow" of urine towards the prostate or kidney instead of out of the body. Causes of reflux are either "uncoordinated muscules" (dyssynergia) or physical abnormalities or urinary tract infections.

Citrate levels may be decreased in CPPS sufferers. (4)

Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb, urater, urinreflux
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(1) Persson BE, Ronquist G. Evidence for a mechanistic association between nonbacterial prostatitis and levels of urate and creatinine in expressed prostatic secretion. J Urol. 155(3):958-60, 1996.
(2) Hou BS, Xia XY, Pan LJ, Yang B, Shao Y, Shang XJ, Yao B, Cui YX, Huang YF. [Determination of uric acid in the expressed prostatic secretion of chronic prostatitis patients and its clinical significance]. Zhonghua Nan Ke Xue 14(3):245-7, 2008. Summary only, article in Chinese.
(3) Motrich RD, Olmedo JJ, Molina R, Tissera A, Minuzzi G, Rivero VE. Uric acid crystals in the semen of a patient with symptoms of chronic prostatitis. Fertil Steril. 85(3):751.e1-751.e4. 2006.
(4) Chen J, Xu Z, Zhao H, Jiang X. Citrate in expressed prostatic secretions has the feasibility to be used as a useful indicator for the diagnosis of category IIIB prostatitis. Urol Int. 78(3):230-4, 2007.
and
Chen J, Zhao HF, Xu ZS. The prostate has secretory dysfunction for category IIIA and IIIB prostatitis. J Urol. 177(6):2166-9, 2007.

General findings

In addition to patient self-reported symptoms various standard tests are performed to check for patient health (e.g. PSA test), bacteria and hyperplasia. All these are usually negative or within the normal range. The CPPS patient is 'healthy and well' despite pain, tiredness, frequency etc. And that quality of life is affected by conditions affecting micturition has been concluded repeatedly(1). It may be noted that older men with LUTS (lower urinary tract symptoms)(2) seem more prone to injuries from falls.(3)
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(1) E.g. Coyne KS, Sexton CC, Irwin DE, Kopp ZS, Kelleher CJ, Milsom I. The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. BJU Int. 2008 Jun;101(11):1388-95. And Bernardes J, Cameron E, Dunn P."A summary report on the impact of Prostatitis and Benign Prostatic Hyperplasia on men's lives and those of their families", discussions on self-help group message boards etc.
(2) This is a borderline wastebasket term. For a fuller discussion see:
Chapple CR, Wein AJ, Abrams P, Dmochowski RR, Giuliano F, Kaplan SA, McVary KT, Roehrborn CG. Lower urinary tract symptoms revisited: a broader clinical perspective. Eur Urol 54(3):563-569, 2008.
(3) Kellogg Parsons J, Mougey J, Lambert L, Wilt TJ, Fink HA, Garzotto M, Barrett-Connor E, Marshall LM. Lower urinary tract symptoms increase the risk of falls in older men. BJU Int. 2009 Jan 9. [Epub ahead of print]