Treatment of chronic prostatitis/chronic pelvic pain syndrome.

Author(s): Nickel JC

Affiliation(s): Department of Urology, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada. jcn@post.queensu.ca

Publication date & source: 2008-02, Int J Antimicrob Agents., 31 Suppl 1:S112-6. Epub 2007 Oct 22.

Publication type: Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't

Acceptance of the National Institutes of Health definition of Category III Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) and the development and validation of the Chronic Prostatitis Symptom Index has stimulated significant research into treatment of this condition. Evidence-based suggestions for treatment include the following. (i) Antimicrobials cannot be recommended for men with longstanding, previously treated CP/CPPS. (ii) Alpha-blockers can be recommended as first-line medical therapy, particularly in alpha-blocker-naive men with moderately severe symptoms who have relatively recent onset of symptoms. (iii) Alpha-blockers cannot be recommended in men with longstanding CP/CPPS who have tried and failed alpha-blockers in the past. And (iv) anti-inflammatory therapy, finasteride and pentosan polysulfate are not recommended as primary treatment; however, they may have a useful adjunctive role in a multimodal therapeutic regimen. Early data on herbal therapies, particularly quercetin and cernilton, are intriguing, but larger multicentre, randomised, placebo-controlled trials are required before a high level of evidence recommendation can be made on its use. At this time, surgery (including minimally invasive) is recommended only for definitive indications and not generally for CP/CPPS.