Chronic prostatitis can cause pain and urinary symptoms, and usually occurs without positive bacterial cultures from prostatic secretions (known as chronic abacterial prostatitis or chronic pelvic pain syndrome [CP/CPPS]). Bacterial infection can result from urinary tract instrumentation, but the cause and natural history of CP/CPPS are unknown.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for chronic bacterial prostatitis? What are the effects of treatments for chronic abacterial prostatitis/chronic pelvic pain syndrome? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 33 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: 5 alpha-reductase inhibitors, allopurinol, alpha-blockers, biofeedback, local injections of antimicrobial drugs, mepartricin, non-steroidal anti-inflammatory drugs (NSAIDs), oral antimicrobial drugs, pentosan polysulfate, prostatic massage, quercetin, radical prostatectomy, sitz baths, transurethral microwave thermotherapy, and transurethral resection.
Chronic prostatitis can cause pain and urinary symptoms, and usually occurs without positive bacterial cultures from prostatic secretions (known as chronic abacterial prostatitis or chronic pelvic pain syndrome [CP/CPPS]).
Bacterial infection can result from urinary tract instrumentation, but the cause and natural history of CP/CPPS are unknown.
Chronic bacterial prostatitis has identifiable virulent micro-organisms in prostatic secretions.
Oral antimicrobial drugs are likely to be beneficial, although trials comparing them with placebo or no treatment have not been found.Clinical success rates with oral antimicrobials have reached about 70% to 90% at 6 months in studies comparing different regimens.Trimethoprim–sulfamethoxazole (co-trimoxazole) and quinolones are most commonly used and seem the most beneficial.
Alpha-blockers may reduce symptoms and reduce recurrence of chronic prostatitis if added to antimicrobial treatment. We don't know whether local injections of antimicrobial drugs, NSAIDs, transurethral resection, or radical prostatectomy improve symptoms compared with no treatment.
Effective treatment regimens for CP/CPPS remain to be defined, and strategies are based on symptomatic control and anxiety relief.
We don't know how effective alpha-blockers are in people with abacterial prostatitis.
Oral antimicrobial drugs have not been shown to improve symptoms.We don't know whether 5 alpha-reductase inhibitors, NSAIDs, pentosan polysulfate, allopurinol, transurethral microwave thermotherapy, prostatic massage, sitz baths, biofeedback, mepartricin, or quercetin reduce symptoms in men with CP/CPPS.