Skip to main content

Advertisement

SpringerLink
Log in

Management of Chronic Prostatitis (CP)

  • Lower Urinary Tract Symptoms & Voiding Dysfunction (J Sandhu, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review the most up-to-date diagnosis and treatment of chronic prostatitis. We conducted a review of the literature based on the diagnosis and treatment of chronic prostatitis.

Recent Findings

The use of advanced phenotyping, links to lifestyle, and multimodal approaches has helped to enhance the treatment of chronic prostatitis and its negative effects on quality of life.

Summary

Chronic prostatitis is a common and complex condition that requires a multimodal approach to treat symptoms. Recent advances in phenotyping and risk factors help to individualize treatment and enhance treatment outcomes.

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 major Importance

  1. Krieger JN, Nyberg L, Jr., Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999;282(3):236–237.

    Article  CAS  PubMed  Google Scholar 

  2. Zhang R, Sutcliffe S, Giovannucci E, Willett WC, Platz EA, Rosner BA, et al. Lifestyle and risk of chronic prostatitis/chronic pelvic pain syndrome in a cohort of United States Male Health Professionals. J Urol. 2015;194(5):1295–300.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Collins MM, Stafford RS, O'Leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol. 1998;159(4):1224–8.

    Article  CAS  PubMed  Google Scholar 

  4. Krieger JN, Lee SWH, Jeon J, Cheah PY, Liong ML, Riley DE. Epidemiology of prostatitis. Int J Antimicrob Agents. 2008;31(Suppl 1):S85–90.

    Article  CAS  PubMed  Google Scholar 

  5. Roberts RO, Lieber MM, Rhodes T, Girman CJ, Bostwick DG, Jacobsen SJ. Prevalence of a physician-assigned diagnosis of prostatitis: the Olmsted County study of urinary symptoms and health status among men. Urology. 1998;51(4):578–84.

    Article  CAS  PubMed  Google Scholar 

  6. Nickel JC. Prostatitis. Can Urol Assoc J. 2011;5(5):306–15.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Duloy AM, Calhoun EA, Clemens JQ. Economic impact of chronic prostatitis. Curr Urol Rep. 2007;8(4):336–9.

    Article  PubMed  Google Scholar 

  8. Anderson RU, Wise D, Sawyer T, Chan CA. Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training. J Urol. 2006;176(4 Pt 1):1534–8. discussion 1538–1539

    Article  PubMed  Google Scholar 

  9. Bowen DK, Dielubanza E, Schaeffer AJ. Chronic bacterial prostatitis and chronic pelvic pain syndrome. BMJ Clin Evid. 2015;2015

  10. Thakkinstian A, Attia J, Anothaisintawee T, Nickel JC. alpha-Blockers, antibiotics and anti-inflammatories have a role in the management of chronic prostatitis/chronic pelvic pain syndrome. BJU Int 2012;110(7):1014–1022.

    Article  CAS  PubMed  Google Scholar 

  11. Sharp VJ, Takacs EB, Powell CR. Prostatitis: diagnosis and treatment. Am Fam Physician. 2010;82(4):397–406.

    PubMed  Google Scholar 

  12. Lipsky BA, Byren I, Hoey CT. Treatment of bacterial prostatitis. Clin Infect Dis : Off Publ Infect Dis Soc Am. 2010;50(12):1641–52.

    Article  Google Scholar 

  13. El Meliegy AI, Torky M. An observational study to monitor the efficacy and tolerability of levofloxacin 500 mg once daily for treatment of chronic bacterial prostatitis in Saudi Arabia. Urol Ann. 2015;7(1):71–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Zhang ZC, Jin FS, Liu DM, Shen ZJ, Sun YH, Guo YL. Safety and efficacy of levofloxacin versus ciprofloxacin for the treatment of chronic bacterial prostatitis in Chinese patients. Asian J Androl. 2012;14(6):870–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Cai T, Mazzoli S, Addonisio P, Boddi V, Geppetti P, Bartoletti R. Clinical and microbiological efficacy of prulifloxacin for the treatment of chronic bacterial prostatitis due to Chlamydia trachomatis infection: results from a prospective, randomized and open-label study. Methods Find Exp Clin Pharmacol. 2010;32(1):39–45.

