San Antonio--A new estimate shows that chronic prostatitis, especially nonbacterial prostatitis, is common in American men, and that most diagnosis and treatment takes place in primary care.
The incidence of chronic prostatitis was 4.9 per 1,000 men per year, and that of chronic nonbacterial prostatitis (chronic pelvic pain syndrome, or CPPS) was 3.3 per 1,000 men per year. That translates to 270,000 new diagnoses of CPPS annually in the United States, said J. Quentin Cle-mens, MD, assistant professor of urology at the Northwestern University Feinberg School of Medicine, Chicago, who presented results of the analysis at the AUA annual meeting here.
Dr. Clemens and teams from Northwestern and Kaiser Permanente Northwest in Portland, OR, looked for all new diagnoses coded for chronic prostatitis in the HMO's database from May 2002 to May 2004 and reviewed charts of a sample of those patients to determine the proportion of different types of chronic prostatitis among those diagnoses.
Those men had characteristics that are not necessarily typical of the men with CPPS whom urologists see, especially urologists at tertiary care centers involved with studying CPPS. Chronic pelvic pain syndrome has been defined, in part, by persistence of symptoms for 3 months or more. When men with symptoms of shorter duration were eliminated, the incidence was 1.2 per 1,000 men per year. When men without pain symptoms (thought by some to be necessary to diagnose CPPS) were excluded, the incidence was 2.6 per 1,000 men per year. Dysuria occurred in 46.6% of patients, perineal pain in 34.4%, testicular pain in 16.5%, pain in the bladder or pubic area in 15.9%, pain in the tip of the penis in 11.1%, and ejaculatory pain in 8.5%.
"Most of the symptoms were less complex and less long-standing than the typical male pelvic pain cohorts that have been studied at tertiary referral centers," possibly because men are not being diagnosed and treated first by urologists, Dr. Clemens told Urology Times. "We in urology feel that prostatitis is a urologic condition, but the diagnosis really is being made much more commonly by primary care physicians."
In fact, in this HMO, primary care physicians made about three-fourths of the diagnoses. A majority of patients never saw a urologist. Only one-third of the men who were seen by a primary care doctor eventually saw a urologist.
A new picture emerges
The picture of chronic prostatitis drawn by this study is different from what urologists are accustomed to. It shows that chronic prostatitis is much more common than had been believed, and that the clinical picture early in the syndrome is somewhat different from what urologists see.
Whether the data show that men are being treated successfully in primary care isn't clear, but this picture of less-complicated symptoms early on does present opportunities.
In fact, the new focus of chronic prostatitis studies being planned by the National Institute of Diabetes and Digestive and Kidney Diseases is on recently diagnosed patients.
"We feel that some of the standard treatments probably work much better in patients with new diagnoses-or at least that's the hypothesis, and that's what we want to check," Dr. Clemens said.
In the next few years, clinicians should learn whether early diagnosis and treatment can reduce the burden of this common condition.