Physical Therapies, Acupuncture Bring Good Treatment News as Alpha Blocker Disappoints at 2008 AUA Meeting
Although news from a major clinical trial was disappointing, the 2008 American Urological Association meeting also brought good news of helpful treatment for men with CP/CPPS from an unexpected quarter-physical and alternative therapies. Some of those were supported with well-designed, controlled, and even sham-controlled studies, a scientific gold standard that few thought could be applied to these therapies.
The disappointing news was from the clinical trial of the alpha blocker alfuzosin from the NIDDK-sponsored Chronic Prostatitis Collaborative Research Network (CPCRN). Few drug therapies for CP/CPPS have passed the gold-standard test and shown clinically significant help, but it looked like alpha blockers might just pass. Because some of the previous promising trials included many men who had not had their symptoms long and had not taken alpha blockers before, the CPCRN tested one of these drugs, alfuzosin (Uroxatral), in a randomized, placebo-controlled trial including only these men.
The results were kept under wraps until a "late-breaking new" plenary session, which generated some excitement and hope. But in the plenary session, we heard, "It was a great hypothesis ruined by good science," from Curtis Nickel, MD, of Queens University in Kingston, Ontario, who presented the results. Improvements on the NIH Chronic Prostatitis Symptom Index (CPCSI) and on a global improvement scale were just the same in the drug therapy and placebo groups.
More hopeful results, however, came from studies on physical therapy techniques, acupuncture, and "self care." One of these from the NIDDK-sponsored Urologic Pelvic Pain Collaborative Research Network (a combination of CPCRN and the Interstitial Cystitis Collaborative Research Network or ICCRN researchers) showed the value of pelvic floor-directed therapy for CP/CPPS and IC, even though this was a feasibility study. The trial pitted physical therapy, including lower body connective tissue manipulation ,pelvic floor massage, and trigger point treatment, against general, whole body massage and judged a positive response based on patients' reports that they were moderately or markedly better. For the women with IC, the results were absolutely clear-none benefitted from the general massage, but 45 percent did from the physical therapy.
Men responded very differently, however. Forty-five percent responded to the general massage and 67 percent to the physical therapy. Although that wasn't a significant difference, those very high response rates suggest that therapeutic touch, and specifically pelvic floor-directed therapy, can go a long way to easing symptoms for men with CP/CPPS.
A sham-controlled study of transrectal electrical stimulation, a kind of physical therapy directed at the pelvic floor musculature and the area of the prostate, did show benefit. The point difference between the therapy and sham groups on the total NIH CPSI score was not very large , but it was statistically significant. Pain scores, however, showed wide differences favoring the treatment, as did a more general assessment of how the men were responding.
A cleverly designed study of acupuncture also showed positive results compared with sham treatment. For the sham treatment, technicians who did not know which treatment was the traditional one inserted needles inserted shallowly and only a half inch away from the traditional points. The bar for response (at least a 6 points on the NIH CPSI) was set high, but the differences were significant. And the median improvement in the treatment group was very high at 9 points.
Another interesting study pointed to diet as potentially helpful treatment, but the study so far has not differentiated men with CP/CPPS from men with IC. The majority of men, however, likely had CP/CPPS. The investigators, who previously confirmed that certain food and drink did indeed exacerbate IC symptoms found that similar foods and beverages (coffee, tea, alcohol, citrus fruits, spicy foods, hot pepper, tomato products, and carbonated beverages) also made a difference for about half of the men. This isn't as high a proportion as for women with IC, but men with CP/CPPS might want to take a closer look at whether they are sensitive to these foods and eliminate or minimize them in their diet if they are.
This research team also tackled the problem of how to decide whether a man has CP/CPPS or IC. Applying a statistical technique called "principal components analysis," they analyzed patients' answers to two standard questionnaires used in these conditions, the NIH CPSI and the O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI). Based mainly on the severity of symptoms, the analysis did appear to shake out which men had which condition. That opens the possibility that physicians could use these standard questionnaires to help them decide which condition a man has when his symptoms don't clearly put him in one category or the other.
Self care is also an important component of treatment of pudendal nerve problems, which can mimic CP/CPPS. Stanley Antolak, MD, from the Twin Cities area in Minnesota, presented results of his clinical experience with pudendal neuropathy and urged his colleagues to look for damage to that nerve, which requires only simple tests, such as the ability to feel pinpricks or warmth in the areas that nerve serves. Sitting on a cutout cushion and avoiding activity that causes compression, such as prolonged sitting, weight lifting from a seated position, and bicycle riding, can help. The next steps are physical therapy, nerve blocks, and surgery.
