Clinical Phenotyping In CP/CPPS
One of the more frustrating aspects of CP/CPPS to both patients and clinicians is the lack of a uniform and efficacious approach to treating this condition. As described above, different agents, therapies, and interventions have been attempted with varying degrees of success. In certain cases, a compound shows promising results in one trial, only to be discounted in another. The seeming lack of progress in treating this challenging condition is related to the heterogeneous nature of this patient population. It is becoming increasingly clear that CP/CPPS patients differ greatly in presentation and response to treatment. This is likely secondary to the different etiologic mechanisms and variability in a patient’s physical and psychological makeup.
To account for these differences, an emerging concept of clinical phenotyping called UPOINT is taking hold. UPOINT is a six-point clinical classification system that categorizes the phenotype of patients with urologic chronic pelvic pain syndromes (UCPPS)—which includes the chronic prostatitis syndromes—into one or more of six clinically identifiable domains: Urinary, Psychosocial, Organ Specific, Infection, Neurologic/Systemic and Tenderness (muscle).36
Patients can be categorized into one or more of these UPOINT domains and clinicians can develop an individually designed therapeutic plan specifically addressing the clinical phenotypes identified. Most patients will be categorized with more than one UPOINT domain and will require multimodal therapy. Figure 1 (below) outlines this concept.
Clinical prostatitis can be classified into three main categories according to clinical presentation and laboratory findings. Whereas etiology and treatment for the infectious prostatic syndromes (Category I and II) are clearly defined, Category III remains a challenging clinical entity. CP/CPPS patients tend to be heterogeneous in presentation and response to treatment. To that end, a clinical phenotyping system can prove helpful in classifying CP/CPPS patients and finding appropriate therapy.
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