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Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients

  • Authors:
    • Vittorio Magri
    • Emanuela Marras
    • Antonella Restelli
    • Florian M.E. Wagenlehner
    • Gianpaolo Perletti
  • View Affiliations / Copyright

    Affiliations: Urology Secondary Care Clinic, Azienda Ospedaliera Istituti Clinici di Perfezionamento, Milan, Italy, Department of Theoretical and Applied Sciences, Biomedical Research Division, Università degli Studi dell'Insubria, Busto Arsizio/Varese, Italy, Microbiology Unit, Fondazione IRCCS Ospedale Maggiore Policlinico Mangiagalli Regina Elena, Milan, Italy, Department of Urology, Pediatric Urology and Andrology, Justus Liebig‑University, Giessen, Germany
    Copyright: © Magri et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Pages: 658-666
    |
    Published online on: December 19, 2014
       https://doi.org/10.3892/etm.2014.2152
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Abstract

The complex network of etiological factors, signals and tissue responses involved in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) cannot be successfully targeted by a single therapeutic agent. Multimodal approaches to the therapy of CP/CPPS have been and are currently being tested, as in the frame of complex diagnostic‑therapeutic phenotypic approaches such as the urinary, psychosocial, organ‑specific, infection, neurological and muscle tenderness (UPOINTS) system. In this study, the effect of combination therapy on 914 patients diagnosed, phenotyped and treated in a single specialized prostatitis clinic was analyzed. Patients received α‑blockers, Serenoa repens (S. repens) extracts combined or not with supplements (lycopene and selenium) and, in the presence of documented or highly suspected infection, antibacterial agents. Combination treatment induced marked and significant improvements of National Institutes of Health Chronic Prostatitis Symptom Index (NIH‑CPSI) prostatitis symptom scores, International Index of Erectile Function (IIEF) sexual dysfunction scores, urinary peak flow rates and bladder voiding efficiency. These improvements, assessed after a 6‑month course of therapy, were sustained throughout a follow‑up period of 18 months. A clinically appreciable reduction of ≥6 points of the total NIH‑CPSI score was achieved in 77.5% of patients subjected to combination therapy for a period of 6 months. When the patients were divided in two cohorts, depending on the diagnosis of CP/CPPS [inflammatory (IIIa) vs. non‑inflammatory (IIIb) subtypes], significant improvements of all signs and symptoms of the syndrome were observed in both cohorts at the end of therapy. Intergroup comparison showed that patients affected by the IIIa sub‑category of CP/CPPS showed more severe signs and symptoms (NIH‑CPSI total, pain and quality of life impact scores, and Qmax) at baseline when compared with IIIb patients. However, the improvement of symptoms after therapy was significantly more pronounced in IIIa patients when compared with IIIb patients. In contrast to current opinion, the evidence emerging from the present investigation suggests that the inflammatory and non‑inflammatory sub‑categories of CP/CPPS may represent two distinct pathological conditions or, alternatively, two different stages of the same condition. In conclusion, a simple protocol based on α‑blockers, S. repens extracts and supplements and antibacterial agents, targeting the urinary, organ specific and infection domains of UPOINTS, may induce a clinically appreciable improvement of the signs and symptoms of CP/CPPS in a considerable percentage of patients. In patients not responding sufficiently to such therapy, second‑line agents (antidepressants, anxiolytics, muscle relaxants, 5‑phosphodiesterase inhibitors and others) may be administered in order to achieve a satisfactory therapeutic response.
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1 

Habermacher GM, Chason JT and Schaeffer AJ: Prostatitis/chronic pelvic pain syndrome. Annu Rev Med. 57:195–206. 2006. View Article : Google Scholar : PubMed/NCBI

2 

Nickel JC and Shoskes DA: Phenotypic approach to the management of the chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 106:1252–1263. 2010. View Article : Google Scholar : PubMed/NCBI

3 

Shoskes DA, Nickel JC, Rackley RR and Pontari MA: Clinical phenotyping in chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis: a management strategy for urologic chronic pelvic pain syndromes. Prostate Cancer Prostatic Dis. 12:177–183. 2009. View Article : Google Scholar

4 

Nickel JC, Shoskes DA and Wagenlehner FM: Management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): the studies, the evidence and the impact. World J Urol. 31:747–753. 2013. View Article : Google Scholar : PubMed/NCBI

