What is the pharmacological treatment of non-bacterial prostatitis, also known as Chronic Pelvic Pain Syndrome (CPPS) or Chronic Prostatitis (CP)/Chronic Pelvic Pain Syndrome (CPPS)?

From the Guidelines

The pharmacological treatment of non-bacterial prostatitis primarily involves a multimodal approach, including alpha-blockers, anti-inflammatory medications, and other supportive therapies, as there is no single treatment that reliably benefits most or all patients 1. When considering treatment options, it's essential to note that the clinical characteristics of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) are similar to those of interstitial cystitis/bladder pain syndrome (IC/BPS), and treatment approaches may overlap 1.

• Alpha-blockers such as tamsulosin, alfuzosin, or silodosin can be used to relax the smooth muscle of the prostate and bladder neck, improving urinary symptoms.
• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce inflammation and pain.
• For patients with neuropathic pain components, medications such as amitriptyline or pregabalin may be beneficial.
• Muscle relaxants like baclofen can help if pelvic floor muscle spasm is contributing to symptoms. It's crucial to tailor treatment to the individual patient's symptoms and response, as the balance between benefits and risks/burdens can vary significantly 1.
• Treatment duration varies based on symptom response, but typically continues for at least 4-12 weeks with regular reassessment of efficacy and side effects.
• The treatment approach can include established IC/BPS therapies as well as other therapies that are more specific to CP/CPPS, as some men have symptoms that meet criteria for both conditions 1.

From the Research

Pharmacological Treatment of Non-Bacterial Prostatitis

The pharmacological treatment of non-bacterial prostatitis involves various medications, including:

• Alpha-blockers: These medications have been shown to improve symptoms in men with chronic non-bacterial prostatitis 2
• Bioflavonoids: Although bioflavonoids have been reported to improve symptoms, a study found no significant improvement in symptoms compared to alpha-blockers 2
• Anti-inflammatory agents: These medications may be used in combination with alpha-blockers or other medications to reduce inflammation and improve symptoms 3
• Muscle relaxants: These medications may be used in combination with alpha-blockers and anti-inflammatory agents to reduce muscle spasms and improve symptoms 3

Treatment Approaches

Different treatment approaches have been studied, including:

• Monotherapy: Using a single medication, such as an alpha-blocker, to treat symptoms 3
• Combination therapy: Using multiple medications, such as an alpha-blocker, anti-inflammatory agent, and muscle relaxant, to treat symptoms 3
• Stepwise approach: Starting with antibiotics, followed by bioflavonoids, and then alpha-blockers, to reduce symptoms 3

Efficacy of Treatments

The efficacy of these treatments varies, with:

• Alpha-blockers showing significant improvement in symptoms in most men with chronic non-bacterial prostatitis 2
• Bioflavonoids showing no significant improvement in symptoms compared to alpha-blockers 2
• Combination therapy showing no significant advantages over monotherapy 3
• Stepwise approach showing effective reduction in symptoms for up to 1 year in patients with chronic prostatitis 3