CHRONIC PELVIC PAIN SYNDROME: A PROSPECTIVE STUDY USING UPOINT

e312

THE JOURNAL OF UROLOGY姞

Vol. 183, No. 4, Supplement, Monday, May 31, 2010

with prostatitis-like syndrome identified at baseline in the placebo and dutasteride groups, respectively. There was a significant decrease in total and most sub-scores of the CPSI at 48 months in the dutasteride group compared with the placebo group (Table). In the prostatitis-like pain subgroup and prostatitis-like syndrome subgroup, there were significantly more 4-point responders (63.3% and 58.6% respectively) and 6-point responders (49.2% and 46.6% respectively) in the dutasteride groups compared with placebo groups (49.8 % and 45.4% respectively for 4-point responders; 37.5% and 32.8% respectively for 6-point responders). CONCLUSIONS: Treatment with dutasteride over 4 years improved prostatitis-related symptoms in older men identified with prostatitis-like pain and prostatitis-like syndrome. Table. Mean changes in Chronic Prostatitis Symptom Index (CPSI) sub-scores from baseline Mean change from baseline at Month 48 Patient Total CPSI CPSI CPSI groups CPSI Pain Urinary QoL Prostatitis-like Placebo -2.84 -2.93 0.37 -0.21 pain Dutasteride -5.35 -3.92 -0.78 -0.53 p value Prostatitis-like syndrome

⬍0.0001

0.0008

⬍0.0001

0.0005

Placebo

-2.47

-2.64

0.31

-0.24

Dutasteride

-4.60

-3.33

-0.65

-0.46

p value

0.0031

0.0890

0.0033

0.0719

Source of Funding: GlaxoSmithKline

798 PHENOTYPICALLY DIRECTED MULTIMODAL THERAPY FOR CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME: A PROSPECTIVE STUDY USING UPOINT Daniel Shoskes*, Dolinga Robert, Cleveland, OH; Curtis Nickel, Kingston, Canada INTRODUCTION AND OBJECTIVES: Chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS) is likely multifactorial. Multicenter placebo controlled trials have failed their primary endpoints using “one size fits all” therapies. In order to phenotype CP/CPPS patients we developed the UPOINT system with six yes/no domains (Urinary, Psychosocial, Organ Specific, Infection, Neurologic/Systemic and Tenderness of muscles). We have shown a direct correlation between domain number and symptom duration as well as NIH-Chronic Prostatitis Symptom Index (CPSI) scores. In this study, we treated patients with multimodal therapy based on the UPOINT phenotype (one therapy recommended for each positive domain) and hypothesized that patients would have significant long term symptom improvement. METHODS: From March 2008 to April 2009, patients with CP/CPPS were classified according to UPOINT and offered multimodal therapy based on the positive domains (eg. Urinary: alpha blocker or antimuscarinic, Organ specific: quercetin; Neurologic: pregabalin, Tenderness: physical therapy). One hundred patients agreed to therapy and were re-examined at least 26 weeks later. Primary endpoint was a minimum 6 point drop in total CPSI (90% power for a 1.2 point drop). RESULTS: Mean age was 46 years and median symptom duration was 24 months. A median of 3 UPOINT domains were positive (range 1-5), the most common being Organ specific (70%), Tenderness (64%) and urinary (59%). With a minimum follow up of 26 weeks and median of 50 weeks, 84% had a 6 point or greater fall in total CPSI. Number of positive domains and initial CPSI score did not predict treatment response. Average changes for the 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 pairs p⬍0.0001). No individual phenotype predicted symptom improvement, however use of quercetin was the only individual therapy associated with a higher drop in total CPSI (8.47⫹/-6.4 vs 13.9 ⫹/-6.2, p⬍0.0001). CONCLUSIONS: Phentoypically directed multimodal therapy using the UPOINT system leads to significant improvement in symptoms and quality of life in men with CP/CPPS. While a placebo controlled trial for every therapy combination is not feasible, the results

using UPOINT compare favorably to all large trials of monotherapy. This algorithmic technique is simple to use (www.upointmd.com) and a major improvement over the status quo of empiric therapy. Source of Funding: None

799 CLINICAL PHENOTYPING OF PATIENTS WITH CHRONIC PROSTATITIS-CHRONIC PELVIC PAIN SYNDROME IN TWO SPECIALIZED EUROPEAN INSTITUTIONS Florian Wagenlehner, Giessen, Germany; Vittorio Magri, Milan, Italy; Gianpaolo Perletti, Busto A./Varese, Italy; Sebastian Schneider, Wolfgang Weidner*, Giessen, Germany INTRODUCTION AND OBJECTIVES: Patients with chronic prostatitis-chronic pelvic pain syndrome (CP-CPPS) are difficult to treat due to the unknown etiology and the complex symptomatology. A novel clinical phenotyping system, denominated UPOINT, was suggested to better correlate with multimodal treatment concepts than current diagnosis. The aim of this study was to correlate the UPOINT phenotyping system to patients⬘ symptoms in a large database of CP-CPPS patients from two European institutions. METHODS: A total of 1219 well characterized patients with CP-CPPS (937 from Milan, Italy and 282 from Giessen, Germany) were retrospectivley classified into a six-domain phenotype system, consisting of urinary, psychosocial, organ specific, infection (but not qualifying for chronic bacterial prostatitis), neurologic, and tenderness of skeletal muscles domains. Severity of symptoms were assessed by the Chronic Prostatitis Symptom Index (NIH-CPSI) and the International Prostate Symptom Score (IPSS). Statistical calculations were performed by ANOVA and Spearman⬘s correlation. RESULTS: 385 and 834 patients were diagnosed with CPCPPS IIIa and IIIb, respectively. 65%, 35%, 84%, 10%, 41% and 62% of patients were positive for the domains urinary, psychosocial, organ specific, infection, neurologic, and tenderness of skeletal muscles, respectively. 11%, 24%, 33%, 22%, 10% and 0.3% of patients were positive for 1, 2, 3, 4, 5 and 6 domains respectively. The mean total NIH-CPSI score increased stepwise and significantly (P⬍0.0001 [Spearman’s; rho⫽1]; P⫽0.002, ANOVA) from 17 in patients with only one positive domain to 34 in patients with 6 positive domains. Similar significance was also found with the three subdomains of the NIH-CPSI score. Similarly a significant stepwise increase in the mean IPSS score from 7 in patients with one positive domain to 38 in patients with 6 positive domains was noted. CONCLUSIONS: A large heterogenity of clinical phenotypes was found in this patient cohort from two specialized institutions. With increasing positive phenotypes patients⬘ symptomatology also increased. It might be beneficial in the future to include additional phenotypes for further stratification of patients. The exact role of clinical phenotyping has yet to be evaluated in treatment studies. Taking however the complex heterogenous etiology of CP-CPPS into consideration, a phenotype oriented treatment might closer match the underlying etiology than a non specific treatment and therefore result in improved outcome. *FW and VM contributed equally to this work. Source of Funding: None

800 CATASTROPHIZING AND SPOUSAL RESPONSES IN MEN SUFFERING FROM CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME (CP/CPPS) Dean A. Tripp*, Jessica Ginting, J. Curtis Nickel, Kingston, Canada; Kathleen J. Propert, Philadelphia, PA; John Kusek, Chronic Prostatitis Collaborative Research Network, Bethesda, MD INTRODUCTION AND OBJECTIVES: Catastrophic thinking about one’s pain symptoms and ability to self-manage strongly influences patient adjustment, as does spousal support. We examined the