5 

Nickel JC, Downey J, Ardern D, Clark J and Nickel K: Failure of a monotherapy strategy for difficult chronic prostatitis/chronic pelvic pain syndrome. J Urol. 172:551–554. 2004. View Article : Google Scholar : PubMed/NCBI

6 

Shoskes DA, Hakim L, Ghoniem G and Jackson CL: Long-term results of multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome. J Urol. 169:1406–1410. 2003. View Article : Google Scholar : PubMed/NCBI

7 

Shoskes DA, Nickel JC and Kattan MW: Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT. Urology. 75:1249–1253. 2010. View Article : Google Scholar : PubMed/NCBI

8 

Magri V, Wagenlehner F, Perletti G, Schneider S, Marras E, Naber KG and Weidner W: Use of the UPOINT chronic prostatitis/chronic pelvic pain syndrome classification in European patient cohorts: sexual function domain improves correlations. J Urol. 184:2339–2345. 2010. View Article : Google Scholar : PubMed/NCBI

9 

Samplaski MK, Li J and Shoskes DA: Clustering of UPOINT domains and subdomains in men with chronic prostatitis/chronic pelvic pain syndrome and contribution to symptom severity. J Urol. 188:1788–1793. 2012. View Article : Google Scholar : PubMed/NCBI

10 

Zhao Z, Zhang J, He J and Zeng G: Clinical utility of the UPOINT phenotype system in Chinese males with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a prospective study. PLoS One. 8:e520442013. View Article : Google Scholar : PubMed/NCBI

11 

Shoskes DA and Nickel JC: Classification and treatment of men with chronic prostatitis/chronic pelvic pain syndrome using the UPOINT system. World J Urol. 31:755–760. 2013. View Article : Google Scholar : PubMed/NCBI

12 

Davis SN, Binik YM, Amsel R and Carrier S: Is a sexual dysfunction domain important for quality of life in men with urological chronic pelvic pain syndrome? Signs ‘UPOINT’ to yes. J Urol. 189:146–151. 2013. View Article : Google Scholar

13 

Giubilei G, Mondaini N, Crisci A, Raugei A, Lombardi G, Travaglini F, et al: The Italian version of the National Institutes of Health Chronic Prostatitis Symptom Index. Eur Urol. 47:805–811. 2005. View Article : Google Scholar : PubMed/NCBI

14 

Propert KJ, Litwin MS, Wang Y, Alexander RB, Calhoun E, Nickel JC, et al: Responsiveness of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). Qual Life Res. 15:299–305. 2006. View Article : Google Scholar : PubMed/NCBI

15 

Rosen RC, Cappelleri JC and Gendrano N: The International Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res. 14:226–244. 2002. View Article : Google Scholar : PubMed/NCBI

16 

Magri V, Montanari E, Škerk V, Markotić A, Marras E, Restelli A, Naber KG and Perletti G: Fluoroquinolone-macrolide combination therapy for chronic bacterial prostatitis: retrospective analysis of pathogen eradication rates, inflammatory findings and sexual dysfunction. Asian J Androl. 13:819–827. 2011. View Article : Google Scholar : PubMed/NCBI

17 

Morgia G, Cimino S, Favilla V, Russo GI, Squadrito F, Mucciardi G, et al: Effects of Serenoa repens, selenium and lycopene (Profluss®) on chronic inflammation associated with benign prostatic hyperplasia: results of ‘FLOG’ (Flogosis and Profluss in Prostatic and Genital Disease), a multicentre Italian study. Int Braz J Urol. 39:214–221. 2013.PubMed/NCBI

18 

Morgia G, Mucciardi G, Galì A, Madonia M, Marchese F, Di Benedetto A, et al: Treatment of chronic prostatitis/chronic pelvic pain syndrome category IIIa with Serenoa repens plus selenium and lycopene (Profluss) versus S. repens alone: an Italian randomized multicenter-controlled study. Urol Int. 84:400–406. 2010. View Article : Google Scholar : PubMed/NCBI

19 

Vickers AJ: Parametric versus non-parametric statistics in the analysis of randomized trials with non-normally distributed data. BMC Med Res Methodol. 5:352005. View Article : Google Scholar : PubMed/NCBI

