From the Guidelines
Chronic Prostatitis typically presents with persistent symptoms or recurrent UTIs, and treatment options are limited by a lack of high-quality evidence.
Symptoms
- The clinical presentation of Chronic Prostatitis (CP) often involves more persistent symptoms or recurrent Urinary Tract Infections (UTIs) 1
- Acute Bacterial Prostatitis (ABP) often presents abruptly with febrile UTI symptoms, whereas Chronic Bacterial Prostatitis (CBP) involves a broader spectrum of symptoms 1
Treatment Options
- The optimal durations of treatment for ABP or CBP are unknown and have not been established by high-quality studies 1
- Diagnosis for CBP involves comparing bacteria levels in prostatic fluid and urinary cultures, yet definitive testing is debated, and urology consultation may be needed 1
- Enterobacterales are the primary pathogens in ABP, and CBP encompasses a broader spectrum of species, which may include atypical microorganisms 1
- Treatment should be guided by the classification proposed by the National Institute of Diabetes, Digestive, and Kidney Diseases, which distinguishes bacterial prostatitis from chronic pelvic pain syndrome 1
From the Research
Symptoms of Chronic Prostatitis
- Chronic prostatitis is characterized by a wide range of clinical manifestations, including urogenital pain, lower urinary tract symptoms (LUTS), psychological issues, and sexual dysfunction 2
- The condition can present with pelvic pain, lower urinary tract symptoms, and prostatic pain lasting at least three months without consistent culture results 3
- Symptoms may cluster into a group with primarily pelvic or localized disease, and a group with more systemic symptoms 4
Treatment Options for Chronic Prostatitis
- Treatment options for chronic bacterial prostatitis (CBP) include a prolonged course of an antibiotic that adequately penetrates the prostate, alpha blockers, and nonopioid analgesics 3
- For chronic nonbacterial prostatitis (CNP)/chronic pelvic pain syndrome (CPPS), weak evidence supports the use of alpha blockers, pain medications, and a four- to six-week course of antibiotics 3
- Other treatment options include pelvic floor physical therapy, phytotherapy, pain management techniques, and psychological intervention 3, 5, 4
- A multidisciplinary team (MDT) approach, including urologists, pain specialists, nurse specialists, specialist physiotherapists, general practitioners, cognitive behavioural therapists/psychologists, and sexual health specialists, is recommended 2
- Treatment is best done using multiple simultaneous therapies aimed at the different aspects of the condition 4
Classification and Diagnosis
- The National Institutes of Health divides prostatitis into four syndromes: acute bacterial prostatitis, chronic bacterial prostatitis (CBP), chronic nonbacterial prostatitis (CNP)/chronic pelvic pain syndrome (CPPS), and asymptomatic inflammatory prostatitis 3
- The UPOINT (urinary, psychosocial, organ-specific, infection, neurologic/systemic, tenderness) approach summarizes the various factors that may contribute to presentation and can guide treatment 3
- Appropriate evaluation, testing, and differential diagnosis are crucial to effective management of chronic prostatitis 5