Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT.

OBJECTIVES: Large, controlled trials in chronic pelvic pain syndrome (CPPS) have failed due to patient heterogeneity. To phenotype CPPS patients, we developed the UPOINT system with 6 domains (Urinary, Psychosocial, Organ-Specific, Infection, Neurologic/Systemic and Tenderness). In this study, we treated patients with multimodal therapy based on the UPOINT phenotype and measured response after at least 6 months.

METHODS: Patients with CPPS were offered multimodal therapy based on the UPOINT phenotype (eg, Urinary: alpha blocker or antimuscarinic; Organ-specific: quercetin; Tenderness: physical therapy). One hundred patients agreed to therapy and were reexamined after 26 weeks. Primary endpoint was a minimum 6-point drop in NIH-Chronic Prostatitis Symptom Index (CPSI).

RESULTS: Mean age was 46 years, and median symptom duration was 24 months. A median of 3 UPOINT domains were positive, the most common being Organ-specific (70%), Tenderness (64%), and Urinary (59%). With a median 50-week follow-up, 84% had at least a 6-point fall in CPSI. Number of domains and initial CPSI did not predict response. Mean changes (+/-SD) for 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 P<.0001). No domain predicted outcome; however, quercetin use resulted in a greater CPSI decrease.

CONCLUSIONS: Multimodal therapy using UPOINT leads to significant improvement in symptoms and quality of life. Moreover, a placebo-controlled trial for every therapy combination is not feasible, and results using UPOINT compare favorably with all large trials of monotherapy.