PCPs show major gaps in understanding of CP/CPPS

September 1, 2007

Primary care physicians show large deficits in familiarity with and knowledge of chronic prostatitis/chronic pelvic pain syndrome along with significant variability in their approaches to diagnosis and treatment.

"We undertook this study because multiple epidemiological studies indicate that CP/CPPS is very common and it is likely that men with typical symptoms will present first to a primary care practitioner," said first author J. Quentin Clemens, MD, MSci. "Our findings that these physicians generally have limited experience with this condition suggest they should be the target for future educational efforts. Such a strategy will result in improved patient care by at least enabling an earlier diagnosis and referral to specialists with the knowledge and expertise to provide more directed management."

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, and was conducted by Dr. Clemens in collaboration with colleagues from the University of Illinois at Chicago, UCLA, and the Harvard Medical School, Boston. Dr. Clemens, who was at Northwestern University in Chicago at the time of the study, is now associate professor of urology, University of Michigan, Ann Arbor.

"The patient is a 38-year-old man who complains of nonspecific perineal pain and urinary frequency for several months. He is in a longstanding monogamous relationship, with no history of sexually transmitted diseases or urinary tract infection, a normal prostate exam and urinalysis, and negative urine culture."

The case was followed by questions about the etiology of, and familiarity with, CP/CPPS and options for evaluation and management.

The respondents were asked how many patients they had seen like the one in the vignette and how many they had seen with a diagnosis of CP/CPPS. For both types of patients, the mean answer was about three (range, 0-50 patients). One-third of the physicians reported they had never seen a patient such as the one described in the vignette.

Knowledge gaps defined

Their overall limited experience with CP/CPPS patients was reflected in responses to knowledge assessment questions, Dr. Clemens noted.

"Almost half of the respondents (48%) indicated they were not at all familiar with the NIH classification of prostatitis, which was published in 1999 and is considered in urology part of the standard knowledge base for managing prostatitis," he told Urology Times.

Other knowledge assessment questions asked about features of CP/CPPS. Almost two-thirds of the respondents correctly identified pelvic pain as the hallmark symptom and almost three-fourths correctly indicated that it is a non-infectious condition. However, 37% incorrectly believed its etiology involved a sexually transmitted disease and 35% thought it was caused by a psychiatric illness.

When the respondents were stratified by sex and practice make-up, male physicians provided more correct answers than females did, and physicians who saw a higher proportion of male patients exhibited greater knowledge than their counterparts seeing fewer males did.