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, with antibiotics being the primary treatment for bacterial infections, and symptom relief measures for non-bacterial cases, despite the lack of high-quality evidence to support specific treatment durations 1. When considering treatment options, it's essential to differentiate between acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP), as well as non-bacterial prostatitis.

• For ABP, fluoroquinolones like ciprofloxacin or levofloxacin are commonly prescribed, although the optimal treatment duration is unknown 1.
• For CBP, longer antibiotic courses are often required, but again, the exact duration has not been established by high-quality studies 1.
• For non-bacterial prostatitis, treatment focuses on symptom relief, with options including alpha-blockers like tamsulosin, anti-inflammatory medications like ibuprofen, and lifestyle modifications such as increased fluid intake and avoiding irritants like caffeine and alcohol. Key considerations in treatment include:
• The clinical presentation and laboratory tests for diagnosis, particularly for ABP 1
• The comparison of bacteria levels in prostatic fluid and urinary cultures for CBP diagnosis, although definitive testing is debated 1
• The limited utility of testing for prostate-specific antigen (PSA) and maneuvers to express prostatic fluid, such as prostate massage 1 Given the insufficient quality of evidence to enable clear recommendations, treatment should be individualized, and patients should be closely monitored for response to therapy and potential side effects, with urology consultation considered as needed 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 Key pathogens that can be treated with these options include:
• Escherichia coli
• Enterococcus faecalis
• Methicillin-susceptible Staphylococcus epidermidis

From the Research

Treatment Options for Prostatitis

The treatment options for prostatitis depend on the cause and severity of the condition.

• For bacterial prostatitis, antimicrobial therapy is the primary treatment option 3, 4, 5, 6.
• Fluoroquinolones are the preferred agents for treating bacterial causes of prostatitis due to their ability to penetrate the prostate tissue 3, 4, 5.
• For chronic prostatitis, treatment may involve a combination of antibiotics, alpha-blockers, and anti-inflammatory agents 3, 4.
• Alpha-blockers can help relieve urinary symptoms, while anti-inflammatory agents can help reduce pain and inflammation 3, 4.
• In some cases, phytotherapy or alternative therapies such as acupuncture or electromagnetic therapy may be used to treat chronic prostatitis 4.
• For patients with chronic pelvic pain syndrome (CPPS), treatment may involve a multimodal approach including antibiotics, alpha-blockers, and anti-inflammatory agents, as well as lifestyle modifications such as diet and exercise 4.

Pharmacologic Treatment

• Fluoroquinolones, such as levofloxacin, have been shown to be effective in treating chronic bacterial prostatitis 3.
• Alpha-blockers, such as tamsulosin, terazosin, and alfuzosin, can help relieve urinary symptoms in patients with CPPS 3.
• Anti-inflammatory agents, such as non-steroidal anti-inflammatory drugs (NSAIDs), can help reduce pain and inflammation in patients with prostatitis 4.
• Macrolides, such as azithromycin, may be effective in treating Chlamydial prostatitis 4.

Non-Pharmacologic Treatment

• Lifestyle modifications, such as diet and exercise, may help alleviate symptoms of prostatitis 4.
• Phytotherapy, such as quercetin and pollen extract, may be used to treat chronic prostatitis 4.
• Alternative therapies, such as acupuncture and electromagnetic therapy, may be used to treat chronic prostatitis 4.