https://doi.org/10.4081/aiua.2023.11300

Chronic prostatitis and related psychological problems. Which came first: The chicken or the egg? A systematic review

Vol. 95 No. 1 (2023)
Published: March 20, 2023
Prostatitis syndromes, Chronic bacterial prostatitis, Chronic pelvic pain, Psychological issues, Depression, Anxiety, Stress, Unhappiness, Cognitive status, Personality
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Authors

Konstantinos Stamatiou
stamatiouk@gmail.com
Department of Urology, Tzaneio Hospital, Pireus, Greece.
Margherita Trinchieri
Psichiatry Unit, ASST Rhodense, G. Salvini Hospital, Garbagnate, Milano, Italy.
Martina Trinchieri
Società Italiana di Psicoanalisi della Relazione SIPRe, Milano, Italy.
Gianpaolo Perletti
Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, Varese, Italy.
Vittorio Magri
Urology Unit, ASST Fatebenefratelli Sacco, Milano, Italy.

Introduction/Aim: A spectrum of psychological problems is commonly found in CP/CPPS patients, though it is not yet clear whether, a priori, psychological dysfunctions are the cause of these pain syndromes, or whether these pain conditions are themselves causing psychological disturbances. In this article we present the current perspective on the impact of psychological problems in chronic prostatitis syndromes and we discuss the implications thereof from a clinical perspective.

Materials and Methods: A database and a manual search were conducted in the MEDLINE database of the National Library of Medicine, EMBASE, and other libraries using the key words “prostatitis syndromes”, “chronic bacterial prostatitis”, “chronic pelvic pain”, in various combinations with the terms “psychological issues”, “depression” “anxiety”, “stress”, “unhappiness”, “cognitive status” and “personality”. Two independent reviewers performed data extraction. We included clinical studies with available information on chronic prostatitis and related psychological conditions. We considered full-text written papers. We excluded reviews and case reports. In order to reduce the risk of bias we analyzed only studies including patients with confirmed CBP or CP/CPPS. Bibliographic information in the selected publications was checked for relevant records not included in the initial search.

Results: Database search allowed us to retrieve 638 studies to which we added to 16 additional studies retrieved by hand-searching. After screening, 34 relevant papers were identified for thorough review. Most studies included patients with chronic pelvic pain and prostatitis-like symptoms, whereas a smaller number of studies included patients with methodologically con- firmed CP/CPPS including studies with a microbiologically confirmed diagnosis of CBP. The psychosocial factors examined in the selected studies include pain, catastrophizing, stress, personality factors and social aspects. Comorbid psychiatric disorders evidenced in the studies included depression, anxiety and trauma-related disorders, somatization disorders, and substance abuse. Some studies investigated the association of pain with each individual psychological disturbance, while others examined the impact of pain in association with the overall quality of life. Sample size, study design and diagnostic measures varied among studies.

Conclusions: Despite limitations and variations in sample size, study design and diagnostic measures in all included studies, a relation between chronic prostatitis and psychological problems is a consistent finding. The existing evidence does not permit to definitely conclude whether psychological problems are a risk factor for CP/CPPS or whether they represent an array of symptoms that are associated with the exacerbation of this disease.

