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Erschienen in: Drugs & Aging 10/2021

29.09.2021 | Review Article

Diagnostic and Management Strategies for Patients with Chronic Prostatitis and Chronic Pelvic Pain Syndrome

verfasst von: Vanessa N. Pena, Noah Engel, Andrew T. Gabrielson, Matthew J. Rabinowitz, Amin S. Herati

Erschienen in: Drugs & Aging | Ausgabe 10/2021

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Abstract

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common and often heterogenous condition that can have severe consequences on patient quality of life. In this review, we describe the pathophysiology, diagnostic work-up, and treatment of patients with CP/CPPS incorporating the most recent literature. Studies have demonstrated that CP/CPPS involves a complex pathophysiology, including infectious, immunologic, neurologic, endocrinologic, and psychologic etiologies, with frequent intersections between the different entities. Despite robust research assessing a variety of therapeutics targeting these etiologies, clinical trials have failed to identify an empiric treatment strategy applicable specifically to older adult male patients with CP/CPPS. As such, it can be challenging to manage older male patients with this condition. The advent of clinical phenotyping of patients with CP/CPPS has led to advances in tailored management strategies. Monomodal therapy has been largely unsuccessful because of the unclear and complex etiology of CPPS. As a result, CP/CPPS therapy has transitioned to a multimodal approach, including both pharmacologic and non-pharmacologic therapies. The best studied pharmacologic therapies include antibiotics, alpha-blockers, anti-inflammatory and immunomodulatory agents, phytotherapies, phosphodiesterase inhibitors, hormonal agents, neuromodulatory agents, and antidepressants. The best studied non-pharmacological therapies include pelvic floor physical therapy, myofascial trigger point release, acupuncture and electroacupuncture, psychological support and biofeedback, and electrocorporeal shockwave therapy and local thermotherapy.
Literatur
13.
14.
Zurück zum Zitat Leskinen MJ, Vainionp R, Syrjnen S, et al. Herpes simplex virus, cytomegalovirus, and papillomavirus DNA are not found in patients with chronic pelvic pain syndrome undergoing radical prostatectomy for localized prostate cancer. Urology. 2003;61(2):397–401 (S0090429502021660).CrossRefPubMed Leskinen MJ, Vainionp R, Syrjnen S, et al. Herpes simplex virus, cytomegalovirus, and papillomavirus DNA are not found in patients with chronic pelvic pain syndrome undergoing radical prostatectomy for localized prostate cancer. Urology. 2003;61(2):397–401 (S0090429502021660).CrossRefPubMed
15.
Zurück zum Zitat Nickel JC, Alexander RB, Schaeffer AJ, et al. Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls. J Urol. 2003;170(3):818–22 (S0022-5347(05)63240-5).CrossRefPubMed Nickel JC, Alexander RB, Schaeffer AJ, et al. Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls. J Urol. 2003;170(3):818–22 (S0022-5347(05)63240-5).CrossRefPubMed
18.
Zurück zum Zitat True LD, Berger RE, Rothman I, Ross SO, Krieger JN. Prostate histopathology and the chronic prostatitis/chronic pelvic pain syndrome: a prospective biopsy study. J Urol. 1999;162(6):2014–8 (S0022-5347(05)68090-1).CrossRefPubMed True LD, Berger RE, Rothman I, Ross SO, Krieger JN. Prostate histopathology and the chronic prostatitis/chronic pelvic pain syndrome: a prospective biopsy study. J Urol. 1999;162(6):2014–8 (S0022-5347(05)68090-1).CrossRefPubMed
19.
Zurück zum Zitat Schaeffer AJ, Knauss JS, Landis JR, et al. Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: the National Institutes of Health chronic prostatitis cohort study. J Urol. 2002;168(3):1048–53 (S0022-5347(05)64572-7).CrossRefPubMed Schaeffer AJ, Knauss JS, Landis JR, et al. Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: the National Institutes of Health chronic prostatitis cohort study. J Urol. 2002;168(3):1048–53 (S0022-5347(05)64572-7).CrossRefPubMed
