What are the treatment options for prostatitis (inflammation of the prostate gland)?

From the Guidelines

Treatment for prostatitis should be guided by the type of prostatitis diagnosed, with acute bacterial prostatitis typically requiring a 2-4 week course of antibiotics, while chronic bacterial prostatitis requires a longer course, and chronic pelvic pain syndrome focusing on symptom management with alpha-blockers, anti-inflammatories, and pelvic floor physical therapy. When considering treatment options for prostatitis, it's essential to differentiate between the various types, including acute bacterial prostatitis (ABP), chronic bacterial prostatitis (CBP), chronic pelvic pain syndrome (CPPS), and asymptomatic inflammatory prostatitis. According to the guidelines for the prevention, diagnosis, and management of urinary tract infections in pediatrics and adults: a wikiguidelines group consensus statement 1, the clinical presentation, diagnostic approach, and treatment for acute and chronic prostatitis are not clearly established due to insufficient quality of evidence. However, based on general medical knowledge and the provided evidence, treatment for ABP may involve antibiotics such as ciprofloxacin or trimethoprim-sulfamethoxazole, while CBP may require a longer course of the same medications. Some key points to consider when treating prostatitis include:

• Increased fluid intake to help flush out bacteria
• Sitz baths to reduce pain and discomfort
• Avoiding alcohol and caffeine, which can irritate the prostate
• Over-the-counter pain relievers to manage symptoms
• Completing the full course of antibiotics, even if symptoms improve early
• Following up with a doctor if symptoms persist or worsen despite treatment, as noted in the example treatment approaches 1. It's crucial to note that the optimal durations of treatment for ABP or CBP are unknown and have not been established by high-quality studies, highlighting the need for additional prospective studies to determine the appropriate duration of treatment for these conditions 1.

From the FDA Drug Label

1. 8 Chronic Bacterial Prostatitis Levofloxacin tablets are indicated for the treatment of chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis [see Clinical Studies (14.6)].
2. 6 Chronic Bacterial Prostatitis Adult patients with a clinical diagnosis of prostatitis and microbiological culture results from urine sample collected after prostatic massage (VB3) or expressed prostatic secretion (EPS) specimens obtained via the Meares-Stamey procedure were enrolled in a multicenter, randomized, double-blind study comparing oral levofloxacin 500 mg, once daily for a total of 28 days to oral ciprofloxacin 500 mg, twice daily for a total of 28 days.

The treatment options for chronic bacterial prostatitis include:

• Levofloxacin 500 mg orally once daily for 28 days 2
• Ciprofloxacin 500 mg orally twice daily for 28 days 2 These treatments are effective against Escherichia coli, Enterococcus faecalis, and methicillin-susceptible Staphylococcus epidermidis.

From the Research

Treatment Options for Prostatitis

The treatment options for prostatitis depend on the cause and type of prostatitis. The following are some of the treatment options:

• Antibiotics: Fluoroquinolones are the preferred agents for treating bacterial causes of prostatitis 3, 4, 5, 6.
• Anti-inflammatory agents: These can be used to relieve pain symptoms 5.
• Alpha-adrenergic receptor antagonists (alpha-blockers): These can be used to relieve urinary symptoms 3, 5.
• Pelvic floor training/biofeedback: This can be used to relieve symptoms, but more research is needed to confirm its effectiveness 5.
• 5alpha-reductase inhibitors, glycosaminoglycans, quercetin, cernilton (CN-009), and saw palmetto: These can be used as third-line agents 5.
• Surgical interventions: These can be offered to treatment-refractory patients, including transurethral microwave therapy to ablate prostatic tissue 5.

Classification of Prostatitis

Prostatitis can be classified into four distinct entities:

• Acute bacterial prostatitis (Category I): This is an acute prostatic infection with a uropathogen, often with systemic symptoms of fever, chills, and hypotension 5.
• Chronic bacterial prostatitis (Category II): This is characterized by recurrent episodes of documented urinary tract infections with the same uropathogen and causes pelvic pain, urinary symptoms, and ejaculatory pain 5.
• Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) (Category III): This is characterized by pelvic pain for more than 3 of the previous 6 months, urinary symptoms, and painful ejaculation, without documented urinary tract infections from uropathogens 5.
• Asymptomatic inflammatory prostatitis (Category IV): This is, by definition, asymptomatic and is often diagnosed incidentally during the evaluation of infertility or prostate cancer 5.

Diagnosis of Prostatitis

The diagnosis of prostatitis relies on separating the different entities from each other. If there is no history of documented urinary tract infections with a urinary tract pathogen, then cultures should be taken when patients are symptomatic 5. Prostatic localization cultures, called the Meares-Stamey 4 glass test, would identify the prostate as the source for a urinary tract infection in chronic bacterial prostatitis 5.

Multimodal Treatment Approach

A phenotyping directed multimodal treatment approach, considering the main symptoms, can be used to treat prostatitis 6. This approach considers evidence-based monotherapeutic studies and may include a combination of antibiotics, anti-inflammatory agents, alpha-blockers, and other therapies. However, the evidence for multimodal combination treatment is still sparse 6.