ACUTE STRESS IN MEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Hypotheses: 1. Risk factors that mediate the onset of chronic pelvic pain syndrome (CPPS) may be identified by comparing psychosocial variables (stress, affect and personality traits) in subjects with CPPS vs. normal controls. 2. Measurement of free cortisol responses to awakening, as an index of hypothalamic-pituitary adrenal (HPA) axis activity/dysregulation, will be changed as a result of experimentally-induced acute social stress. 3. Stress will induce alterations in immune cell function and cytokine secretion associated with the HPA axis and cortisol response. Goals: Stress triggers a cascade of pathophysiological events that involve disruption of the HPA axis which may be linked to the development and persistence of CPPS. Chronic activation of the physiologic stress response induces putative glucocorticoid resistance and altered immunity, release of proinflammatory cytokines and prostaglandins that may contribute to pelvic tension myalgia, and ultimately to cycling psychological distress. No systematic evaluation of the physiological role of acute and chronic stress in pathogenesis of CPPS in men has been undertaken, however, clinicians have anecdotally observed that stress exacerbates symptoms. Certain inherent personality traits (genetic and developmental factors) modulate reactivity to stress. We have strong preliminary evidence from our CPPS patients indicating that physiotherapeutic myofascial release and cognitive behavioral therapy, proven methods to relieve stress, have provided both curative and partial relief of pain in some CPPS sufferers. Knowledge of how stress-induced neurobiochemical changes evoke pelvic pain in men may lead to development of new and innovative approaches for the prevention and treatment of CPPS. Experimental Design: We intend to enroll 24 to 32 subjects per yr at Stanford to participate in this stress analysis ancillary study. The cohort of normal control subjects will be recruited from the Stanford community area and age-matched with the subjects in this study with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). The stress and psychological surveys, saliva collection tubes for cortisol and instructions will be provided on the day of baseline visit. Participation in the Trier Acute Stress Test with collection of salivary cortisol and blood samples will occur two to three weeks later. Specific Aim 1: Characterization and investigation of the relationships of psychosocial variables (stress, affect, and personality traits) in subjects with CPPS versus controls. Specific Aim 2: Measurement of salivary cortisol response. Samples will be obtained upon awakening and during a normal day in the home/work setting. Subjects then undergo the experimental acute stress test and we collect salivary cortisol samples and blood samples in the GCRC at Stanford.