20.
Zurück zum Zitat Nickel JC, Roehrborn CG, O’Leary MP, Bostwick DG, Somerville MC, Rittmaster RS. The relationship between prostate inflammation and lower urinary tract symptoms: examination of baseline data from the REDUCE trial. Eur Urol. 2008;54(6):1379–84 (S0302-2838(07)01443-1).CrossRefPubMed Nickel JC, Roehrborn CG, O’Leary MP, Bostwick DG, Somerville MC, Rittmaster RS. The relationship between prostate inflammation and lower urinary tract symptoms: examination of baseline data from the REDUCE trial. Eur Urol. 2008;54(6):1379–84 (S0302-2838(07)01443-1).CrossRefPubMed
21.
Zurück zum Zitat Alexander RB, Brady F, Ponniah S. Autoimmune prostatitis: evidence of T cell reactivity with normal prostatic proteins. Urology. 1997;50(6):893–9 (S0090-4295(97)00456-1).CrossRefPubMed Alexander RB, Brady F, Ponniah S. Autoimmune prostatitis: evidence of T cell reactivity with normal prostatic proteins. Urology. 1997;50(6):893–9 (S0090-4295(97)00456-1).CrossRefPubMed
24.
Zurück zum Zitat Motrich RD, Maccioni M, Molina R, et al. Presence of INFgamma-secreting lymphocytes specific to prostate antigens in a group of chronic prostatitis patients. Clin Immunol. 2005;116(2):149–57 (S1521-6616(05)00083-5).CrossRefPubMed Motrich RD, Maccioni M, Molina R, et al. Presence of INFgamma-secreting lymphocytes specific to prostate antigens in a group of chronic prostatitis patients. Clin Immunol. 2005;116(2):149–57 (S1521-6616(05)00083-5).CrossRefPubMed
38.
Zurück zum Zitat Lee JC, Yang CC, Kromm BG, Berger RE. Neurophysiologic testing in chronic pelvic pain syndrome: a pilot study. Urology. 2001;58(2):246–50 (S0090-4295(01)01143-8).CrossRefPubMed Lee JC, Yang CC, Kromm BG, Berger RE. Neurophysiologic testing in chronic pelvic pain syndrome: a pilot study. Urology. 2001;58(2):246–50 (S0090-4295(01)01143-8).CrossRefPubMed
39.
Zurück zum Zitat Yang CC, Lee JC, Kromm BG, Ciol MA, Berger R. Pain sensitization in male chronic pelvic pain syndrome: why are symptoms so difficult to treat? J Urol. 2003;170(3):823–7 (S0022-5347(05)63241-7).CrossRefPubMed Yang CC, Lee JC, Kromm BG, Ciol MA, Berger R. Pain sensitization in male chronic pelvic pain syndrome: why are symptoms so difficult to treat? J Urol. 2003;170(3):823–7 (S0022-5347(05)63241-7).CrossRefPubMed
44.
Zurück zum Zitat Zermann DH, Ishigooka M, Doggweiler R, Schmidt RA. Neurourological insights into the etiology of genitourinary pain in men. J Urol. 1999;161(3):903–8 (S0022-5347(01)61802-0).CrossRefPubMed Zermann DH, Ishigooka M, Doggweiler R, Schmidt RA. Neurourological insights into the etiology of genitourinary pain in men. J Urol. 1999;161(3):903–8 (S0022-5347(01)61802-0).CrossRefPubMed
50.
Zurück zum Zitat Spanos C, Pang X, Ligris K, Letourneau R, Alferes L, Alexacos N, et al. Stress-induced bladder mast cell activation: implications for interstitial cystitis. J Urol. 1997;157(2):669–72.CrossRefPubMed Spanos C, Pang X, Ligris K, Letourneau R, Alferes L, Alexacos N, et al. Stress-induced bladder mast cell activation: implications for interstitial cystitis. J Urol. 1997;157(2):669–72.CrossRefPubMed
52.
Zurück zum Zitat Makovey I, Dolinga R, Shoskes DA. “Spousal revenge syndrome”: description of a new chronic pelvic pain syndrome patient cohort. Can J Urol. 2016;23(1):8176–8.PubMed Makovey I, Dolinga R, Shoskes DA. “Spousal revenge syndrome”: description of a new chronic pelvic pain syndrome patient cohort. Can J Urol. 2016;23(1):8176–8.PubMed
55.
Zurück zum Zitat Naslund MJ, Strandberg JD, Coffey DS. The role of androgens and estrogens in the pathogenesis of experimental nonbacterial prostatitis. J Urol. 1988;140(5):1049–53 (S0022-5347(17)41924-0).CrossRefPubMed Naslund MJ, Strandberg JD, Coffey DS. The role of androgens and estrogens in the pathogenesis of experimental nonbacterial prostatitis. J Urol. 1988;140(5):1049–53 (S0022-5347(17)41924-0).CrossRefPubMed