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Citations

Crossref
Scopus
Google Scholar
Europe PMC
Stamatiou K, Samara E, Lacroix RN, et al. One, No One and One Hundred Thousand: Patterns of chronic prostatic inflammation and infection. Exp Ther Med. 2021; 22:966. DOI: https://doi.org/10.3892/etm.2021.10398
Collins MM, Stafford RS, O'Leary MP, Barry MJ. Distinguishing chronic prostatitis and benign prostatic hyperplasia symptoms: results of a national survey of physician visits. Urology. 1999; 53:921-5. DOI: https://doi.org/10.1016/S0090-4295(98)00636-0
Naber KG, Weidner W. Chronic prostatitis-an infectious disease? J Antimicrob Chemother. 2000; 46:157-61 DOI: https://doi.org/10.1093/jac/46.2.157
Page M, McKenzie J, Bossuyt P, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:71. DOI: https://doi.org/10.1136/bmj.n71
Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses; 2013. https://www.ohri.ca/programs/clinical_epidemiolo- gy/oxford.asp
Schaeffer AJ, Landis JR, Knauss JS, et al. Demographic and clinical characteristics of men with chronic prostatitis: the national institutes of health chronic prostatitis cohort study. J Urol. 2002; 168:593-8. 6 DOI: https://doi.org/10.1016/S0022-5347(05)64686-1
Lee SW, Cheah PY, Liong ML, et al. Demographic and clinical characteristics of chronic prostatitis: prospective comparison of the University of Sciences Malaysia Cohort with the United States National Institutes of Health Cohort. J Urol. 2007; 177:153-7. DOI: https://doi.org/10.1016/j.juro.2006.08.098
Tripp DA, Curtis Nickel J, Landis JR, et al. Predictors of quality of life and pain in chronic prostatitis/chronic pelvic pain syndrome: findings from the National Institutes of Health Chronic Prostatitis Cohort Study. BJU Int. 2004; 94:1279-82. DOI: https://doi.org/10.1111/j.1464-410X.2004.05157.x
Naliboff BD, Stephens AJ, Afari N, et al. Widespread Psychosocial Difficulties in Men and Women With Urologic Chronic Pelvic Pain Syndromes: Case-control Findings From the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network. Urology. 2015; 85:1319-27. DOI: https://doi.org/10.1016/j.urology.2015.02.047
de la Rosette JJ, Ruijgrok MC, Jeuken JM, et al. Personality variables involved in chronic prostatitis. Urology. 1993; 42:654-62. DOI: https://doi.org/10.1016/0090-4295(93)90529-J
Anderson RU, Orenberg EK, Morey A, et al. Stress induced hypo- thalamus-pituitary-adrenal axis responses and disturbances in psychological profiles in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol. 2009; 182:2319. DOI: https://doi.org/10.1016/j.juro.2009.07.042
Li HC, Wang ZL, Li HL, et al. Correlation of the prognosis of chronic prostatitis/chronic pelvic pain syndrome with psychological and other factors: a Cox regression analysis. Zhonghua Nan Ke Xue. 2008; 14:723-7.
Egan KJ, Krieger JN. Psychological problems in chronic prostatitis patients with pain. Clin J Pain. 1994; 10:218-26. DOI: https://doi.org/10.1097/00002508-199409000-00008
Aubin S, Berger RE, Heiman JR, Ciol MA. The association between sexual function, pain, and psychological adaptation of men diagnosed with chronic pelvic pain syndrome type III. J Sex Med. 2008; 5:657-67. DOI: https://doi.org/10.1111/j.1743-6109.2007.00736.x
Mehik A, Hellström P, Sarpola A, et al. Fears, sexual disturbances and personality features in men with prostatitis: a population-based cross-sectional study in Finland. BJU Int. 2001; 88:35-8. DOI: https://doi.org/10.1046/j.1464-410x.2001.02259.x
Smith KB, Pukall CF, Tripp DA, Nickel JC. Sexual and relationship functioning in men with chronic prostatitis/chronic pelvic pain syndrome and their partners. Arch Sex Behav. 2007; 36:301-11. DOI: https://doi.org/10.1007/s10508-006-9086-7
