Skip to main content

Advertisement

SpringerLink
Log in

Chronic Prostatitis/Chronic Pelvic Pain Syndrome: a Literature Review of NIH III Prostatitis

  • Inflammatory/Infectious Bladder Disorders (MS Mourad, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review seeks to review up to date literature surrounding the chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) to provide an overview of the subject. The review includes current understandings of the syndrome, the use of UPOINT, novel treatment strategies and future targets for management.

Recent Findings

Using the US National Institute of Health Chronic Prostatitis Symptom Index helps clinicians to monitor prostatitis symptoms, whilst using UPOINT as guidance of therapies based on patient phenotype(s) has advanced our ability to treat patients suffering with CP/CPPS. Furthermore, novel treatments look beyond traditional prostatic targets to treat CP/CPPS.

Summary

Whilst the use of UPOINT has opened up new targets for the treatment of CP/CPPS, more work is needed to both improve the quality of trials assessing them, as well as further elucidate the underlying pathophysiology behind this troublesome syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Sandhu J, Tu HYV. Recent advances in managing chronic prostatitis/chronic pelvic pain syndrome. F1000Res. 2017;6:F1000 Faculty Rev-1747.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Nickel JC, Shoskes DA. Phenotypic approach to the management of the chronic prostatitis/chronic pelvic pain syndrome. BJUI. 2010;106:1252–63.

    Article  Google Scholar 

  3. Nickel JC. The three as of chronic prostatitis therapy: antibiotics, α-blockers and anti-inflammatories. What is the evidence? BJUI. 2004;94:1230–3.

    Article  Google Scholar 

  4. Thankkinstian A, Attia J, Anothaisintawee T, Nickel JC. α-blockers, antibiotics and anti-inflammatories have a role in the management of chronic prostatitis/chronic pelvic pain syndrome. BJUI. 2012;110:1014–22.

    Article  CAS  Google Scholar 

  5. Krieger JN, Lee SW, Jeon J, Cheah PY, Liong ML, Riley DE. Epidemiology of prostatitis. Int J Antimicrob Agents. 2007;31(Suppl1):S85–90.

    PubMed  PubMed Central  Google Scholar 

  6. •• Anderson RU, Wise D, Nathanson BH. Chronic prostatitis and/or chronic pelvic pain as a psychoneuromuscular disorder - a meta-analysis. Urology. 2018;120:23–9 Current evidence showing benefit of treating CP/CPPS as psychoneuromuscular disorder.

    Article  PubMed  Google Scholar 

  7. DeWitt-Foy ME, Nickel JC, Shoskes DA. Management of chronic prostatitis/chronic pelvic pain syndrome. Eur Urol Focus. 2019;5(1):2–4.

  8. Shoskes DA, Nickel JC, Dolinga R, Prots D. Clinical phenotyping of patients with chronic prostatitis/chronic pelvic pain syndrome and correlation with symptom severity. Urology. 2009;73(3):538–42.

    Article  PubMed  Google Scholar 

  9. Rees J, Abrahams M, Doble A, Cooper A. Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJUI. 2015;116:509–25.

    Article  CAS  Google Scholar 

  10. Lipsky BA, Byren I, Hoey CT. Treatment of bacterial prostatitis. CID. 2010;50:1641–52.

    Article  Google Scholar 

  11. Tsivkovskii R, Sabet M, Tarazi Z, Griffith DC, Lomovskaya O, Dudley MN. Levofloxacin reduces inflammatory cytokine levels in human bronchial epithelia cells: implications for aerosol MP-376 (levofloxacin solution for inhalation) treatment of chronic pulmonary infections. FEMS Immunol Med Microbiol. 2011;61(2):141–6.

    Article  CAS  PubMed  Google Scholar 

  12. Ogino H, Fujii M, Ono M, Maezawa K, Kizu J, Hori S. In vivo and in vitro effects of fluoroquinolones on lipopolysaccharide-induced pro-inflammatory cytokine production. J Infect Chemother. 2009;15(3):168–73.

