Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT.
OBJECTIVE
Large, controlled trials in chronic pelvic pain syndrome (CPPS) have failed due to patient heterogeneity. To phenotype CPPS patients, we developed the UPOINT system with 6 domains (Urinary, Psychosocial, Organ-Specific, Infection, Neurologic/Systemic and Tenderness). In this study, we treated patients with multimodal therapy based on the UPOINT phenotype and measured response after at least 6 months.


METHODS
Patients with CPPS were offered multimodal therapy based on the UPOINT phenotype (eg, Urinary: alpha blocker or antimuscarinic; Organ-specific: quercetin; Tenderness: physical therapy). One hundred patients agreed to therapy and were reexamined after 26 weeks. Primary endpoint was a minimum 6-point drop in NIH-Chronic Prostatitis Symptom Index (CPSI).


RESULTS
Mean age was 46 years, and median symptom duration was 24 months. A median of 3 UPOINT domains were positive, the most common being Organ-specific (70%), Tenderness (64%), and Urinary (59%). With a median 50-week follow-up, 84% had at least a 6-point fall in CPSI. Number of domains and initial CPSI did not predict response. Mean changes (+/-SD) for CPSI subscores were pain 11.5+/-3.2 to 6.1+/-3.9, urine 4.7+/-3.1 to 2.6+/-2.0, QOL 9.1+/-2.3 to 4.5+/-2.8, and total 25.2+/-6.1 to 13.2+/-7.2 (all P<.0001). No domain predicted outcome; however, quercetin use resulted in a greater CPSI decrease.


CONCLUSIONS
Multimodal therapy using UPOINT leads to significant improvement in symptoms and quality of life. Moreover, a placebo-controlled trial for every therapy combination is not feasible, and results using UPOINT compare favorably with all large trials of monotherapy.
Shoskes
Daniel A
DA
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA. dshoskes@mac.com
Nickel
J Curtis
JC
Kattan
Michael W
MW
D000293:Adolescent; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D002908:Chronic Disease; D015331:Cohort Studies; D003408:Cresols / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D010147:Pain Measurement; D017699:Pelvic Pain / Q000145:classification* / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D010641:Phenotype; D010665:Phenylpropanolamine / Q000627:therapeutic use*; D011336:Probability; D011446:Prospective Studies; D011472:Prostatitis / Q000145:classification* / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D011799:Quinazolines / Q000627:therapeutic use*; D018570:Risk Assessment; D012720:Severity of Illness Index; D000068737:Tolterodine Tartrate; D016896:Treatment Outcome; D055815:Young Adult
D000317:Adrenergic alpha-Antagonists; D001559:Benzhydryl Compounds; D003408:Cresols; D018727:Muscarinic Antagonists; D011799:Quinazolines; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate; C047638:alfuzosin