    Article  CAS  PubMed  Google Scholar 

  16. Busetto GM, Giovannone R, Ferro M, Tricarico S, del Giudice F, Matei DV, et al. Chronic bacterial prostatitis: efficacy of short-lasting antibiotic therapy with prulifloxacin (Unidrox®) in association with saw palmetto extract, lactobacillus sporogens and arbutin (Lactorepens®). BMC Urol. 2014;14:53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. •• Bartoletti R, Cai T, Nesi G, et al. The impact of biofilm-producing bacteria on chronic bacterial prostatitis treatment: results from a longitudinal cohort study. World J Urol. 2014;32(3):737–42. Patients with chronic bacterial prostatitis found to have biofilm-producting bacteria are less likely to experience improvement in symptoms after fluoroquinolone treatment than patients without biofilm-producing bacteria

    Article  CAS  PubMed  Google Scholar 

  18. Nickel JC. Treatment of chronic prostatitis/chronic pelvic pain syndrome. Int J Antimicrob Agents. 2008;31(Supplement 1):112–6.

    Article  CAS  PubMed Central  Google Scholar 

  19. Wagenlehner FM, van Till JW, Magri V, et al. National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) symptom evaluation in multinational cohorts of patients with chronic prostatitis/chronic pelvic pain syndrome. Eur Urol. 2013;63(5):953–9.

    Article  PubMed  Google Scholar 

  20. Zhao Z, Zhang J, He J, Zeng G. Clinical utility of the UPOINT phenotype system in Chinese males with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a prospective study. PLoS One. 2013;8(1):e52044.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. •• Davis SN, Binik YM, Amsel R, Carrier S. Is a sexual dysfunction domain important for quality of life in men with urological chronic pelvic pain syndrome? Signs “UPOINT” to yes. J Urol. 2013;189(1):146–51. The two domains from UPOINTs that most strongly predicted quality of life were the psychosocial and sexual dysfunction domains. This study provided support for adding a sexual dysfunction domain to the UPOINT phenotyping system.

    Article  PubMed  Google Scholar 

  22. Gallo L. Effectiveness of diet, sexual habits and lifestyle modifications on treatment of chronic pelvic pain syndrome. Prostate Cancer Prostatic Dis. 2014;17(3):238–45.

    Article  CAS  PubMed  Google Scholar 

  23. Zhang R, Chomistek AK, Dimitrakoff JD, 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 

  24. Tripp DA, Nickel JC, Shoskes D, Koljuskov A. A 2-year follow-up of quality of life, pain, and psychosocial factors in patients with chronic prostatitis/chronic pelvic pain syndrome and their spouses. World J Urol. 2013;31(4):733–9.

    Article  PubMed  Google Scholar 

  25. Koh JS, Ko HJ, Wang SM, Cho KJ, Kim JC, Lee SJ, et al. Depression and somatic symptoms may influence on chronic prostatitis/chronic pelvic pain syndrome: a preliminary study. Psychiatry Investig. 2014;11(4):495–8.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Wagenlehner FM, Ballarini S, Naber KG. Immunostimulation in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a one-year prospective, double-blind, placebo-controlled study. World J Urol. 2014;32(6):1595–603.

    Article  CAS  PubMed  Google Scholar 

  27. Wagenlehner FME, van Till JWO, Houbiers JGA, Martina RV, Cerneus DP, Melis JHJM, et al. Fatty acid amide hydrolase inhibitor treatment in men with chronic prostatitis/chronic pelvic pain syndrome: an adaptive double-blind, randomized controlled trial. Urology. 2017;103:191–7.

    Article  PubMed  Google Scholar 

  28. Nickel JC, Atkinson G, Krieger JN, Mills IW, Pontari M, Shoskes DA, et al. Preliminary assessment of safety and efficacy in proof-of-concept, randomized clinical trial of tanezumab for chronic prostatitis/chronic pelvic pain syndrome. Urology. 2012;80(5):1105–10.

    Article  PubMed  Google Scholar 

  29. Nickel JC, O'Leary MP, Lepor H, Caramelli KE, Thomas H, Hill LA, et al. Silodosin for men with chronic prostatitis/chronic pelvic pain syndrome: results of a phase II multicenter, double-blind, placebo controlled study. J Urol. 2011;186(1):125–31.

    Article  CAS  PubMed  Google Scholar 

  30. Giannantoni A, Porena M, Gubbiotti M, Maddonni S, Di Stasi SM. The efficacy and safety of duloxetine in a multidrug regimen for chronic prostatitis/chronic pelvic pain syndrome. Urology. 2014;83(2):400–5.

    Article  PubMed  Google Scholar 

  31. Choe HS, Lee SJ, Han CH, Shim BS, Cho YH. Clinical efficacy of roxithromycin in men with chronic prostatitis/chronic pelvic pain syndrome in comparison with ciprofloxacin and aceclofenac: a prospective, randomized, multicenter pilot trial. J Infect Chemother : Off J Japan Soc Chemother. 2014;20(1):20–5.

