15 Men with CPPS also have a lower baseline adrenocorticotropic hormone (ACTH) level and blunted ACTH rise in response to stress than men without symptoms.16 In the same study, men with CPPS were found to have more anxiety and perceived stress. There is also a psychosocial context to the presentation of pain.

The same biologic insult in given individuals can result in different pain experiences. This includes how the individual interacts with those around him,17 including spousal support. Thus, there may be common underlying mechanisms that we can #Apoptosis inhibitor keyword# target to treat CPPS as a whole, but we must also consider that, on some level, the pathogenesis and thus treatment of each patient with CPPS will be unique to that patient.18 [Michel Pontari, Inhibitors,research,lifescience,medical MD] Evaluation and Treatment of Men With CP/CPPS Category III prostatitis, also known as CPPS, is a common condition with significant impact on quality of life.19 There is little consensus on appropriate therapy and indeed both patient and urologist frustration is high in dealing Inhibitors,research,lifescience,medical with the disorder. Part of the problem is the heterogeneous nature of CPPS, which is, by definition, a syndrome rather than a disease that can be targeted by one specific therapy. Large, multicenter trials of promising treatments (eg, antibiotics, α-blockers,20 neuroleptic agents) have often shown minimal or no benefit when

compared with placebo; however, the heterogeneous nature of patients in these studies may have prevented a positive result for patients with the appropriate mechanism or etiology of symptoms. This would be analogous to testing an effective migraine drug in patients only defined Inhibitors,research,lifescience,medical as having a headache, which could include patients with a brain tumor, infected tooth, or neck spasm. Currently, we do not have validated biomarkers that would allow us to classify patients in a way that could guide therapy. A scheme of our current best understanding of the pathophysiology

of CPPS is seen in Figure 2. Figure 2 Proposed pathophysiology of chronic prostatitis/chronic pelvic Inhibitors,research,lifescience,medical pain syndrome. In response to this situation, a 6-point clinical phenotyping system has been proposed to classify patients with chronic pelvic pain (CPPS and IC) and to direct appropriate therapy.21 The clinical domains Electron transport chain are urinary symptoms, psychosocial dysfunction, organ-specific findings, infection, neurologic/systemic, and tenderness of muscles. This produces the mnemonic UPOINT. Each domain is clinically defined, is linked to specific mechanisms of symptom production or propagation, and is associated with specific therapy. Symptom severity is then measured using the NIH Chronic Prostatitis Symptom Index (CPSI). The number of positive UPOINT domains correlates with symptom severity and symptom duration.22 These findings have been confirmed by researchers in Sweden,23 Italy, and Germany.24 The ultimate goal was to use UPOINT to improve patient outcomes.