An Epidemiological Study With Prostatitis-Like Symptoms: Result From The Fangchenggang Area Male Health And Examination Survey (Famhes)

Purpose: Chronic prostatitis (CP) is a common cause of complaint in male adult but information on the prevalence of chronic prostatitis is hindered by the confusion regarding its definition, and debate over the relative significance of histopathological, clinical and symptom related definitions. The symptoms are varied and include suprapubic pain, low back pain , orchialgia, dysuria at the tip of the penis and urinary frequency and urgency as well as sex dysfunction,these symptoms are ambiguous, diagnostic methods are controversial, and treatments are long and produce inconsistent results. Thus, although not life threatening, CP has become one of those diseases that is difficult for the patient and for the physician who attempts to help, sometimes without success. Treatment is often unsatisfactory to the patient and physician, and cure is elusive for many. The etiology of the disease is largely obscure. The methods used to estimate the prevalence of CP are inconsistent due to the lack of a definitive diagnostic tool. To date there have been few epidemiological studies on the prevalence of prostatitis-like symptoms in China, especially in southern China. The first objective of the current study was to investigate the prevalence and risk factors for prostatitis-like symptoms and impact of prostatitis-like symptoms on the quality of life among a large male adult population in Guangxi Fangchenggang district; the second objective was to identify the prevalence of ED in Guangxi Fangchenggang district male adult and to determine possible risk factors of ED, the correlation between NIH-CPSI and IIEF-5. The third objective was to investigate the correlation between the amount of WBC in expressed prostatic secretion ( EPS ) and NIH-CPSI in male adult. The identification and characterization of prevalence and these relevant risk factors might accelerate or augment the development of preventive, diagnostic and therapeutic strategies for the treatment of CP.Methods: From 2009.09 to 2009.12, a total of 4303 male residents aged 17-88 years having medical checkup as usual in Fangchenggang district of Guangxi provinces were invited to take part in the survey to complete the questionnaire , which consisted of social-demographics (age, education, marital status,occupation,etc), lifestyle characteristics (smoking, alcohol consumption, and physical activity), health status, and medical history . score of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and International Index of Erectile Function-5.(IIEF-5). expressed prostatic secretion(EPS) evaluation of WBC. Data analysis was conducted using SPSS software.Results:1. 3349 qualified questionnaires were received giving a response rate of 77.8% ,Of all subjects, 197 (5.9 % ) reported prostatitis–like symptoms, most of them are less than 40 years old. The average CPSI-pain score is 6.98±2.52,CPSI-urinary score is 2.88±2.55,CPSI-QOL score is 6.45±2.37, total CPSI score is 16.31±5.86. According to CPSI-pain score, 123(62.44%) reporting mild and 74(37.56%) reporting moderate to severe prostatitis–like symptoms; According to total CPSI score, 79(40.10%)reporting mild, 115(58.38%) reporting moderate and 3(1.52%) reporting severe prostatitis–like symptoms .According to QOL- score, 32(16.4%) reporting mild, 113(57.7%)reporting moderate and 41(20.9%)reporting severe. A statistically significant positive correlation was observed between age and CPSI-pain score (r=0.178,P=0.013<0.05),but a statistically significant correlation was not observed between age and CPSI-urinary score,CPSI-QOL score , total CPSI score(P>0.05)for subjects with prostatitis–like symptoms.the degree of impairment of QOL were correlative to CPSI-pain score (F=4.338, P=0.000<0.05)and total CPSI score(F=15.460, P=0.000<0.05). In a multivariate analysis, there is a correlation between education degree and prostatitis–like symptoms(P<0.05). there is not correlation between age ,hypertension,obesity,fasting blood glucose level,smoking,alcohol consumption,physical activity, marital status and prostatitis–like symptoms( P>0.05).2. 3193 qualified questionnaires were received giving a response rate of 74.2% .Of all subjects, 188 (5.89% ) reported prostatitis–like symptoms and 3005 (94.11%)reported no prostatitis–like symptoms.the prevalence of ED in Guangxi Fangchenggang district male adult is 52.58% (1679/3193) ,with 268(8.39%) reporting severe , 101(3.16%)reporting moderate and 1310(41.03%) reporting mild symptoms of ED. Subjects with prostatitis-like symptoms had higher prevalence of ED compare to those without prostatitis-like symptoms ( 73.40% vs 51.28%, P<0.005). Significant risk factors of ED include age, education degree, marital status and total CPSI score ( P<0.005). There is a negative correlation between NIH-CPSI and IIEF-5 in all subjects , the subjects with prostatitis-like symptoms and those without prostatitis - like symptoms(P<0.01).After adjustment for age, the result is the same. In subjects with prostatitis-like symptoms and those without prostatitis - like symptoms, there is a negative correlation between IIEF-5 and NIH-CPSI pain score, NIH-CPSI urinary score, total NIH-CPSI score and NIH-CPSI pain plus urinary score except NIH-CPSI QOL score(P﹤0.01).3. 1242 were entered into this study. 107 (8.6% ) reported prostatitis–like symptoms and 1135 (91.4%)reported no prostatitis–like symptoms. there were no linear correlation between the amount of WBC in EPS and CPSI scores in all subjects (n=1242)(TheΡvalue were 0.130,0.622,0.651,0.320 respectively. They were all >0.05).In the subjects with prostatitis-like symptoms(n=107), there were also no linear correlation between the amount of WBC in EPS and CPSI scores. (TheΡvalue were 0.192,0.416,0.742,0.278 respectively,They were all >0.05). In the subjects without prostatitis-like symptoms(n=1135), there were also no linear correlation between the amount of WBC in EPS and CPSI scores. (TheΡvalue were 0.254,0.968,0.934,0.607 respectively,They were all >0.05).Conclusion: This is the first epidemiological study with prostatitis-like symptoms among a large male adult population in southern China. The results of this study demonstrated that:1. Prostatitis-like symptoms are common among male adult in Guangxi Fangchenggang district, similar to other citys in China . prostatitis–like symptoms exerted a significant impact on QOL, the degree of impairment of QOL were correlative to CPSI-pain score and total CPSI score. Education degree may be one of a risk factor for prostatitis–like symptoms. We should major in improving the education degree and QOL of sbujects for CP prevention and treatment.2. ED is very common among male adult in Guangxi Fangchenggang district, especially for subjects with prostatitis-like symptoms. Age, education degree, marital status and total CPSI score may be risk factors for ED. Whether in all subjects or in the subjects with prostatitis-like symptoms ,there is a negative correlation between IIEF-5 and NIH-CPSI.The severity of Chronic prostatitis symptoms can predict the risk of ED.3. Whether in all subjects or in the subjects with prostatitis-like symptoms ,there were no linear correlation between the amount of WBC in EPS and the severity symptom.So the amount of WBC in EPS was unsuitable to apply as a the only index of diagnosising , evaluating and observing curative effect. The index should be taken into account in a variety of factors. The improvement of clinical symptom and QOL was the key.