69.
Zurück zum Zitat 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. 2014;20(1):20–5 (S1341-321X(13)00016-0).CrossRefPubMed 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. 2014;20(1):20–5 (S1341-321X(13)00016-0).CrossRefPubMed
71.
Zurück zum Zitat Cheng C, Lai Y, Hsueh TY, et al. The efficacy of levofloxacin or ciprofloxacin in the management of chronic non-bacterial prostatitis. Int J Urol. 2010;17:A335. Cheng C, Lai Y, Hsueh TY, et al. The efficacy of levofloxacin or ciprofloxacin in the management of chronic non-bacterial prostatitis. Int J Urol. 2010;17:A335.
83.
Zurück zum Zitat Sivkov AV, Oshchepkov VN, Egorov AA. Double-blind placebo-controlled trial of terazosine efficacy in patients with chronic abacterial prostatitis. Urologiia. 2005;1:47–53. Sivkov AV, Oshchepkov VN, Egorov AA. Double-blind placebo-controlled trial of terazosine efficacy in patients with chronic abacterial prostatitis. Urologiia. 2005;1:47–53.
87.
Zurück zum Zitat Youn CW, Son K, Choi H, Kwon DD, Park K, Ryu SB. Comparison of the efficacy of antibiotic monotherapy and antibiotic plus alpha-blocker combination therapy for patients with inflammatory chronic prostatitis/chronic pelvic pain syndrome. Korean J Urol. 2008;49(1):72–6.CrossRef Youn CW, Son K, Choi H, Kwon DD, Park K, Ryu SB. Comparison of the efficacy of antibiotic monotherapy and antibiotic plus alpha-blocker combination therapy for patients with inflammatory chronic prostatitis/chronic pelvic pain syndrome. Korean J Urol. 2008;49(1):72–6.CrossRef
89.
Zurück zum Zitat Lü M, Zhao S, Wang S, Shi B, Fan Y, Wang J. Alpha-blockers and bioflavonoids in men with chronic nonbacterial prostatitis (NIH-IIIa): a prospective, placebo-controlled trial. Zhonghua Liu Xing Bing Xue Za Zhi. 2004;25(2):169–72.PubMed Lü M, Zhao S, Wang S, Shi B, Fan Y, Wang J. Alpha-blockers and bioflavonoids in men with chronic nonbacterial prostatitis (NIH-IIIa): a prospective, placebo-controlled trial. Zhonghua Liu Xing Bing Xue Za Zhi. 2004;25(2):169–72.PubMed
94.
Zurück zum Zitat Cha WH, Kim KH, Seo YJ. Comparison of the efficacy of a terpene mixture and alpha-blocker for treatment of category III chronic prostatitis/chronic pelvic pain syndrome: a prospective study. Korean J Urol. 2009;50(2):148–53.CrossRef Cha WH, Kim KH, Seo YJ. Comparison of the efficacy of a terpene mixture and alpha-blocker for treatment of category III chronic prostatitis/chronic pelvic pain syndrome: a prospective study. Korean J Urol. 2009;50(2):148–53.CrossRef
100.
Zurück zum Zitat Jiang M, Wu G, Liu H. Dexketoprofen trometamol in the treatment of chronic prostatitis/chronic pelvic pain syndrome. Zhonghua Nan Ke Xue. 2009;15(9):825–8.PubMed Jiang M, Wu G, Liu H. Dexketoprofen trometamol in the treatment of chronic prostatitis/chronic pelvic pain syndrome. Zhonghua Nan Ke Xue. 2009;15(9):825–8.PubMed
102.
Zurück zum Zitat Zeng X, Ye Z, Yang W, et al. Clinical evaluation of celecoxib in treating type IIIA chronic prostatitis. Zhonghua Nan Ke Xue. 2004;10(4):278–81.PubMed Zeng X, Ye Z, Yang W, et al. Clinical evaluation of celecoxib in treating type IIIA chronic prostatitis. Zhonghua Nan Ke Xue. 2004;10(4):278–81.PubMed
105.
Zurück zum Zitat Yang M, Zhao X, Wu Z, Xiao N, Lü C, Hou Y. Corticoid combined with an antibiotic for chronic nonbacterial prostatitis. Zhonghua Nan Ke Xue. 2009;15(3):237–40.PubMed Yang M, Zhao X, Wu Z, Xiao N, Lü C, Hou Y. Corticoid combined with an antibiotic for chronic nonbacterial prostatitis. Zhonghua Nan Ke Xue. 2009;15(3):237–40.PubMed
110.
Zurück zum Zitat Shoskes DA. Phytotherapy in chronic prostatitis. Urology. 2002;60(6 Suppl.):35–7 ((discussion 37. doi: S009042950202383X)).CrossRefPubMed Shoskes DA. Phytotherapy in chronic prostatitis. Urology. 2002;60(6 Suppl.):35–7 ((discussion 37. doi: S009042950202383X)).CrossRefPubMed
114.
116.
