Many (belated) thanks for your reply, Dr. Dimitrakov! It was very helpful indeed- and hopeful! It's nice to know that the gene therapy you're working on "involves more than drugs". I'm intrigued! Forgive me if this is a stupid question, but am I correct in my (wishful?) thinking that this could be ameliorative/curative as well as preventative?
I'm also happy to see that your paper "Management of chronic prostatitis/chronic pelvic pain syndrome: an evidence-based approach" is available online for free:
http://pubmed.ncbi.nlm.nih.gov/16698346
Kevin pointed out that "the 3 A's" are Dr. Nickel's shorthand for antibiotics, alpha-blockers, and anti-inflammatories. These have been considered "first-line" treatments against "prostatitis," but as I understand it, they don't offer much promise for chronic cases. However, as alpha-blockers go, am I correct in my impression that alfuzosin is the most promising, if not for us long-term cases, then at least for alpha-blocker naive men in the early stages of CPPS?
I found a paper (again, free online- this is such a great resource for those of us with limited means!) in which Dr. Nickel describes very well "Repetitive Initiator Stimuli," and, really, the whole new paradigm of CPPS:
http://pubmed.ncbi.nlm.nih.gov/17592539
It is now apparent that the condition occurs in anatomically and/or genetically susceptible men who suffer from some initiator factor (usually repetitive). These initiators can be infection (urethritis, cystitis, prostatitis), dysfunctional high-pressure voiding (bladder neck, prostate, sphincter, or urethral pathology), failure to relax the pelvic floor muscles at rest or during voiding, trauma (bicycle seat, prolonged sitting), or allergic phenomenon. This can lead to a self-perpetuating immunologic inflammatory state and/or neurogenic injury, creating acute and then chronic pain. Peripheral and then central nervous system sensitization involving neuroplasticity may lead to a centralized neuropathic pain state, further modulated by upper central nervous system centers.
New avenues of therapy will involve novel diagnostic strategies leading to neuromodulatory, physical, and cognitive-behavioral therapies. Such treatment trials are already ongoing and hold promise for better management of CP/CPPS.
(Figure 1 in that paper is quite illuminating for the visually-minded. I can't recall if Webslave included it in his excellent collection of diagrams a while back, nor can I find the appropriate thread to link to- sorry Webslave!)
Well, I'm still exactly not sure why Dr. Nickel had an arrow going from "the 3 A's" to "Repetitive Initiator Stimuli" in that diagram- I guess because "the 3 A's" sometimes work for men in early stages of this condition?
The exciting thing is that it really sounds to me like Drs. Anderson, Berger, Dimitrakov, Nickel, Shoskes, et al. (our heroes here at the forum!) are all working from pretty much the same concept of CPPS, but each studying it from their own angle, bringing their own strengths to the table. It's great to see this come together. While I don't feel lucky that I got CPPS, I'm certainly glad I have it at a time when all the above are doing such great work to figure it out! Thank you again for your tireless efforts, and best of luck to you all!