    Article  CAS  PubMed  Google Scholar 

  13. Roehrborn CG. Alfuzosin: overview of pharmacokinetics, safety, and efficacy of a clinically uroselective α-blocker. Urology. 2001;58(6):55–63.

    Article  CAS  PubMed  Google Scholar 

  14. Kirby RS, Lowe D, Bultitude MI, Shuttleworth KE. Intraprostatic urinary reflux: an etiological factor in abacterial prostatitis. Br J Urol. 1982;54:729–31.

    Article  CAS  PubMed  Google Scholar 

  15. Duclos AJ, Lee CT, Shoskes DA. Current treatment options in the management of chronic prostatitis. Ther Clin Risk Manag. 2007;3(4):507–12.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Hochreiter WW. Anti-inflammatory therapies for chronic prostatitis. Eur Urol Suppl. 2003;2(2):30–3.

    Article  CAS  Google Scholar 

  17. Anothaisintawee T, Attia J, Nickel CJ, Thammakraisorn S, et al. Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis. JAMA. 2011;305(1):78–86.

    Article  CAS  PubMed  Google Scholar 

  18. Wagenlehner FM, Schneider H, Ludwig M, Schnitker J, et al. A pollen extract (Cernilton) in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome: a multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study. Eur Urol. 2009;56(3):544–51.

    Article  PubMed  Google Scholar 

  19. Nickel JC, Shoskes DA, Wagenlehner FM. Management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): the studies, the evidence, and the impact. World J Urol. 2013;31(4):747–53.

    Article  PubMed  Google Scholar 

  20. Bates SM, Hill VA, Anderson JB, Chapple CR, et al. A prospective, randomized, double-blind trial to evaluate the role of a short reducing course of oral corticosteroid therapy in the treatment of chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 2007;99(2):355–9.

  21. Kessler TM, Mordasini L, Weisstanner C, Jüni P, da Costa BR, Wiest R, et al. Sono-electro-magnetic therapy for treating chronic pelvic pain syndrome in men: a randomized, placebo-controlled, double-blind trial. PLoS One. 2014;9(12):e113368.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Ateya A, Fayez A, Hani R, Zohdy W, Gabbar MA, Shamloul R. Evaluation of prostatic massage in treatment of chronic prostatitis. Urology. 2006;67(4):674–8.

    Article  PubMed  Google Scholar 

  23. • Magri V, Wagenlehner F, Perletti G, Schneider S. Use of the UPOINT chronic prostatitis/chronic pelvic pain syndrome classification in European patient cohorts: sexual function domain improves correlations. J Urol. 2010;184(6):2339–45 Creation of sexual function domain further helps corrolate UPOINT to clinical phenotyping.

    Article  PubMed  Google Scholar 

  24. Shoskes DA, Nickel JC, Kattan MW. Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT. Urology. 2010;75(6):1249–53.

    Article  PubMed  Google Scholar 

  25. Guan X, Zhao C, Ou ZY, Wang L, et al. Use of the UPOINT phenotype system in treating Chinese patients with chronic prostatitis/chronic pelvic pain syndrome: a prospective study. Asian J Androl. 2015;17(1):120–3.

    Article  PubMed  Google Scholar 

  26. Qin Z, Wu J, Zhou J, Liu Z. Systematic review of acupuncture for chronic prostatitis/chronic pelvic pain syndrome. Medicine (Baltimore). 2016;95(11):e3095.

    Article  Google Scholar 

  27. • Liu BP, Wang YT, Chen SD. Effect of acupuncture on clinical symptoms and laboratory indicators for chronic prostatitis/chronic pelvic pain syndrome: a systematic review and meta-analysis. Int Urol Nephrol. 2016;48(12):1977–91 Meta analysis suggesting the benefits of use of acupuncture in CP/CPPS.