Wu LX, Liang CZ, Hao ZY, et al. Epidemiological study of chron- ic prostatitis patients with depression symptoms. Zhonghua Nan Ke Xue. 2006; 12:583.
Ku JH, Jeon YS, Kim ME, et al. Psychological problems in young men with chronic prostatitis-like symptoms. Scand J Urol Nephrol. 2002; 36:296-301. DOI: https://doi.org/10.1080/003655902320248272
Mo MQ, Long LL, Xie WL, et al. Sexual dysfunctions and psychological disorders associated with type IIIa chronic prostatitis: a clinical survey in China. Int Urol Nephrol. 2014; 46:2255-61. DOI: https://doi.org/10.1007/s11255-014-0810-2
Krieger JN, Stephens AJ, Landis JR, et al. MAPP Research Network. Relationship between chronic nonurological associated somatic syndromes and symptom severity in urological chronic pelvic pain syndromes: baseline evaluation of the MAPP study. J Urol. 2015; 193:1254. DOI: https://doi.org/10.1016/j.juro.2014.10.086
Koh JS, Ko HJ, Wang SM, et al. The association of personality trait on treatment outcomes in patients with chronic prostatitis/chronic pelvic pain syndrome: an exploratory study. J Psychosom Res. 2014; 76:127-33. DOI: https://doi.org/10.1016/j.jpsychores.2013.11.004
Ullrich PM, Turner JA, Ciol M, Berger R. Stress is associated with subsequent pain and disability among men with nonbacterial prostatitis/pelvic pain. Ann Behav Med. 2005; 30:112-8. DOI: https://doi.org/10.1207/s15324796abm3002_3
Zeng HQ, Zhang CH, Lu GC. Psychological factors and erectile function in men with refractory chronic prostatitis. Zhonghua Nan Ke Xue. 2008; 14:728-30.
Chung SD, Lin HC. Association between chronic prostatitis/chronic pelvic pain syndrome and anxiety disorder: a pop- ulation-based study. PLoS One. 2013; 8:e64630. DOI: https://doi.org/10.1371/journal.pone.0064630
Collins MM, Meigs JB, Barry MJ, et al. Prevalence and Correlates of Prostatitis in the Health Professionals Follow-Up Study Cohort. J Urol. 2002; 167:1363-66. DOI: https://doi.org/10.1016/S0022-5347(05)65301-3
Mändar R, Korrovits P, Rahu K, et al. Dramatically deteriorated quality of life in men with prostatitis-like symptoms. Andrology. 2020; 8:101-109. DOI: https://doi.org/10.1111/andr.12647
Gao J, Zhang X. A cross-sectional study of symptoms, sexual dysfunction and psychological burden in Chinese men with chronic prostatitis/chronic pelvic pain syndrome. BJU International. 2019; 123:4.
Clemens JQ, Brown SO, Calhoun EA. Mental health diagnoses in patients with interstitial cystitis/painful bladder syndrome and chronic prostatitis/chronic pelvic pain syndrome: a case/control study. J Urol. 2008; 180:1378-82. DOI: https://doi.org/10.1016/j.juro.2008.06.032
Tripp DA, Nickel JC, Shoskes D, Koljuskov A. A 2-year follow-up of quality of life, pain, and psychosocial factors in patients with chronic prostatitis/chronic pelvic pain syndrome and their spouses. World J Urol. 2013; 31:733-9. DOI: https://doi.org/10.1007/s00345-013-1067-6
Zhang GX, Bai WJ, Xu T, Wang XF. A preliminary evaluation of the psychometric profiles in Chinese men with chronic prostatitis/chronic pelvic pain syndrome. Chin Med J (Engl). 2011; 124:514-8.
Drannik GN, Gorpynchenko II, Nurimanov K, et al. Relationships Among Depression and Levels of Cytokines and Testosterone in Patients with Chronic Abacterial Prostatitis. Journal of allergy and clinical immunology 2017; 139:AB209. DOI: https://doi.org/10.1016/j.jaci.2016.12.678
Naliboff BD, Stephens AJ, Lai HH, et al. MAPP Research Network. Clinical and Psychosocial Predictors of Urological Chronic Pelvic Pain Symptom Change in 1 Year: A Prospective Study from the MAPP Research Network. J Urol. 2017; 198:848-857. DOI: https://doi.org/10.1016/j.juro.2017.05.065