Another interesting therapy was a saw palmetto, selenium, and lycopene combination that seemed to give good results. An erectile dysfunction drug, tadalafil (Cialis), improved sexual function and well being.
In basic research, one of the most interesting studies was of autoimmunity to prostate tissue that produced CP/CPPS-type pain and tissue inflammation in mice. This model of CP/CPPS indicated that some prostate-directed therapy, such as lidocaine injection, as well as neuropathic pain drugs may ease CP/CPPS pain. Also intriguing was this model's suggestion of an immune basis for CP/CPPS.
Below, you can read more details of all the studies presented at the meeting. In addition, you can view the late-breaking news presentations on the internet at http://webcasts.prous.com/aua2008/. Go to Plenary Sessions, then Late Breaking News.
Good Science Supports Acupuncture for CP/CPPS Pain
Randomized, double blind comparison of acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain syndrome
Shaun W Lee, Penang, Malaysia, Men Long Liong, Kah Hay Yuen, Wing Seng Leong, Phaik Yeong Cheah, Oxford, United Kingdom, Nurzalina Abdul Karim Khan, Christopher Chee, Weng Pho Choong, Yue Wu, Wooi Long Choong, Kedah, Malaysia, Hin Wai Yap, Penang, Malaysia, John N Krieger, Seattle, WA
It's not easy to put an alternative therapy like acupuncture to a sham-controlled, double-blind test. That's the gold standard for evaluating the efficacy of a therapy-pitting a it against a placebo and keeping the knowledge of which is which from both those who administer the therapy and those who receive it. But these investigators were able to do it with acupuncture. Technicians treated 44 men with traditional acupuncture methods at certain traditional chinese medicine acupuncture points on the abdomen, groin, and lower leg (CV1, CV4, SP6, SP9) and 45 men with the sham treatment. For the sham, the needles were inserted to a much shorter depth (a half inch) and at point a half inch away from the actual acupuncture point. (The technicians did not know which one was the actual treatment.) The men were treated twice a week for 30 minutes for 10 weeks. The measure of success was a 6-point decline in NIH CPSI score from the beginning to the end of the 10 weeks. In the acupuncture group, 32 of 44 men (73 percent) responded, compared with 21 of 45 (47 percent) in the sham group, a statistically significant difference. The median score dropped from 25 to 14 in the treatment group and from 25 to 19 in the sham group, also a significant difference. The investigators hope more studies will show what the optimal treatment regimen is, how long the response lasts, and whether combining acupuncture with other treatments can improve the response.
Sham-controlled Study Supports Pelvic Floor Therapy, Too
Pelvic floor electrical stimulation in the treatment of chronic pelvic pain syndrome: a randomized, sham-controlled trial
Jordan D Dimitrakov, Boston, MA, Ivan Dechev, Plovdiv, Bulgaria
Because pelvic floor dysfunction has been implicated in CP/CPPS symptoms, especially pain, these researchers tested electrical stimulation therapy of the pelvic floor (using the Inova pelvic floor stimulation system from Empi) delivered through a probe placed in the rectum. The sham treatment involved using the probe without electrical stimulation, but patients could not tell whether they were getting the actual treatment through the probe. They got the active or sham treatment twice daily for a month, then twice weekly for another five months. Those who got electrostimulation were offered another 6 months of treatments twice a week. Changes at 1 month, 6 months, and 12 months were significant compared with the sham for all the assessments, which included pain scores on the NIH CPSI, total scores, and patients' estimates of improvement in their pain and how they were doing overall. NIH CPSI pain scores dropped about 4 points at 1 month, 3 points at 6 months and 5 points at 12 months for those who got actual electrostimulation versus about 2 points, 1 point and 2 points for the sham treatment. Total NIH CPSI scores for the treated men dropped about 5 points, 5 points, and 7 points (considered clinically significant) at those times for the treated men versus 4 points, 2 points, and 3 points for the sham treated men. At 6 months, 77 percent of the men who got the electrostimulation said they had no pain or mild pain versus 37 percent of the sham-treated men, 71 percent who got electrostimulation said their response to treatment was good or excellent versus 31 percent of the sham-treated men, and 81 percent of the men who got electrostimulation said they were well or very well, compared with 25 percent of the sham-treated men.
