Main view thoughts on causes

If NIH-I&II are excluded the answer is quite honestly simply: nobody knows for sure! But the following ideas and hypotheses on etiology and pathogenesis have been put forth (see Karlovsky (1), Pontari and Ruggieri (2), for a fuller review):

Popular ideas

1. Undiscovered micro-organism causing "hidden" chronic infection (i.e. unhealed). The most popular vectors are bacteria. This has been pursued with pig-headed insistence despite no proof. But, remember Helicobacter pylori...
2. Neuro-muscular or musculoskeletal disorders, e.g. myofascial pain.
3. Persistent inflammation triggered by an inappropriate immunological response to a previous, and supposedly healed, infection.

Less popular ideas

1. Auto-immune condition.
2. Persistent neuropathy (damage to nerves controlling pain regulation/signaling) possibly caused by any of the above causes (or neurogenic inflammation and/or "idiopathic" mast cell activation). Pudendal neuropathy is popular, but oft unproven.

Other ideas

1. Estrogen-similar substances, e.g. soy flavonoids.
2. Endocrinological (hormonal) disorders.
3. Psychological (when you do not know cause nor what to do blame the patient...).

Do notice that causes can be multiple. For example bacteria may trigger an inflammatory/neurological reaction that triggers a muscular reaction etc etc. Diet and life-style may in their turn exacerbate or skew symptoms, thus "confounding" the issue. Many of the above causes may also include some hitherto undiscovered genetic mechanism predisposing for the disease. Or some undiscovered pollutant.

Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb
__________________
(1) Karlovsky ME, Pontari MA. Theories of prostatitis etiology. Curr Urol Rep 3(4):307-312, 2002.
(2) Pontari MA, Ruggeri MR Mechanisms in prostatitis/chronic pelvic pain syndrome. J Urol 172(3):839-845 2004

Prevalence

Prostatitis is thought to be the most common urological complaint for patients under 50 years of age. It is estimated to occur in 5-8% (and maybe up to 16%) of the male population (as lifetime prevalence). About 90-95% of these cases are attributable to CP/CPPS. Frequency increases with age and seemingly has a northward increase. The mean patient is a male between 38 and 48 years that has suffered from diffuse problems for up to, commonly, eight years. But onset can begin at as early an age as the upper teens.

Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb

What is chronic prostatitis / chronic pelvic pain syndrome ?

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
____________________
(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.

“Being able to control the pain or to see a possible painless future is psychologically beneficial”

Introduction
It is easier to define what CP/CPPS is not than what it is. Despite many years of searching for obvious microbial causes to CP/CPPS none has been found. This does not mean that there are none, but the likelihood is very very small. The focus on the prostate and the visible micturition problems are likely misleading thought and effort. I would even venture to say that the dysuria is a secondaty phenomenon that obscures other more important symptoms. In a recent article doctor C Nickel asserts that “the biomedical model has failed” and that “our traditional etiologic model may not be correct” (1) it is more likely that medical science has been barking up the wrong tree altogether.

Why did I write this?
I got the diagnosis of chronic prostatitis/chronic pelvic pain syndrome, couple of years ago and was, well, quite frankly surprised that there was no known etiology, or known cure. So I just assumed the specialist was lazy and not up to date with the latest info. How wrong I realized I was about 400 medical papers later and a couple of web sites (that where not to useful) later. While reading I made notes that it occured to me I could edit and publish on a "blog". Maybe someone will find something of interest.

Topics
I aim to discuss the following topics (in no special order):
Current definition and history
Estimated prevalence
Current management and diagnosis
Healthy men and not
Symptom clusters and what those may indicate
Seasonality
General topics (sexual, mental health and comorbidities)
Current treatment and what it may indicate.
Microorganisms
Non-microbial inflammatory reactions
Neurology
Urodynamics
Muscoloskeletal
Th1/Th2 balance
Pain, brain and viscera
Psychology
Coping strategies
Visceral immunity and pain
Vitamin D, light and cold
HPA axis and vasopressin
HPG axis
Oral health, Th17 and mercury
Nutrition

Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb
__________________
(1)Nickel C. CP/CPPS: the biomedical model has failed! So what’s next? Contemporary Urology, July 2006