    Article  PubMed  Google Scholar 

  28. Zhang R, Chomistek AK, Dimitrakoff JD, Giovannucci EL, et al. Physical activity and chronic prostatitis/chronic pelvic pain syndrome. Med Sci Sports Exerc. 2015;47(4):757–64.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Giubilei G, Mondaini N, Minervini A, Saieva C, Lapini A, Serni S, et al. Physical activity of men with chronic prostatitis/chronic pelvic pain syndrome not satisfied with conventional treatments--could it represent a valid option? The physical activity and male pelvic pain trial: a double-blind, randomized study. J Urol. 2007;177(1):159–65.

    Article  PubMed  Google Scholar 

  30. Petersen AM, Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol. 2005;98(4):1154–62.

    Article  CAS  PubMed  Google Scholar 

  31. Nickel JC, Tripp DA, Chuai S, Litwin, et al. Psychosocial variables affect the quality of life of men with chronic prostatitis/chronic pelvic pain syndrome. BJUI. 2007;101:59–64.

    Google Scholar 

  32. Tripp DA, Nickel CJ, Wang Y, Litwin MS, et al. Catastrophizing and pain-contingent rest predict patient adjustment in men with chronic prostatitis/chronic pelvic pain syndrome. J Pain. 2006;7(10):697–708.

    Article  PubMed  Google Scholar 

  33. Brünahl CA, Klotz SGR, Dybowski C, Riegel B. Combined cognitive-behavioural and physiotherapeutic therapy for patients with chronic pelvic pain syndrome (COMBI-CPPS): study protocol for a controlled feasibility trial. Trials. 2018;19(1):20.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Magistro G, Wagenlehner FM, Grabe M, Weidner W, et al. Contemporary management of chronic prostatitis/chronic pelvic pain syndrome. Eur Urol. 2016;69(2):286–97.

    Article  PubMed  Google Scholar 

  35. Nickel CJ, Shoskes DA, Roehrborn CG, Moyad M. Nutraceuticals in prostate disease: the urologist’s role. Rev Urol. 2008;10(3):192–206.

    Google Scholar 

  36. Shoskes DA, Zeitlin SI, Shahed A, Rajfer J. Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. Urology. 1999;54(6):960–3.

    Article  CAS  PubMed  Google Scholar 

  37. Shahed AR, Shoskes DA. Oxidative stress in prostatic fluid of patients with chronic pelvic pain syndrome: correlation with gram positive bacterial growth and treatment response. J Androl. 2000;21(5):669–75.

    CAS  PubMed  Google Scholar 

  38. • Morgia G, Russo GI, Urzi D, Privitera S, et al. A phase II, randomized, single-blinded, placebo-controlled clinical trial on the efficacy of Curcumina and Calendula suppositories for the treatment of patients with chronic prostatitis/chronic pelvic pain syndrome type III. Arch Ital Urol Androl. 2017;89(2):110–3 RCT showing benefit of using phytotherapies for CP/CPPS.

    Article  CAS  PubMed  Google Scholar 

  39. Jin C, Chen Z, Zhang J. Meta-analysis of the efficacy of Ningmitai capsule on the treatment of chronic prostatitis in China. Medicine(Baltimore). 2018;97(33):e11840.

    Google Scholar 

  40. Zhang K, Zeng X, Chen Y, Zhao R, Wang H, Wu J. Therapeutic effects of Qian-Yu decoction and its three extracts on carrageenan-induced chronic prostatitis/chronic pelvic pain syndrome in rats. BMC Complement Altern Med. 2017;17(1):75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Barnes RW, Hadley HL, O’Donoghue EP. Transurethral resection of the prostate for chronic bacterial prostatitis. Prostate. 1982;3(3):215–9.