Controlled Trial Shows Symptoms Eased by Pelvic Floor Therapy, Massage
Randomized multicenter pilot trial shows benefit of manual physical therapies in the treatment of chronic pelvic pain
MP Fitzgerald, Chicago, IL, RU Anderson, CK Payne, Stanford, CA, J Potts, Cleveland, OH, KM Peters, Royal Oak, MI, JQ Clemens, Ann Arbor, MI, L Cen, S Chuai, JR Landis, Philadelphia, PA
With manual physical therapy, sham therapy just isn't possible, so the investigators compared pelvic floor-directed manual therapy with general, full-body, Western-style massage. The physical therapy was standardized by having the therapists trained and tested on a standard protocol, which included connective tissue manipulation of external tissues of the lower limbs, buttocks, and abdominal wall and trigger-point treatments of the abdominal wall and pelvic floor. The general massage was also standardized. Doctors' skills in identifying pelvic floor tension were also tested and found excellent. Patients were willing to be randomized, and most followed through with all the treatments-weekly therapy for one hour for a median of 10 weeks. Forty-seven patients (23 men and 24 women) were randomized to one treatment or the other at 6 participating centers, and 44 completed the study. All these indicated a larger study was feasible. The major outcome measure (within 2 weeks of the end of therapy) of success was moderate or marked improvement on a global response assessment (which asks patients whether they are better, the same, or worse and how much). Overall, 57% of patients responded to physical therapy compared with 21% to general massage, a significant difference. Men, however, responded differently from women: 67 percent responded to physical therapy and 45 percent to massage. Although that wasn't a statistically significant difference, the response was higher than the women's and implies that therapeutic touch, especially pelvic floor-directed physical therapy, can benefit men with CP/CPPS.
Pudendal Nerve Problems Can Be Identified, Treated Successfully
Prostatitis-like pain: surgical decompression of the pudendal nerves can improve or cure symptoms
Stanley J Antolak, Lake Elmo, MN, Christopher M Antolak, Minneapolis, MN
These urologists argue that CP/CPPS is a wastebasket diagnosis and that doctors need to be alert that the pain may sometimes originate from problems with the pudendal nerve, which serves the perianal, perineal, and genital areas and the inner thigh. The problems are often caused by compression of the nerve, similar to carpal tunnel syndrome in the wrist. Typical symptoms are pain with sitting that is relieved by standing or sitting on a cutout cushion or toilet seat. Simple tests of sensation, such as the Warm Detection Threshold test and pinpricks, in the distribution of the nerve and the Pudendal Nerve Motor Latency Test can confirm the diagnosis. Treatment includes self care, nerve block injections, and decompression surgery when the other measures don't work. Thirty-one men underwent bilateral (on both sides) decompression surgery, and 22 had adequate follow-up for evaluation. One year after surgery, 12 men (54.5 percent) were improved or cured, 7 (31.8 percent) had the same level of symptoms, and 3 (13.6%) were worse. Among the men who improved, average NIH CPSI scores decreased from 31.6 to 23.3 at one year and to 16.1 at two years.
Saw Palmetto, Selenium, Lycopene Combination Eases Symptoms
Treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) with Serenoa repens plus selenio and licopene (Profluss ): a randomized multicenter placebo-controlled study
Giuseppe Morgia, Giuseppe Mucciardi, Massimo Madonia, Tommaso Castelli, Vincenzo Favilla, Carlo Magno, Messina, Italy
This randomized, controlled trial tested a proprietary combination of saw palmetto, selenium, and lycopene in men with CP/CPPS. Fifty-two men each took 235 mg/day or a placebo for eight weeks, filled out NIH CPSI and International Prostate Symptom Score (IPSS) questionnaires, and had their peak urine flow rate and PSA levels measured. NIH CPSI scores dropped 14 points in the treatment group but 7 points in the placebo group. IPSS scores improved significantly in both groups, but the change was greater for the treatment group. PSA dropped significantly only in the treatment group-27 percent versus 7 percent. Peak urine flow rates improved from a median of 17 mL/min to 19 mL/min but stayed steady in the placebo group. Profluss was noted to be safe and well tolerated, to help relieve CP/CPPS symptoms, and to improve voiding dysfunction.
