This study is designed to spawn an interactive research network of clinical centers to validate survey and laboratory diagnostic tools for clinical study protocols of men with category III prostatitis. This is a proposal to be chosen as one of the clinical centers carrying out these studies. Temple University is particularly qualified due to our extensive experience with inflammatory disease of the lower urinary tract, especially Interstitial Cystitis (IC), and the combined specific and unique expertise in all aspects of the clinical and laboratory studies. To fulfill the aims of this study we propose the following: 1. Develop and validate a uniform symptom index for chronic prostatitis. 2. Design a standard protocol to assess the NIDDK criteria for the diagnosis of category III prostatitis. This will be accomplished by analysis of results of: epidemiological questionnaire, quality of life survey, four glass urine test, semen biochemical analysis and culture, and videourodynamics of category III prostatitis patients in comparison to symptomatic and asymptomatic controls. 3. Identify occult organisms in perineal prostate biopsies from nonbacterial prostatitis patients by sequence analysis of polymerase chain reaction (PCR) amplified prokaryotic 16S ribosomal deoxy nucleic acid (rDNA). Using the sequence data, design """"""""signature"""""""" primers allowing amplification of 16S rDNA sequences that are either specific for organisms found in individual patients or generally specific for nonbacterial prostatitis patients or classes of patients. Use these signature primers to identify these same prokaryotic 16S rDNA sequences in less invasive clinical specimens from these same patients such as urine, expressed prostatic secretions (EPS) or semen specimens. Correlate the presence or absence of these prokaryotic 16S rDNA sequences in semen, urine, or EPS with semen biochemistry, inflammation index and symptom score in prostatitis patients and controls over time to determine their use as either a diagnostic tool or as a measurement of treatment outcome. 4. Perform the following multicenter treatment protocols: a) empiric antibiotic therapy; b) alpha adrenergic antagonists using videourodynamic finding; c) gabapentin for treatment of the associated pain; and d) correlation of thrice weekly prostatic massage with changes in inflammation and culture results from 4-glass urine and semen specimens using traditional culture techniques and PCR for 16S rDNA.
