AUA 2009: Newly-Diagnosed Vs Chronic-Refractory Patients

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webslave
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AUA 2009: Newly-Diagnosed Vs Chronic-Refractory Patients

Post by webslave »

(Note: this is an abstract from a conference, not a published study.)

Comparison Of Symptoms In Newly-Diagnosed Vs Chronic-Refractory Patients With Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)

Authors: J Curtis Nickel*, Kingston, ONCanada; Richard B Alexander, Baltimore, MD; Rodney U Anderson, Stanford, CA; Richard Berger, Seattle, WA; William L Duncan, Jackson, MS; John N Krieger, Seattle, WA; Mark S Litwin, Los Angeles, CA; Mary McNaughton-Collins, Boston, MA; Michel A Pontari, Philadelphia, PA; Anthony J Schaeffer, Chicago, IL; Daniel A Shoskes, Cleveland, OH; J. Richard Landis, Philadelphia, PA; John W Kusek, Leroy M Nyberg, Bethesda, MD; Shannon Chuai, Philadelphia, PA; The Chronic Prostatitis Collaborative Research Network

Introduction and Objective: Two distinctly different CP/CPPS cohorts were enrolled into CPCRN randomized clinical trials comparing alfuzosin (diagnosis within the last two years and relatively treatment naive) or pregabalin (more chronic heavily pretreated) with placebo therapy. To gain insight into potential factors associated with CP/CPPS symptom progression, we compared baseline characteristics of these two patient populations. Methods: We compared the following baseline parameters (that were collected for both randomized clinical trials): age, duration of symptoms, Chronic Prostatitis Symptom Index (CPSI), McGill Pain Questionnaire, SF-12 Quality of Life, Hospital Anxiety and Depression Scale (HADS), and Sexual Health Inventory for Men (SHIM). Results: Compared to the 272 patients in the alfuzosin trial the 321 patients in the pregabalin trial had longer symptom duration the (mean 10.2 vs, 1.9 years; p<0.001), were older (47.1 vs. 40.1 years p<0.0001), reported higher CPSI total scores (26.1 vs 24.4; p<0.0004), higher CPSI pain sub-score- (12.4 vs. 11.3; p<0.0001), higher CPSI quality of life sub-score (8.9 vs. 4.6; p<0.0001), poorer SF-12 mental component quality of life (42.1 vs. 44.5; p=0.0092) and more significant anxiety and depression (HADS scores (14.6 vs. 12.8; p=0.0031). There were no differences between cohorts in CPSI urinary sub-scores (4.8 vs. 4.7; p=0.30), SF-12 physical component quality of life (44.6 vs. 45.6; p=0.35) or sexual functioning (SHIM scores 17.1 vs 17.2; p=0.67). Conclusions: Duration of symptoms in CP/CPPS may be associated with cognitive progression but not physical progression. Symptom duration is negatively associated with pain, quality of life (particularly mental QoL), anxiety and depression. The duration of symptoms is not associated with urinary, physical and sexual functioning. Early identification and therapy may prevent this apparent cognitive progression associated with symptom duration.
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Re: AUA 2009: Newly-Diagnosed Vs Chronic-Refractory Patients

Post by carld »

Mark...could this conclusion fall in line with catastrophic thinking...If so this 2009 meeting just shows you how cutting edge this website really is and of course Dr. Wise and his crew... :wink:
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I encourage anxiety prone UCPPS people to consider L-Theanine
Age, 44 onset age 37 Feb 2006 Freq. need to urinate. Sensation of having to urinate soon after going. Perineum discomfort/burning/tightness, pubic area discomfort @ times,poor urine stream, post urine dripping/spray. All symptoms have improved with my protocol. At the worst I give it a 1 to 2 on irritation and discomfort and frequency. Helps: Elavil 5mg for anxiety and mast cell protection, (will only take it as needed) self internal PT as needed, stretching, walking, stairmaster cardio workout and light weights, reducing stress, moment to moment relaxation, deep breathing relaxation and using a Theracane. Makes worse: sitting for long periods, stress, over focusing on it. Currently 95%-98% recovered. Stay positive, relaxed and control your anxiety.
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Re: AUA 2009: Newly-Diagnosed Vs Chronic-Refractory Patients

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This conclusion gives the lie to all those who constantly say how they wish they'd treated their condition sooner, because they left if for years/months and now the "bacteria" are so entrenched that the antibiotics won't work.
  • There are no bacteria
  • The fact that the condition has been neglected means that the COGNITIVE PATHWAYS, the neural "tracks" that allow the syndrome to thrive and the pain to become unrelenting (like anxiety, catastrophic thinking, etc), have deepened and become more fixed in some aspects (but not irreversibly).
So they are partly right, but for the wrong reasons.
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Re: AUA 2009: Newly-Diagnosed Vs Chronic-Refractory Patients

Post by dshoskes »

You can't draw any conclusions about the value of early therapy from this study because most of the men in both trials had had some type of therapy prior to inclusion. Furthermore, this is a comparison of the placebo arms, so ability to improve symptoms with therapy is also not addressed in this study.

In my own experience, greater duration of symptoms definitely increases the number of positive domains (see my other AUA abstract) but so far doesn't seem to predict the outcome of multimodal therapy (of course if you treat early and ONLY 1 domain is positive, you don't need multimodal therapy :) )
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Re: AUA 2009: Newly-Diagnosed Vs Chronic-Refractory Patients

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A stitch in time saves nine? Perhaps. My guess is that not many men are subjected to a comprehensive set of treatments at the outset, so we cannot know how that would affect outcomes. Common sense would seem to indicate that, as with most things, if you attack a problem early and energetically, your chances of success will be greater.
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Re: AUA 2009: Newly-Diagnosed Vs Chronic-Refractory Patients

Post by random321 »

This makes sense why early antibiotic treatment helps as well. Not because it's an actual infection getting treated before it becomes chronic, but because of the anti-inflammatory effect of the antibiotics stops inflammation before the pain-feedback loop develops.
Age:24 | Onset Age:19 | Symptoms: frequent urination, slow flow, perineum pain, penis tip pain, sometimes lower and upper back pain and foot pain, erectile dysfunction, depression. | Helped By: QUERCETIN, Low carb diet, elimination diet, proper progesterone levels, hot baths | Worsened By: Increased DHT(dihydrotestosterone) from TRT, carbs/sugar, food allergies, not masturbating
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