Cialis Improves Erectile Function, Well Being in Men with CP/CPPS
The efficacy of tadalafil for chronic prostatitis/chronic pelvic pain syndrome in young and middle aged patients
Hyun Jun Park, Nam-Cheol Park, Bu-Kyung Park, Chang-Soo Park, Won-Hee Cheon, Jeong-Moon Heo, Busan, Republic of Korea
This randomized, single-blind (the researchers knew which patients got which treatment) trial compared treatment with the antibiotic levofloxacin 400 mg/day with levofloxacin plus tadalafil (Cialis) 10 mg/day for four weeks. In the 38 patients who got the combination, IPSS scores improved by 2.5 points versus 1 point for the antibiotic alone, and the subscores indicating urinary obstruction also improved. NIH CPSI scores dropped by nearly 3 points in the men who got tadalafil versus about 1 point in the antibiotic group. That is a statistically significant difference but is not considered a clinically significant one. Erectile function scores improved significantly more in the men who got tadalafil than in those who got the antibiotic alone. Urinary symptoms did not change greatly, but quality of life improved. This study doesn't clearly support tadalafil for CP/CPPS symptoms, but it does show help for erectile function and possibly for overall well being for men with CP/CPPS.
Alpha Blocker Is a Bust for Early CP/CPPS
A randomized multicenter double-blind clinical trial to evaluate the efficacy and safety of alfuzosin in the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in recently-diagnosed and/or newly-symptomatic alpha-blocker naive patients
J Curtis Nickel, Kingston, ON, Canada, John Krieger, Seattle, WA, Paige C White, Jackson, MS, Mary McNaughton-Collins, Boston, MA, Rodney U Anderson, Stanford, CA, Michel Pontari, Philadelphia, PA, Daniel Shoskes, Cleveland, OH, Mark S Litwin, Los Angeles, CA, Richard B Alexander, Baltimore, MD, Richard Berger, Seattle, WA, Shannon Chuai, J Richard Landis, Philadelphia, PA, John W Kusek, Bethesda, MD, Leroy M Nyberg, Chris Mullins, Anthony J Shaeffer, Chicago, IL, and The Chronic Prostatitis Collaborative Research Network (CPCRN), Bethesda, MD
Alpha blockers are commonly prescribed for men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and some small studies suggested that they might help best early in the course of the disorder. That's why the CPCRN took on a randomized, controlled clinical trial of an alpha blocker, alfuzosin (Uroxatral) in men who had been diagnosed in the last two years and who had never taken an alpha blocker before. The trial included 272 patients at the beginning, and 41 withdrew (considered nonresponders). The men took either alfuzosin 10 mg/day or an identical-looking placebo for 12 weeks. A response was defined as a decrease in the score on the NIH CPSI of 4 or more points from the beginning to the end of the study. Exactly the same proportion of men in each group responded-49 percent. There were also no differences between the groups in terms of their pain, urinary, or quality-of-life subscores. Other measures of pain, quality of life, depression, and erectile function were no different between the groups.
Alpha Blocker Eases Postorgasmic Pain
Male post-orgasmic pain: a challenging treatment issue
Germar-M Pinggera, Michael Mitterberger, Alexander Buttazzoni, Jasmin Bektic, Hannes Strasser, Oriettea Dalpiaz, Leo Pallwein, Friedrich Aigner, Georg Bartsch, Innsbruck, Austria
Postorgasmic or postejaculatory pain can be a problem for a quarter of men with CP/CPPS. The problem isn't exclusive to them, however, and in men who don't have CP/CPPS, the pain may have a different cause. Mostly, this condition is diagnosed after prostate surgery, said these clinicians. Nevertheless, even though men with CP/CPPS were excluded, this study of postejaculatory pain treatment with tamsulosin (Flomax) may be relevant for men with CP/CPPS. The investigators theorized that an alpha blocker might help because bladder neck spasm might play a role in this pain, and they showed previously that tamsulosin encouraged blood flow in the bladder neck and prostate. They treated 23 men with postejaculatory pain with 0.4 mg/day up to 0.8 mg/day for six weeks. The pain was mostly in the penis (80 percent) and rarely in the perineum, abdomen, or scrotum. After treatment, 7 of the 23 (30 percent) had their pain resolve completely, 15 (70 percent) had a significant reduction in pain (at least 3 points on a scale of 0 to 10). Of patients who still had pain, the duration shortened for most (55 percent) to less than 2 minutes compared with 10 minutes before therapy. As the pain decreased, the men's libido increased significantly. The team is now researching how blood flow in the bladder neck and prostate might contribute to the pain. This study was not a placebo-controlled study, nor did it include CP/CPPS patients, but it suggests the possibility that an alpha blocker's place in CP/CPPS therapy might be for postejaculatory pain.