    Article  CAS  Google Scholar 

  32. Pontari MA, Krieger JN, Litwin MS, White PC, Anderson RU, McNaughton-Collins M, et al. Pregabalin for the treatment of men with chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial. Arch Intern Med. 2010;170(17):1586–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Agarwal MM, Elsi Sy M. Gabapentenoids in pain management in urological chronic pelvic pain syndrome: gabapentin or pregabalin? Neurourol Urodyn. 2017;36(8):2028–33.

    Article  CAS  PubMed  Google Scholar 

  34. Kong do H, Yun CJ, Park HJ, Park NC. The efficacy of mirodenafil for chronic prostatitis/chronic pelvic pain syndrome in middle-aged males. World J Men Health. 2014;32(3):145–50.

    Article  Google Scholar 

  35. Magri V, Marras E, Restelli A, Wagenlehner FM, Perletti G. Multimodal therapy for category III chronic prostatitis/chronic pelvic pain syndrome in UPOINTS phenotyped patients. Exp Ther Med. 2015;9(3):658–66.

    Article  CAS  PubMed  Google Scholar 

  36. •• Sahin S, Bicer M, Eren GA, et al. Acupuncture relieves symptoms in chronic prostatitis/chronic pelvic pain syndrome: a randomized, sham-controlled trial. Prostate Cancer Prostatic Dis. 2015;18(3):249–54. Patients with CP/CPPS who receieved acupuncture experienced a reduction in NIH-CPSI score that was statistically significant compared to patients who received sham therapy

    Article  CAS  PubMed  Google Scholar 

  37. Kucuk EV, Suceken FY, Bindayi A, Boylu U, Onol FF, Gumus E. Effectiveness of acupuncture on chronic prostatitis-chronic pelvic pain syndrome category IIIB patients: a prospective, randomized, nonblinded, clinical trial. Urology. 2015;85(3):636–40.

    Article  PubMed  Google Scholar 

  38. •• Falahatkar S, Shahab E, Gholamjani Moghaddam K, Kazemnezhad E. Transurethral intraprostatic injection of botulinum neurotoxin type A for the treatment of chronic prostatitis/chronic pelvic pain syndrome: results of a prospective pilot double-blind and randomized placebo-controlled study. British Journal of Urology International. 2015;116(4):641–9. Patients with CP/CPPS who received botulinum toxin experienced a statistically significant reduction in NIH-CPSI score from their baseline status

    Article  CAS  Google Scholar 

  39. 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 onabotulinum toxin A: a prospective controlled study. Can J Urol. 2018;25(2):9273–80.

    PubMed  Google Scholar 

  40. Li HS, Wang B, Han L, Wang CH, Xin ZC. Transperineal ultrasonic therapy for chronic prostatitis. Zhonghua nan ke xue = Natl J Androl. 2013;19(1):49–53.

    Google Scholar 

  41. 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 

  42. Moayednia A, Haghdani S, Khosrawi S, Yousefi E, Vahdatpour B. Long-term effect of extracorporeal shock wave therapy on the treatment of chronic pelvic pain syndrome due to non bacterial prostatitis. J Res Med Sci : Off J Isfahan Univ Med Sci. 2014;19(4):293–6.

    Google Scholar 

  43. Pajovic B, Radojevic N, Dimitrovski A, Vukovic M. Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS). The Aging Male : The Official Journal of the International Society for the Study of the Aging Male. 2016;19(3):202–7.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, 10065, USA

    Nadir Zaidi, Dominique Thomas & Bilal Chughtai

  2. Department of Obstetrics and Gynecology, Weill Cornell Medicine, 425 East 61st Street, 12th Floor, New York, NY, 10065, USA

    Bilal Chughtai

Authors
  1. Nadir Zaidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dominique Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bilal Chughtai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bilal Chughtai.

Ethics declarations

Conflict of Interest

Nadir Zaidi and Dominique Thomas each declare no potential conflicts of interest. Bilal Chughtai is a consultant for Boston Scientific and Allergan.

Human and Animal Rights and Informed Consent

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

Additional information

This article is part of the Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zaidi, N., Thomas, D. & Chughtai, B. Management of Chronic Prostatitis (CP). Curr Urol Rep 19, 88 (2018). https://doi.org/10.1007/s11934-018-0841-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-018-0841-9

Keywords

Search

Navigation