Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome
- PMID: 26411805
- DOI: 10.1016/j.eururo.2015.08.061
Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome
Abstract
Context: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition that causes severe symptoms, bother, and quality-of-life impact in the 8.2% of men who are believed to be affected. Research suggests a complex pathophysiology underlying this syndrome that is mirrored by its heterogeneous clinical presentation. Management of patients diagnosed with CP/CPPS has always been a formidable task in clinical practice. Due to its enigmatic etiology, a plethora of clinical trials failed to identify an efficient monotherapy.
Objective: A comprehensive review of published randomized controlled trials (RCTs) on the treatment of CP/CPPS and practical best evidence recommendations for management.
Evidence acquisition: Medline and the Cochrane database were screened for RCTs on the treatment of CP/CPPS from 1998 to December 2014, using the National Institutes of Health Chronic Prostatitis Symptom Index as an objective outcome measure. Published data in concert with expert opinion were used to formulate a practical best evidence statement for the management of CP/CPPS.
Evidence synthesis: Twenty-eight RCTs identified were eligible for this review and presented. Trials evaluating antibiotics, α-blockers, anti-inflammatory and immune-modulating substances, hormonal agents, phytotherapeutics, neuromodulatory drugs, agents that modify bladder function, and physical treatment options failed to reveal a clear therapeutic benefit. With its multifactorial pathophysiology and its various clinical presentations, the management of CP/CPPS demands a phenotypic-directed approach addressing the individual clinical profile of each patient. Different categorization algorithms have been proposed. First studies applying the UPOINTs classification system provided promising results. Introducing three index patients with CP/CPPS, we present practical best evidence recommendations for management.
Conclusions: Our current understanding of the pathophysiology underlying CP/CPPS resulting in this highly variable syndrome does not speak in favor of a monotherapy for management. No efficient monotherapeutic option is available. The best evidence-based management of CP/CPPS strongly suggests a multimodal therapeutic approach addressing the individual clinical phenotypic profile.
Patient summary: Chronic prostatitis/chronic pelvic pain syndrome presents a variable syndrome. Successful management of this condition is challenging. It appears that a tailored treatment strategy addressing individual patient characteristics is more effective than one single therapy.
Keywords: Chronic pelvic pain syndrome; Chronic prostatitis; Monotherapies; Phenotypically directed multimodal management.
Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Comment in
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Chronic Pelvic Pain Syndrome: Light at the End of the Tunnel?Eur Urol. 2016 Feb;69(2):298-9. doi: 10.1016/j.eururo.2015.09.028. Epub 2015 Oct 9. Eur Urol. 2016. PMID: 26455354 No abstract available.
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Reply to Dino Papeš, Ana Jerončić's Letter to the Editor re: Giuseppe Magistro, Florian M.E. Wagenlehner, Magnus Grabe, Wolfgang Weidner, Christian G. Stief, J. Curtis Nickel. Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Eur Urol 2016;69:286-97.Eur Urol. 2016 Dec;70(6):e166-e167. doi: 10.1016/j.eururo.2016.05.018. Epub 2016 Jul 7. Eur Urol. 2016. PMID: 27210460 No abstract available.
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Reply to Vincenza Conteduca, Cristian Lolli, and Ugo De Giorgi's Letter to the Editor re: Pasquale Rescigno, David Lorente, Diletta Bianchini, et al. Prostate-specific Antigen Decline After 4 Weeks of Treatment with Abiraterone Acetate and Overall Survival in Patients with Metastatic Castration-resistant Prostate Cancer. Eur Urol 2016;70:724-31.Eur Urol. 2016 Dec;70(6):e170-e171. doi: 10.1016/j.eururo.2016.05.029. Epub 2016 May 27. Eur Urol. 2016. PMID: 27240941 No abstract available.
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Re: Giuseppe Magistro, Florian M.E. Wagenlehner, Magnus Grabe, Wolfgang Weidner, Christian G. Stief, J. Curtis Nickel. Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Eur Urol 2016;69:286-97: Determining the effect of alpha-blockers in chronic prostatitis/chronic pelvic pain syndrome: systematic review and meta-analysis.Eur Urol. 2016 Dec;70(6):e163-e165. doi: 10.1016/j.eururo.2016.05.019. Epub 2016 Jun 7. Eur Urol. 2016. PMID: 27283214 No abstract available.
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Re: Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome.J Urol. 2017 May;197(5):1275-1276. doi: 10.1016/j.juro.2017.02.056. Epub 2017 Feb 21. J Urol. 2017. PMID: 29539903 No abstract available.
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