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 forms, despite the lack of high-quality evidence to support specific treatment durations 1. When managing prostatitis, it's crucial to differentiate between acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP), as well as non-bacterial forms like chronic pelvic pain syndrome.

• For ABP, fluoroquinolones such as ciprofloxacin or levofloxacin are commonly prescribed, although the optimal treatment duration remains undefined due to insufficient evidence 1.
• CBP may require longer courses of antibiotics, but again, the exact duration is not established by high-quality studies 1.
• Non-bacterial prostatitis, or chronic pelvic pain syndrome, is managed with a focus on symptom relief, using medications like alpha-blockers (e.g., tamsulosin), anti-inflammatory drugs (e.g., ibuprofen), and muscle relaxants. Key considerations in treating prostatitis include:
• Completing the full antibiotic course to prevent recurrence and antibiotic resistance, even in the absence of clear guidelines on treatment duration 1.
• Utilizing supportive measures such as warm sitz baths, increased fluid intake, and avoidance of irritants like caffeine and alcohol.
• Considering prostate massage as a potential symptom reliever, although its clinical utility is debated 1.
• Recognizing the limited utility of testing for prostate-specific antigen (PSA) and the debated value of definitive testing for CBP diagnosis 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.

Treatment for prostatitis:

• Levofloxacin tablets are indicated for the treatment of chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis.
• The recommended treatment is oral levofloxacin 500 mg, once daily for a total of 28 days 2 2.
• Clinical success rates in microbiologically evaluable population 5 to 18 days after completion of therapy were 75% for levofloxacin-treated patients 2.

From the Research

Treatment Options for Prostatitis

• Antimicrobial therapy is the primary treatment for bacterial prostatitis, with fluoroquinolones being the preferred agents due to their ability to penetrate the prostate tissue 3, 4, 5.
• For chronic bacterial prostatitis, treatment with fluoroquinolones for 2-4 weeks has been shown to cure about 70% of men 4.
• In cases of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), treatment options include alpha-blockers, anti-inflammatory agents, and bioflavonoids, with a stepwise approach to therapy involving antibiotics followed by bioflavonoids and then alpha-blockers appearing to be effective in reducing symptoms 3.
• Phytotherapy, including quercetin, pollen extract, and extract of Serenoa repens, has also been shown to have a positive effect on symptoms and quality of life in patients with CP/CPPS 4.
• For patients with treatment-refractory chronic prostatitis, surgical interventions such as transurethral microwave therapy may be considered 6.

Pharmacologic Considerations

• Fluoroquinolones have been shown to be effective in treating bacterial prostatitis, with levofloxacin demonstrating clinical success rates of 92% at 5-12 days, 77.4% at 1 month, 66.0% at 3 months, and 61.9% at 6 months after treatment 3.
• Alpha-blockers, such as tamsulosin, terazosin, and alfuzosin, have been shown to reduce symptoms in patients with CP/CPPS, with longer durations of therapy resulting in greater treatment responses 3.
• Anti-inflammatory agents, such as non-steroidal anti-inflammatory drugs (NSAIDs), may also be used to reduce pain and inflammation in patients with prostatitis 4, 6.

Multidisciplinary Approach

• A multidisciplinary approach to prostatitis, including urology, infectious disease, and pain management specialists, may be necessary to effectively manage the condition 4.
• The UPOINT system, which identifies groups of clinicians with homogeneous clinical presentation, may be used to recognize phenotypes and guide treatment decisions 4.
• Lifestyle modifications, such as dietary changes and stress management, may also be beneficial in managing prostatitis symptoms 4.