What is Chronic Prostatitis / Chronic Pelvic Pain Syndrome (CP/CPPS)?

CPPS symptoms bar chart

The “prostatitis” diagnosis is assigned to 8% and 1% of patients by urologists and primary care physicians, respectively. There are an estimated 2 million outpatient visits for prostatitis per year in the US. There are more outpatient visits for prostatitis than for BPH or prostate cancer. Dr Nickel (2001) found a 9.7% prevalence of prostatitis-like symptoms in the community. The most conservative study puts the incidence at around 3%, which means at least 4.5 million men in the US and 90 million worldwide. In 2002 a lot of research emerged to show that IC and CPPS are one and the same, and Dr CL Parsons from UC San Diego has suggested both conditions should be renamed as Lower Urinary Dysfunctional Epithelium (LUDE).

Prostatitis vs Chronic ProstatitisChronic prostatitis / chronic pelvic pain syndrome (CP/CPPS) has a wide range of symptoms, with some confusion at the moment due to possible overlap with other conditions. For instance, some men report frequent urination and others don’t. Some report sexual dysfunction and erectile difficulties, others don’t – they can have intercourse daily. In addition, men with sterile orchialgia, epididymitis and urethritis are usually excluded from chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), but recently some experts have said that these men also have CP/CPPS, which not only targets the prostate. Many men who are told they have prostatitis are misdiagnosed. Inflammation may be centred in the bladder. This condition is called Interstitial Cystitis, which features painful, frequent urination, although IC expert C. Lowell Parsons says only 15 % of men with IC have frequency and urgency.

Roughly speaking, when cultures are negative, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) can be described as persistent relapsing pain or discomfort in any of the following areas:

  • Urethra
  • Between rectum and testicles (perineum)
  • Tip of the penis (not related to urination)
  • Below the waist, in your pubic or bladder area
  • Testicles

Some of the functional symptoms are:

  • Pain or burning during urination
  • Pain or discomfort after ejaculation
  • A sensation of pain in the lower back and upper legs
  • A sensation of pain in the groin and above the bladder
  • A sensation of pain or burning high up in the penis (urethra)
  • A sensation of not emptying the bladder completely after finishing urinating
  • Lowering of libido (sexual desire)

Other often reported symptoms are:

  • Fatigue, sometimes to the point of being bedridden
  • Discolored semen (yellowish, from dead white blood cells – a sign of inflammation)
  • pain after ejaculation, lasting from hours to days
  • Impaired memory, find it hard to concentrate
  • painful lymph nodes
  • catch colds easily

Prostatitis pain location bar graphMany people believe that the disease is a generalized, whole-body disorder, not merely isolated to the lower genitourinary tract. This idea has been proved to be true in BPS/IC recently.

The condition is notorious for waxing and waning. The pain can recede for hours and even days, then return inexplicably with force. In addition, people experience remissions which can last months to years, then have another flare-up.

From the 2001 AUA Meeting comes the following definition:

  • The principal symptom is pain or discomfort in the pelvic region or thereabouts lasting 3 months or more.
  • Younger men, median age 43 years.
  • Pain is most severe symptom and most commonly reported symptom (Alexander and Trissel 1996) (Krieger and others 1996).
  • Symptoms are episodic, wax and wane, variable periodicity.
  • Most common site of pain is perineum but wide variation in places throughout the pelvic region that are reported as uncomfortable.
  • Voiding symptoms, irritative contributing more than obstructive symptoms.
  • Sexual function impairment although most men potent.
  • Pain after ejaculation is a very specific complaint that distinguishes prostatitis from BPH or normal men (Litwin and others 1999)

The pain can be unrelenting and emotionally exhausting. It can damage and even destroy marriages, it can rob families of their fathers and husbands. Striking at the very core of a man’s maleness, it is truly a terrible affliction. Men have committed suicide because of this disease.

“The quality of life for a patient with Chronic Prostatitis is similar to that experienced by patients with acute myocardial infarction, unstable angina or active Crohn disease”. J. Curtis Nickel, MD, FRCSC, Canada.

“Some patients experience so much pain that the condition is handled much like a chronic pain syndrome that occurs secondary to cancer. Therapy may begin with judicious use of narcotics until the patient experiences some relief”. Keith B. Armitage, MD et al.