Men with Pelvic Pain Often Sensitive to Foods, Beverages
The effects of foods, beverages and supplements on the symptoms of chronic prostatitis/chronic pelvic pain syndrome
Barbara Shorter, Brookville, NY, Lesser Marty, Julia Tai, Manhasset, NY, Dolorita DeJesus, New Hyde Park, NY, Sheetal Kapadia, Brookville, NY, Casey Seideman, Robert M Moldwin, New Hyde Park, NY
This group of investigators did a study on women with interstitial cystitis/painful bladder syndrome (IC/PBS) confirming that patients' symptoms are often sensitive to foods and beverages, often the same ones. Now, the group has looked at men with pelvic pain to see if they, too, are sensitive. In this study, the investigators did not differentiate between pelvic pain in men that might be IC or CP/CPPS, but they plan to do that in their further data analysis. The 87 men in the study answered the NIH CPSI questionnaire and an extensive questionnaire asking whether each of more than 170 items made their symptoms worse, didn't affect them, or made their symptoms better. Forty patients (47 percent) were food sensitive, 28 (31 percent) were not, and 19 (22 percent) didn't know. Of the 15 patients with the worst symptoms, 11 (73 percent) did have their symptoms get worse with certain foods and beverages. Only 2 of the 15 patients (13 percent) with the most mild symptoms indicated sensitivity to foods and beverages. Neither urinary frequency nor pain or pain with urination were related to food sensitivity. The items that made patients worse were similar to those for the women with IC/PBS. The top eight items in order were coffee, tea, alcohol, citrus fruits, spicy foods, hot pepper, tomato products, and carbonated beverages. It may be valuable for men with CP/CPPS who aren't already aware of food and beverage sensitivities to test these items with elimination and add-back diets to see if that eases symptoms.
A Way to Distinguish CP/CPPS from IC?
Novel use of questionnaires to differentiate chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) from interstitial cystitis/painful bladder syndrome (IC/PBS)
Edan Y. Shapiro, Casey A Seideman, Chad Huckabay, Barbara Shorter, Martin L Lesser, Julia Y Tai, Robert M. Moldwin
Scores on standard questionnaires might help differentiate CP/CPPS from IC/PBS. In this study, 85 men who had been diagnosed with either CP/CPPS (56) or IC (29) answered the NIH CPSI and the O'Leary-Sant Interstitial Cystitis Symptom Index questionnaires. The researchers then used a kind of statistical analysis called "principal components analysis" to see if they could predict the diagnosis based on symptom severity, type of symptom, and anatomic location, which were found to be the "principal components." Two of the three components did help show who had which with 84 percent accuracy. Clinicians who see men with pelvic pain symptoms might be able to use the questionnaires to help distinguish between CP/CPPS and IC in a male patient.
CP/CPPS May Affect Eight Percent of Young Men 16 to 19
Prostatitis prevalence and quality of life impact in 16-19 year-old North American males
Dean A Tripp, Kingston, ON, Canada, Stephanie Ross, Jennifer Pikard, Natalie Stechyson, Chris Mullins, Bethesda, MD, J Curtis Nickel, Kingston, ON, Canada
Two hundred sixty-four Canadian youths and young men 16 to 19 years old were recruited from Queens University in Kingston, Ontario, and from the community to answer the NIH CPSI and other health and mental health questionnaires and questions about their prostate-related symptoms. Prostatitis symptoms were considered to be pain or discomfort in perineum and/or with ejaculation and a total pain score of 4 or greater (on a scale of 0 to 10). The researchers found the prevalence of the symptoms in these youths to be about 8 percent. Overall, about a quarter of the young men (67) reported pain scores of 4 or greater, and 7 percent (18) a score of 8 or greater. Pain, urinary symptoms, and poorer quality of life were associated. The survey demonstrates that teens and young men can have prostatitis symptoms, too, and can have serious pain. They may also be at risk of having frank CP/CPPS in adulthood. Teens and young men are understudied in this field and deserve more research attention.
