A System for Choosing Treatment

[Arnon Krongrad, MD]

A scientific paper on this approach has been published (click here). Using an endpoint of a 6-point drop in the CPSI with the treatments specified by the algorithm, there was failure in 16% of the cases. The overall drop in average CPSI score was from 25 to 13. This paper has been reviewed in a bit more detail on the Prostatitis Blog. In the folllowing video, the algorithm is further reviewed.

Pelvic pain disorders in men: Part II

[James]

While I know and respect the Dr. in the video - I disagree with a 6 point drop being anything but a numerical blip.
Relief is defined by relief - not by a 6 point drop.

I know - my statement is not scientific - and we must use numbers - so that we can then use statistics - and then make the statistics say what we want them to say.....

But really - what sufferer would call a 6 point drop relief - that is not equal to 2 advil for most of us.......

[Arnon Krongrad, MD]

James,

This issue has surfaced before. It's central to the distinction between what patients want and what science discovers.

It's not known to me where the 6-point drop originates as a measure of clinical trial success, but it's pretty commonly used. In any event, it's a greater change than seen with placebo in other studies (3 points) but less than the change seen with global therapeutic massage (not prostate massage; 7.6 points).

As one evaluates a proposed treatments, it becomes important to:

1) Scratch the surface beyond "X percent had treatment success" and look at what "success" actually means
2) Define for oneself what a worthwhile treatment goal would be

One of the issues coming up in the LRP trial, and you touch on it here, is that standardized testing, as with CPSI, is in fact not the whole story. Just watch the videos to see that patients having surgery are reporting resolution of fatigue, general aches, social isolation, and even cognitive dysfunction ("the fog has lifted"). The CPSI does not even begin to capture those dimensions of the illness. It's why the narratives become so important for now. And why this network is also.

[Nik]

I believe the CPSI needs a SERIOUS overhaul. Its far too organ specific.