Zurück zum Zitat Morgia G, Mucciardi G, Galì A, et al. Treatment of chronic prostatitis/chronic pelvic pain syndrome category IIIA with Serenoa repens plus selenium and lycopene (profluss®) versus S. repens alone: an Italian randomized multicenter-controlled study. Urol Int. 2010;84(4):400–6. https://doi.org/10.1159/000302716.CrossRefPubMed Morgia G, Mucciardi G, Galì A, et al. Treatment of chronic prostatitis/chronic pelvic pain syndrome category IIIA with Serenoa repens plus selenium and lycopene (profluss®) versus S. repens alone: an Italian randomized multicenter-controlled study. Urol Int. 2010;84(4):400–6. https://​doi.​org/​10.​1159/​000302716.CrossRefPubMed
121.
Zurück zum Zitat Cavallini G. Mepartricin in the treatment of male pelvic pain syndrome secondary to chronic nonbacterial prostatitis/prostatodynia. Minerva Urol Nefrol. 2001;53(1):13–7.PubMed Cavallini G. Mepartricin in the treatment of male pelvic pain syndrome secondary to chronic nonbacterial prostatitis/prostatodynia. Minerva Urol Nefrol. 2001;53(1):13–7.PubMed
125.
Zurück zum Zitat 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. BJU Int. 2015;116(4):641–9. https://doi.org/10.1111/bju.12951.CrossRefPubMed 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. BJU Int. 2015;116(4):641–9. https://​doi.​org/​10.​1111/​bju.​12951.CrossRefPubMed
127.
Zurück zum Zitat Teichman JM. The role of pentosan polysulfate in treatment approaches for interstitial cystitis. Rev Urol. 2002;4(Suppl. 1):S21–7.PubMedPubMedCentral Teichman JM. The role of pentosan polysulfate in treatment approaches for interstitial cystitis. Rev Urol. 2002;4(Suppl. 1):S21–7.PubMedPubMedCentral
132.
Zurück zum Zitat Persson BE, Ronquist G. Evidence for a mechanistic association between nonbacterial prostatitis and levels of urate and creatinine in expressed prostatic secretion. J Urol. 1996;155(3):958–60 (S0022-5347(01)66357-2).CrossRefPubMed Persson BE, Ronquist G. Evidence for a mechanistic association between nonbacterial prostatitis and levels of urate and creatinine in expressed prostatic secretion. J Urol. 1996;155(3):958–60 (S0022-5347(01)66357-2).CrossRefPubMed
133.
Zurück zum Zitat Persson BE, Ronquist G, Ekblom M. Ameliorative effect of allopurinol on nonbacterial prostatitis: a parallel double-blind controlled study. J Urol. 1996;155(3):961–4 (S0022-5347(01)66358-4).CrossRefPubMed Persson BE, Ronquist G, Ekblom M. Ameliorative effect of allopurinol on nonbacterial prostatitis: a parallel double-blind controlled study. J Urol. 1996;155(3):961–4 (S0022-5347(01)66358-4).CrossRefPubMed
137.
Zurück zum Zitat Shoskes DA, Berger R, Elmi A, et al. Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: the chronic prostatitis cohort study. J Urol. 2008;179(2):556–60 (S0022-5347(07)02590-6).CrossRefPubMed Shoskes DA, Berger R, Elmi A, et al. Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: the chronic prostatitis cohort study. J Urol. 2008;179(2):556–60 (S0022-5347(07)02590-6).CrossRefPubMed
140.
Zurück zum Zitat 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):1534–9 (S0022-5347(06)01377-2).CrossRefPubMed 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):1534–9 (S0022-5347(06)01377-2).CrossRefPubMed
144.
Zurück zum Zitat Shen SL, He DL, Luo Y. Clinical trials of combined therapy of an oral chinese medicine with massage for chronic nonbacterial prostatitis. Zhonghua Nan Ke Xue. 2006;12(9):851–3.PubMed Shen SL, He DL, Luo Y. Clinical trials of combined therapy of an oral chinese medicine with massage for chronic nonbacterial prostatitis. Zhonghua Nan Ke Xue. 2006;12(9):851–3.PubMed
Metadaten
Titel
Diagnostic and Management Strategies for Patients with Chronic Prostatitis and Chronic Pelvic Pain Syndrome
verfasst von
Vanessa N. Pena
Noah Engel
Andrew T. Gabrielson
Matthew J. Rabinowitz
Amin S. Herati
Publikationsdatum
29.09.2021
Verlag
Springer International Publishing
Erschienen in
Drugs & Aging / Ausgabe 10/2021
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI
https://doi.org/10.1007/s40266-021-00890-2

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