Autoimmune Reaction Provokes Prostatitis-type Pain
Characterization of pain mechanisms in a model of chronic prostatitis/chronic pelvic pain syndrome
Praveen Thumbikat, Charles N Rudick, Anthony J Schaeffer, Chicago, IL
Research hints that an autoimmune process might play a role in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), so these investigators created a model of CP/CPPS with an autoimmune cause to see how that affected pain. They induced autoimmunity to prostate tissue in mice and tested the animals sensitivity to pain, both on the lower abdomen and on the underside of the hind paw to assess heightened sensitivity to pain (hyperalgesia) and pain sensitivity to touch that would not be painful in healthy animals (allodynia). Five days after the mice received the autoimmunity-inducing antigen, they began to show signs of pain that went on for more than 30 days, indicating the mice had developed chronic pain. Injecting the anesthetic lidocaine into the animals' prostates, but not lidocaine in their bladder or colon, eased their pain, suggesting that the pain did originate in the prostate. The prostates themselves showed inflammation, and the degree of inflammation and pelvic pain increased with time. Gabapentin (Neurontin) also eased the animals' pain, suggested that their pain is neuropathic or nerve related. Instillation of a hot pepper compound into the colon did not increase pelvic pain, suggesting that colon irritation does not affect prostate-specific pelvic pain. This method of modeling CP/CPPS might help reveal how pelvic pain is regulated and allow testing of drugs that can block development of pain in CP/CPPS, the researchers suggested.
Prostate Inflammation, BPH Progression Unrelated
Does chronic prostatitis play a role in the outcome of patients with lower urinary tract symptoms due to BPH who undergo transurethral resection of the prostate?
Alberto A Antunes, Rafael F Coelho, Daher C Chade, Jarys B Cabral, Jr, Katia R Leite, Geraldo de C Freire, Miguel Srougi, Sao Paulo, Brazil
Does prostate inflammation-and possibly CP/CPPS-have anything to do with BPH? Some studies have suggested that, finding a correlation between inflammation seen in prostate tissues removed in BPH surgery and worsening of BPH symptoms. These investigators looked at the tissues from prostates of 156 men who underwent BPH surgery at their institution and tracked the patients' progress. The researchers found evidence of inflammation in prostate tissue in 48 (31 percent) of the patients. But patients with and without inflammation had essentially the same level of symptoms, quality of life, and PSA levels three months after surgery.
Basic Research Illuminates Prostate Inflammation Process
Chemoattractant signals provide relationship between nuclear factor-kappaB and intraprostatic inflammation
Eugene V Vykhovanets, Sanjeev Shukla, Gregory T MacLennan, Sanjay Gupta, Cleveland, OH
These researchers previously found that the inflammatory signaling protein IL 1beta activates NF kappaB, a protein that controls transfer of genetic information related to inflammation, in the prostate and prompts the migration of white blood cells into the prostate. Now they have found that this activation leads to an increase in the number of receptors for inflammatory signaling compounds and does indeed trigger white blood cell migration and infiltration into the prostate, suggesting NF kappaB plays a role in prostate inflammation.
CP/CPPS and Prostate Cancer Don't Share Genetic Variation
Do androgen receptor polymorphisms contribute to an increased risk for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and prostate cancer (CaP)?
Ki Hak Song, Seattle, WA, Donald E Riley, Teresa L Gilbert, In Rae Cho, Ilsan, Republic of Korea, Young Seop Chang, Daejeon, Republic of Korea, John N Krieger, Seattle, WA
Because male hormones (androgens) influence prostate growth and because inflammation may be implicated in cancer development, these researchers looked at whether some genetic variation related to androgens might predispose men to chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), prostate cancer, or both. They looked short tandem repeats (STRs) at the androgen receptor gene in 63 CP/CPPS patients, 88 prostate cancer patients, and 72 control men. STRs are short repeats of DNA that help identify variations in a gene. CP/CPPS patients and prostate cancer patients had distinct and typical variations at the androgen receptor that were different from controls but also different from each other. Some change in the androgen receptor, concluded the researchers, might predispose a man to one condition or the other, but the specific variations and the disease mechanisms likely differ.