Rodríguez LV, Stephens AJ, Clemens JQ, et al. MAPP Research Network. Symptom Duration in Patients With Urologic Chronic Pelvic Pain Syndrome is not Associated With Pain Severity, Nonurologic Syndromes and Mental Health Symptoms: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain Network Study. Urology. 2019; 124:14-22. DOI: https://doi.org/10.1016/j.urology.2018.11.015
Tripp DA, Nickel JC, Wang Y, et al. National Institutes of Health-Chronic Prostatitis Collaborative Research Network (NIH- CPCRN) Study Group. Catastrophizing and pain-contingent rest predict patient adjustment in men with chronic prostatitis/chronic pelvic pain syndrome. J Pain. 2006; 7:697-708. DOI: https://doi.org/10.1016/j.jpain.2006.03.006
Wang X, Cui S, Gong ZY, et al. The effects of chronic prostatitis/chronic pelvic pain syndromes on mental and sexual function. Chinese Journal of Andrology 2013; 27:41-44.
Wallner LP, Clemens JQ, Sarma AV. Prevalence of and risk fac- tors for prostatitis in African American men: the Flint Men’s Health Study. Prostate. 2009; 69:24-32. DOI: https://doi.org/10.1002/pros.20846
Ahn SG, Kim SH, Chung KI, et al. Depression, Anxiety, Stress Perception, and Coping Strategies in Korean Military Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Korean J Urol. 2012; 53:643-648. DOI: https://doi.org/10.4111/kju.2012.53.9.643
McNaughton Collins M, Pontari MA, O'Leary MP, et al. Chronic Prostatitis Collaborative Research Network. Quality of life is impaired in men with chronic prostatitis: the Chronic Prostatitis Collaborative Research Network. J Gen Intern Med. 2001; 16:656- 62. DOI: https://doi.org/10.1111/j.1525-1497.2001.01223.x
Wenninger K, Heiman JR, Rothman I, et al. Sickness impact of chronic nonbacterial prostatitis and its correlates. J Urol. 1996; 155:965-8. DOI: https://doi.org/10.1016/S0022-5347(01)66359-6
Rudick CN, Berry RE, Johnson JR, et al. Uropathogenic Escherichia coli induces chronic pelvic pain. Infect Immun 2011; 79:628-35. DOI: https://doi.org/10.1128/IAI.00910-10
Davis SN, Maykut CA, Binik YM, et al. Tenderness as measured by pressure pain thresholds extends beyond the pelvis in chronic pelvic pain syndrome in men. J Sex Med 2011; 8:232-9. DOI: https://doi.org/10.1111/j.1743-6109.2010.02041.x
Paulis G. Inflammatory mechanisms and oxidative stress in pro- statitis: the possible role of antioxidant therapy. Res Rep Urol. 2018; 10:75-87. DOI: https://doi.org/10.2147/RRU.S170400
Miller HC. Stress prostatitis. Urology 1988; 32:507-510. DOI: https://doi.org/10.1016/S0090-4295(98)90030-9
Magri V, Wagenlehner F, Perletti G, et al. Use of the UPOINT chronic prostatitis/chronic pelvic pain syndrome classification in European patient cohorts: sexual function domain improves correlations. J Urol. 2010; 184:2339-2345. DOI: https://doi.org/10.1016/j.juro.2010.08.025
Shoskes DA, Nickel JC, Rackley RR, Pontari MA. Clinical phenotyping in chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis: a management strategy for urologic chronic pelvic pain syndromes. Prostate Cancer Prostatic Dis. 2009; 12:177-183. DOI: https://doi.org/10.1038/pcan.2008.42
Lian F, Shah A, Mueller B, Welliver C. Psychological perspectives in the patient with chronic orchialgia. Review Transl Androl Urol. 2017; 6(Suppl 1):S14-S19. DOI: https://doi.org/10.21037/tau.2017.03.91

How to Cite

Stamatiou, K., Trinchieri, M., Trinchieri, M., Perletti, G., & Magri, V. (2023). Chronic prostatitis and related psychological problems. Which came first: The chicken or the egg? A systematic review. Archivio Italiano Di Urologia E Andrologia, 95(1). https://doi.org/10.4081/aiua.2023.11300
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