20 

Krieger JN, Nyberg L Jr and Nickel JC: NIH consensus definition and classification of prostatitis. JAMA. 282:236–237. 1999. View Article : Google Scholar : PubMed/NCBI

21 

Wagenlehner FM, van Till JW, Magri V, Perletti G, Houbiers JG, Weidner W and Nickel JC: National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) symptom evaluation in multinational cohorts of patients with chronic prostatitis/chronic pelvic pain syndrome. Eur Urol. 63:953–959. 2013. View Article : Google Scholar

22 

Wagenlehner FM, Weidner W and Naber KG: Therapy for prostatitis, with emphasis on bacterial prostatitis. Expert Opin Pharmacother. 8:1667–1674. 2007. View Article : Google Scholar : PubMed/NCBI

23 

Wagenlehner FM, Ballarini S and Naber KG: Immunostimulation in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a one-year prospective, double-blind, placebo-controlled study. World J Urol. 32:1595–1603. 2014. View Article : Google Scholar : PubMed/NCBI

24 

Tran CN and Shoskes DA: Sexual dysfunction in chronic prostatitis/chronic pelvic pain syndrome. World J Urol. 31:741–746. 2013. View Article : Google Scholar : PubMed/NCBI

25 

Schaeffer AJ, Knauss JS, Landis JR, Propert KJ, Alexander RB, Litwin MS, 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. 168:1048–1053. 2002. View Article : Google Scholar : PubMed/NCBI

26 

Nickel JC, Alexander RB, Schaeffer AJ, Landis JR, Knauss JS, Propert KJ, et al: Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls. J Urol. 170:818–822. 2003. View Article : Google Scholar : PubMed/NCBI

27 

Sung YH, Jung JH, Ryang SH, Kim SJ and Kim KJ: Clinical significance of national institutes of health classification in patients with chronic prostatitis/chronic pelvic pain syndrome. Korean J Urol. 55:276–280. 2014. View Article : Google Scholar : PubMed/NCBI

28 

Parnham MJ, Haber VE, Giamarellos-Bourboulis EJ, Perletti G, Verleden GM and Vos R: Azithromycin: Mechanisms of action and their relevance for clinical applications. Pharmacol Ther. 143:225–245. 2014. View Article : Google Scholar : PubMed/NCBI

29 

Perletti G, Skerk V, Magri V, Markotic A, Mazzoli S, Parnham MJ, Wagenlehner FM and Naber KG: Macrolides for the treatment of chronic bacterial prostatitis: an effective application of their unique pharmacokinetic and pharmacodynamic profile. Mol Med Rep. 4:1035–1044. 2011.PubMed/NCBI

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Copy and paste a formatted citation
Spandidos Publications style
Magri V, Marras E, Restelli A, Wagenlehner FM and Perletti G: Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients. Exp Ther Med 9: 658-666, 2015.
APA
Magri, V., Marras, E., Restelli, A., Wagenlehner, F.M., & Perletti, G. (2015). Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients. Experimental and Therapeutic Medicine, 9, 658-666. https://doi.org/10.3892/etm.2014.2152
MLA
Magri, V., Marras, E., Restelli, A., Wagenlehner, F. M., Perletti, G."Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients". Experimental and Therapeutic Medicine 9.3 (2015): 658-666.
Chicago
Magri, V., Marras, E., Restelli, A., Wagenlehner, F. M., Perletti, G."Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients". Experimental and Therapeutic Medicine 9, no. 3 (2015): 658-666. https://doi.org/10.3892/etm.2014.2152
Copy and paste a formatted citation
x
Spandidos Publications style
Magri V, Marras E, Restelli A, Wagenlehner FM and Perletti G: Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients. Exp Ther Med 9: 658-666, 2015.
APA
Magri, V., Marras, E., Restelli, A., Wagenlehner, F.M., & Perletti, G. (2015). Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients. Experimental and Therapeutic Medicine, 9, 658-666. https://doi.org/10.3892/etm.2014.2152
MLA
Magri, V., Marras, E., Restelli, A., Wagenlehner, F. M., Perletti, G."Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients". Experimental and Therapeutic Medicine 9.3 (2015): 658-666.
Chicago
Magri, V., Marras, E., Restelli, A., Wagenlehner, F. M., Perletti, G."Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients". Experimental and Therapeutic Medicine 9, no. 3 (2015): 658-666. https://doi.org/10.3892/etm.2014.2152
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