CP/CPPS therapies may yield long-sought answers

Research has begun to examine a range of novel treatment modalities, some with quite promising results.

The encouraging news is that research has begun to examine a range of novel treatment modalities, some with quite promising results. Two of these treatments-one combining trigger point release with relaxation techniques and the other a plant-based therapy-are discussed in this issue of Urology Times.

The technique developed by Anderson et al from Stanford University is a two-pronged approach that combines a form of physiotherapy to release myofascial trigger points in pelvic muscles and paradoxical relaxation training, which teaches patients to accept tension and reduce their tendency to tighten pelvic muscles. The Stanford protocol has been shown to alleviate pain and urinary symptoms and, more recently, has been shown to improve sexual function in men with refractory chronic prostatitis/chronic pelvic pain syndrome (see, "Tandem therapies help relieve CP/CPPS symptoms").

A second promising treatment is Cernilton, a rye-pollen extract widely used in Europe for the treatment of lower urinary tract symptoms. Weidner et al presented preliminary, 12-week data showing that pain scores improved by 5 points and quality of life by 2.5 points in men receiving the agent, compared with improvements of 3 points and 1 point in pain and quality of life, respectively, in those receiving placebo (see, "Pollen extract improves pain in men with CP/CPPS"). The study is ongoing, and patients will be followed for 6 months.

As Dr. Curtis Nickel points out in this article, these differences between treatment and placebo are not huge, but are edging toward clinical significance. For a number of urologic diseases, such as erectile dysfunction and BPH, the placebo effect tends to be high (approximately 30%), and the same holds true in this study of men with CP/CPPS. Nevertheless, these data on the use of Cernilton in CP/CPPS are encouraging and warrant further investigation in larger trials.

Certainly, these two treatment approaches are not alone in the research agenda for CP/CPPS. Of note, two randomized clinical trials under the auspices of the 12-site Chronic Prostatitis Collaborative Research Network are currently enrolling patients. One will compare treatment with the alpha-blocker alfuzosin hydrochloride (Uroxatral) versus placebo, and the other will compare gabaentin (Neurontin), an anticonvulsant also widely used for pain control, versus placebo.

Research to date has failed to identify a single treatment modality with proven efficacy in men with CP/CPPS, and perhaps never will, given its wide range of symptoms and uncertain etiologies. New findings, however, have taken an important step in moving the management of this poorly understood condition from the realm of empiric therapy to the realm of objective, evidence-based medicine.

Dr. O'Leary, MD, is associate professor of surgery, division of urology, Harvard Medical School, Boston.

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