Patients with CP/CPPS may be classified with new system

June 1, 2010

Chronic prostatitis/chronic pelvic pain syndrome is a complex, heterogeneous syndrome in terms of etiology and symptoms, making its treatment difficult. Thus, a first step to improved management of these conditions is to better classify and stratify patients.

Barcelona, Spain-Chronic prostatitis/chronic pelvic pain syndrome is a complex, heterogeneous syndrome in terms of etiology and symptoms, making its treatment difficult. Thus, a first step to improved management of these conditions is to better classify and stratify patients.

At the European Association of Urology annual congress here, a team of researchers from Germany and Italy reconfirmed the value of the phenotypic classification system described by Daniel A. Shoskes, MD, and J. Curtis Nickel, MD, with a retrospective clinical study (Urol 2009; 73:538-42). The classification, known as UPOINT, consists of six domains: urinary, psychosocial, organ-specific, infection, neurologic, and tenderness of skeletal muscles. Each domain is further divided into one to four "items" (eg, the neurologic domain includes "pain beyond abdomen and pelvis" as one of four items).

A total of 385 patients were diagnosed with CP/CPPS category IIIa, while 834 patients had CP/CPPS category IIIb. The majority of the patients, 84%, were positive for the organ-specific domain, and 65% and 62% were positive for the urinary and tenderness of skeletal muscles domains, respectively.

In addition, 35%, 10%, and 41% of patients were positive for the psychosocial, infection, and neurologic domains, respectively; 11%, 24%, 33%, 22%, and 10% of patients were positive for one, two, three, four, and five domains, respectively.

Overall, there was a positive correlation between increased number of domains and the increase in mean total NIH-CPSI score. Whereas the Milan cohort showed a significant correlation between UPOINT and the NIH-CPSI, no such correlation was found in the Giessen cohort.

"The difference between the two centers might be due to the difference in patient selection in the two centers and differences in methodology of investigations of patients," Dr. Wagenlehner said. "Milan is a primary and secondary care clinic, which means that a higher number of treatment-naive patients might have been included.

"A phenotype-related targeted treatment represents a simple treatment algorithm that can be used by urologists that already are treating CP/CPPS patients," Dr. Wagenlehner concluded, noting that additional phenotypes may help to further stratify patients.

"However, a treatment that is based on a phenotypic classification could already today yield better results than the current non-specific treatment."