From the Guidelines
Prostatitis treatment should be guided by the type of prostatitis, with acute bacterial prostatitis typically requiring a 7-14 day course of antibiotics, while chronic bacterial prostatitis may need a longer 4-12 week course, as recommended by the European Association of Urology guidelines 1. When diagnosing prostatitis, it is essential to consider the clinical presentation, laboratory tests, and potentially, urology consultation 1.
- The optimal duration of treatment for acute and chronic bacterial prostatitis is unknown and has not been established by high-quality studies 1.
- For acute bacterial prostatitis, a course of antibiotics like ciprofloxacin or trimethoprim-sulfamethoxazole may be recommended 1.
- Chronic pelvic pain syndrome (non-bacterial prostatitis) treatment focuses on symptom relief with alpha-blockers, anti-inflammatories, and pelvic floor physical therapy. Key considerations in managing prostatitis include:
- Increased fluid intake
- Warm sitz baths
- Avoiding caffeine and alcohol
- Over-the-counter pain relievers It is crucial to address the underlying complicating factors and consider local resistance patterns and specific host factors when selecting antimicrobial therapy 1.
- A urine culture and susceptibility testing should be performed to guide the choice of antibiotic.
- The duration of treatment should be closely related to the treatment of the underlying abnormality, with a minimum of 7-14 days recommended 1.
From the Research
Definition and Causes of Prostatitis
- Prostatitis is a collection of signs and symptoms that occur as a result of inflammation or swelling of the prostate gland 2
- There are many different causes for prostatitis, including infection; occasionally no clear etiology for the inflammation is found 2
- Acute bacterial prostatitis is an acute infection of the prostate gland that causes pelvic pain and urinary tract symptoms 3
Classification of Prostatitis
- Prostatitis is subclassified into: acute bacterial prostatitis, chronic bacterial prostatitis, chronic pelvic pain and asymptomatic inflammatory prostatitis 4
- A working classification system for prostatitis was developed in 1999, but there are few randomized controlled trials that distinguish between the various treatment options 2
Diagnosis of Prostatitis
- Diagnosis is predominantly made based on history and physical examination, but may be aided by urinalysis 3
- Urine cultures should be obtained in all patients who are suspected of having acute bacterial prostatitis to determine the responsible bacteria and its antibiotic sensitivity pattern 3
- A digital rectal examination should be performed after a midstream urine (MSU) sample has been collected for urine dipstick, microscopy and culture 4
Treatment of Prostatitis
- Bacterial prostatitis can be acute or chronic but always requires some degree of antimicrobial therapy 2
- Fluoroquinolones are the preferred agents for treating bacterial causes of prostatitis and have demonstrated efficacy in some cases of chronic prostatitis when an organism has not been identified 2, 3
- Treatment responses to α-blockers appear to be greater with longer durations of therapy in α-blocker-naïve patients 2
- Combination therapy with an α-blocker, an anti-inflammatory, and a muscle relaxant does not appear to offer significant advantages over monotherapy 2
- Pelvic floor physical therapy is a useful second-line therapy, but randomized controlled trials and standardization of technique for CP/CPPS are needed before recommendations can be substantiated 5
Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)
- CP/CPPS is not highly responsive to therapy and is often a waxing and waning illness with symptoms in multiple domains 5
- Many practitioners use antimicrobials as a first-line agent, particularly a fluoroquinolone, such as levofloxacin 5
- Second-line pharmacotherapy includes alpha-blockers, 5-alpha reductase inhibitors and anti-inflammatories for men with urinary symptoms or pain as a predominant symptom domain 5