Primary Care Physician Practices in the Diagnosis, Treatment and Management of Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome

EA Calhoun; JQ Clemens; MS Litwin; E Walker-Corkery; T Markossian; JW Kusek; M McNaughton-Collins

Disclosures

Prostate Cancer Prostatic Dis. 2009;12(3):288–295 

In This Article

Abstract and Introduction

Abstract

To describe practice patterns of primary care physicians (PCPs) for the diagnosis, treatment and management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), we surveyed 556 PCPs in Boston, Chicago, and Los Angeles (RR = 52%). Only 62% reported ever seeing a patient like the one described in the vignette. In all, 16% were 'not at all' familiar with CP/CPPS, and 48% were 'not at all' familiar with the National Institutes of Health classification scheme. PCPs reported practice patterns regarding CP/CPPS, which are not supported by evidence. Although studies suggest that CP/CPPS is common, many PCPs reported little or no familiarity, important knowledge deficits and limited experience in managing men with this syndrome.

Introduction

The term 'prostatitis' is used to describe several conditions, including well-defined acute and chronic bacterial infections, poorly defined chronic pelvic pain syndrome and asymptomatic inflammation in the prostate, identified in pathology specimens. To limit the confusion, the National Institutes of Health (NIH) developed a classification system and definitions for the prostatitis syndromes[1] (Table 1).

Although literature reviews provide compelling evidence that histological prostatitis is common[2,3] and symptomatic, clinically evident prostatitis is of greater importance to the patient and the physician. The prevalence of current prostatitis-like symptoms[4,5] or an earlier physician's diagnosis of prostatitis[6] is about 10%.

This study focuses on the predominant type of prostatitis, NIH Category III or chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). CP/CPPS is a common,[7] bothersome condition among men of all ages that impairs health-related quality of life[8,9] and has a substantial economic impact.[10,11] The hallmark of CP/CPPS is the pain in pelvic area.[12] The NIH Chronic Prostatitis Symptom Index (Figure 1) is a reliable, valid, self-administered index that measures symptoms of chronic prostatitis and their impact on daily life.[13]

Figure 1.

The National Institutes of Health (NIH) Chronic Prostatitis Symptom Index.[13]

Although patients with CP/CPPS have traditionally been managed by urologists, many present first to primary care physicians (PCPs) with symptoms suggestive of CP/CPPS. Nonetheless, few studies[14–16] have examined what is known about PCPs' practice patterns regarding CP/CPPS. To ascertain the knowledge, attitudes and beliefs of PCPs regarding the diagnosis and treatment of CP/CPPS, we conducted a multi-center survey of PCPs in 2006.

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