chronic prostatitis

Chronic prostatic inflammation most commonly results from inadequately treated acute prostatitis, or genito-urinary tuberculosis.

Presentation is usually with chronic, low grade perineal pain, usually varying in severity and frequency. The pain may be exacerbated by sitting on a hard chair. Other features may include low back pain, which may extend down the leg, mild bouts of fever and dysuria.

Rectal examination usually reveals an enlarged, firm, and irregular prostate. Massage exudes a purulent urethral discharge.

Treatment chronic bacterial prostatits is with the use of an appropriate antibiotic, generally a fluroquinolone such as ciprofloxacin, for a course of 4-8 weeks

• use of a fluoroquinolone is associated with a remission rate of about 70% in this condition (1)
• use of antibiotics may need to be combined with a programme of regular prostatic massage in particularly resistant cases (1)
• there is evidence that the combination of an alpha blocker and antimicrobial therapy in chronic bacterial prostatitis is more effective than antimicrobial therapy alone (2)

Serum glucose should be checked to exclude diabetes mellitus.

Notes:

• a systematic review found "found low- to very low-quality evidence that alpha blockers, antibiotics, 5-ARI, anti-inflammatories, phytotherapy, intraprostatic BTA injection, and traditional Chinese medicine may cause a reduction in prostatitis symptoms without an increased incidence of adverse events in the short term, except for alpha blockers which may be associated with an increase in mild adverse events (3)"

Reference:

1. Pulse (2000); 60 (41): 120.
2. Barbalias GA, Nikiforidis G, Liatsikos EN. Alpha-blockers for the treatment of chronic prostatitis in combination with antibiotics. J Urol 1998;159:883–887
3. ranco JVA et al. Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Reviews 08 October 2019

Last edited 07/2020 and last reviewed 07/2021