    Article  CAS  PubMed  Google Scholar 

  42. •• Chopra S, Satkunasivam R, Aron M. Feasibility of robotic radical prostatectomy for medication refractory chronic prostatitis/chronic pelvic pain syndrome: initial results. Indian J Urol. 2016;32(3):238–41 Case report on the use of surgery for CP/CPPS in appropriately selected patients.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Frazier HA, Spalding TH, Paulson DF. Total prostatoseminal vesiculectomy in the treatment of debilitating perineal pain. J Urol. 1992;148(2):409–11.

    Article  CAS  PubMed  Google Scholar 

  44. Krongrad A, Shenghan L. Laparoscopic prostatectomy for severely symptomatic treatment-refractory chronic prostatitis: preliminary observations from an ongoing phase II clinical trial. UroToday Int J. 2011;4(2):1944–5784.

    Article  Google Scholar 

  45. Franco JVA, Turk T, Xiao YT, Iakhno S, et al. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review. Cochrane Database Syst Rev. 2018;1:CD01255.

    Google Scholar 

  46. Abdel-Meguid TA, Mosli HA, Farsi H, Alsayyad A, Tayib A, Sait M, et al. Treatment of refractory category III nonbacterial chronic prostatitis/chronic pelvic pain syndrome with intraprostatic injection of onabotulinumtoxin A: a prospective controlled study. Can J Urol. 2018;25(2):9273–80.

    PubMed  Google Scholar 

  47. Hong H, Kim CS, Maeng S. Effects of pumpkin seed oil and saw palmetto oil in Korean men with symptomatic benign prostatic hyperplasia. Nutr Res Pract. 2009;3(4):323–7.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Tantawy SA, Elgohary HM, Kamel DM. Trans-perineal pumpkin seed oil phonophoresis as an adjunctive treatment for chronic nonbacterial prostatitis. Res Rep Urol. 2018;10:95–101.

    PubMed  PubMed Central  Google Scholar 

  49. Hajighorbani M, Ahmadi-Hamedani M, Shahab E, Hayati F, et al. Evaluation of the protective effect of pentoxifylline on carrageenan-induced chronic non-bacterial prostatitis in rats. Inflammopharmacology. 2017;25(3):343–50.

    Article  CAS  PubMed  Google Scholar 

  50. Prins GS, Korach KS. The role of estrogens and estrogen receptors in normal prostate growth and disease. Steroids. 2008;73(3):233–44.

    Article  CAS  PubMed  Google Scholar 

  51. Tiwari-Woodruff S, Voskuhl RR. Neuroprotective and anti-inflammatory effects of estrogen receptor ligand treatment in mice. J Neurol Sci. 2009;286(1–2):81–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Acar D, Cayan S, Aktaş S, Tek M. The effect of tamoxifen on bladder functions and histology, and the role of estrogen receptor beta in a rat chemical cystitis model. Neurourol Urodyn. 2007;26(2):309–16.

    Article  CAS  PubMed  Google Scholar 

  53. •• Mizoguchi S, Mori K, Wang Z, Liu T, Funahashi Y, Sato F, et al. Effects of estrogen receptor β stimulation in a rat model of non-bacterial prostatic inflammation. Prostate. 2017;77(7):803–11 New research with promising novel target for management of CP/CPPS.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK

    Thomas Farmer, Alina Milica, Richard Hindley & Amr Emara

  2. Royal Surrey County Hospital, Egerton Rd, Guildford, GU2 7XX, UK

    Max Johnston

  3. Urology Department, Ain Shams University, Cairo, Egypt

    Amr Emara

Authors
  1. Thomas Farmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Max Johnston
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alina Milica
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard Hindley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amr Emara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amr Emara.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Inflammatory/Infectious Bladder Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Farmer, T., Johnston, M., Milica, A. et al. Chronic Prostatitis/Chronic Pelvic Pain Syndrome: a Literature Review of NIH III Prostatitis. Curr Bladder Dysfunct Rep 14, 83–89 (2019). https://doi.org/10.1007/s11884-019-00508-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-019-00508-9

Keywords

Search

Navigation