P.8.b.007 The impact of depression and somatic symptoms on treatment outcomes in patients with chronic prostatitis/chronic pelvic pain syndrome

Abstract

Purpose of the study: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) mainly presents with perineal or suprapubic pain, voiding difficulty and sexual dysfunction and is usually diagnosed in older male patients [1]. The exact pathophysiology underlying the development of CP/CPPS has yet to be elucidated. The symptoms of CP/CPPS are considered to be the result of an interplay between psychiatric factors and dysfunction in the immune, neurological and endocrine systems [2]. A number of recent studies have suggested that depression may be crucial clinical or pathophysiological component in the development and management of CP/CPPS [3]. The aim of this study was to evaluate the impact of depression and somatic symptoms on treatment outcomes in Korean male patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) attending a routine clinical practice. Methods used: This was a 12-week prospective observational study (n = 80). The Korean version of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) to measure the severity of CP/CPPS, the Korean version of the Patient Health Questionnaire-9 (PHQ-9) to assess depression, the Korean version of the Patient Health Questionnaire-15 (PHQ-15) to evaluate somatisation and the Korean version of the EuroQol Questionnaire-5 Dimensions (EQ-5D), specifically the EQ-5D utility index and the EQ-5D visual analogue scale (EQ-5D VAS), to assess quality of life, were utilised and given at baseline and week 12. The primary and secondary end-points in this study were changes in the NIHCPSI total score from baseline to week 12 according to depression and somatisation. For the analysis of improver and responder rates as defined a priori, a Fisher’s exact test was performed. Logistic regression analyses were used to assess predictors for secondary treatment response end-points. ORs with 95% confidence intervals (CIs) were also provided for the improver/responder analyses. A Spearman correlation analysis was performed to evaluate the associations among baseline individual total scores of the NIHCPSI, PHQ-9 and PHQ-15. Summary of results: The change in NIH-CPSI total score was significantly higher in those without depression than in those with depression (p = 0.003), with a magnitude of difference of 2.8. The responder rate (a 4 point decrease in NIH-CPSI total score from baseline) was significantly higher in those without depression (42.9%) than in those with depression (17.2%, p = 0.023). However, significant differences were not observed between the two groups in the other outcome measures or in all study outcomes between subjects with or without somatisation. A logistic regression analysis revealed that the presence or absence of depression may be a principal predictor of response to treatment. Conclusions: These preliminary results indicate that depression may have a negative impact on treatment outcome and is a likely predictor of response to treatment in patients with CP/CPPS. However, additional studies with adequate power and improved design are necessary to further support the present findings.