Chronic prostatitis/chronic pelvic pain syndrome
- Michel Pontari, MD
Michel Pontari, MD
- Professor of Urology
- Temple University School of Medicine
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a clinical syndrome defined primarily on the basis of urologic symptoms and/or pain or discomfort in the pelvic region. Despite the use of the term "prostatitis," it is unclear to what degree the prostate is the source of symptoms .
The clinical manifestations, evaluation, and management of CP/CPPS will be reviewed here. Acute prostatitis and chronic bacterial prostatitis are discussed separately. (See "Acute bacterial prostatitis" and "Chronic bacterial prostatitis".)
A number of terms have been used to describe the syndrome now commonly called chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). These include prostatodynia (painful prostate) and abacterial prostatitis.
A classification approach supported by the National Institutes of Health (NIH) to standardize definitions and facilitate research is the accepted categorization of prostate syndromes . This schema defines the following classes:
●I – Acute prostatitisTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Potts JM. Chronic pelvic pain syndrome: a non-prostatocentric perspective. World J Urol 2003; 21:54.
- Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999; 282:236.
- Nickel JC, Nyberg LM, Hennenfent M. Research guidelines for chronic prostatitis: consensus report from the first National Institutes of Health International Prostatitis Collaborative Network. Urology 1999; 54:229.
- Krieger JN, Riley DE, Cheah PY, et al. Epidemiology of prostatitis: new evidence for a world-wide problem. World J Urol 2003; 21:70.
- Collins MM, Stafford RS, O'Leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol 1998; 159:1224.
- Nickel JC, Downey J, Hunter D, Clark J. Prevalence of prostatitis-like symptoms in a population based study using the National Institutes of Health chronic prostatitis symptom index. J Urol 2001; 165:842.
- Krieger JN, Egan KJ. Comprehensive evaluation and treatment of 75 men referred to chronic prostatitis clinic. Urology 1991; 38:11.
- Schaeffer AJ. Editorial: Emerging concepts in the management of prostatitis/chronic pelvic pain syndrome. J Urol 2003; 169:597.
- Ohkawa M, Yamaguchi K, Tokunaga S, et al. Ureaplasma urealyticum in the urogenital tract of patients with chronic prostatitis or related symptomatology. Br J Urol 1993; 72:918.
- Shortliffe LM, Sellers RG, Schachter J. The characterization of nonbacterial prostatitis: search for an etiology. J Urol 1992; 148:1461.
- Berger RE, Krieger JN, Kessler D, et al. Case-control study of men with suspected chronic idiopathic prostatitis. J Urol 1989; 141:328.
- Doble A, Thomas BJ, Walker MM, et al. The role of Chlamydia trachomatis in chronic abacterial prostatitis: a study using ultrasound guided biopsy. J Urol 1989; 141:332.
- Hochreiter WW, Duncan JL, Schaeffer AJ. Evaluation of the bacterial flora of the prostate using a 16S rRNA gene based polymerase chain reaction. J Urol 2000; 163:127.
- Leskinen MJ, Rantakokko-Jalava K, Manninen R, et al. Negative bacterial polymerase chain reaction (PCR) findings in prostate tissue from patients with symptoms of chronic pelvic pain syndrome (CPPS) and localized prostate cancer. Prostate 2003; 55:105.
- Lee JC, Muller CH, Rothman I, et al. Prostate biopsy culture findings of men with chronic pelvic pain syndrome do not differ from those of healthy controls. J Urol 2003; 169:584.
- Nickel JC, Roehrborn CG, O'leary MP, et al. Examination of the relationship between symptoms of prostatitis and histological inflammation: baseline data from the REDUCE chemoprevention trial. J Urol 2007; 178:896.
- Nickel JC, Freedland SJ, Castro-Santamaria R, Moreira DM. Chronic Prostate Inflammation Predicts Symptom Progression in Patients with Chronic Prostatitis/Chronic Pelvic Pain. J Urol 2017; 198:122.
- Pontari MA, Ruggieri MR. Mechanisms in prostatitis/chronic pelvic pain syndrome. J Urol 2004; 172:839.
- Mehik A, Hellström P, Nickel JC, et al. The chronic prostatitis-chronic pelvic pain syndrome can be characterized by prostatic tissue pressure measurements. J Urol 2002; 167:137.
- Mehik A, Leskinen MJ, Hellström P. Mechanisms of pain in chronic pelvic pain syndrome: influence of prostatic inflammation. World J Urol 2003; 21:90.
- Mehik A, Hellström P, Sarpola A, et al. Fears, sexual disturbances and personality features in men with prostatitis: a population-based cross-sectional study in Finland. BJU Int 2001; 88:35.
- Anderson RU, Orenberg EK, Morey A, et al. Stress induced hypothalamus-pituitary-adrenal axis responses and disturbances in psychological profiles in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol 2009; 182:2319.
- Walz J, Perrotte P, Hutterer G, et al. Impact of chronic prostatitis-like symptoms on the quality of life in a large group of men. BJU Int 2007; 100:1307.
- Sönmez NC, Kiremit MC, Güney S, et al. Sexual dysfunction in type III chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) observed in Turkish patients. Int Urol Nephrol 2011; 43:309.
- Müller A, Mulhall JP. Sexual dysfunction in the patient with prostatitis. Curr Urol Rep 2006; 7:307.
- Trinchieri A, Magri V, Cariani L, et al. Prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome. Arch Ital Urol Androl 2007; 79:67.
- Rodríguez MA, Afari N, Buchwald DS, National Institute of Diabetes and Digestive and Kidney Diseases Working Group on Urological Chronic Pelvic Pain. Evidence for overlap between urological and nonurological unexplained clinical conditions. J Urol 2009; 182:2123.
- Ustinova EE, Gutkin DW, Pezzone MA. Sensitization of pelvic nerve afferents and mast cell infiltration in the urinary bladder following chronic colonic irritation is mediated by neuropeptides. Am J Physiol Renal Physiol 2007; 292:F123.
- Erickson BA, Schaeffer AJ, Van Le B. Chronic prostatitis. BMJ Clin Evid 2008; 2008.
- Turner JA, Ciol MA, Von Korff M, Berger R. Validity and responsiveness of the national institutes of health chronic prostatitis symptom index. J Urol 2003; 169:580.
- Schaeffer AJ. Etiology and management of chronic pelvic pain syndrome in men. Urology 2004; 63:75.
- Nickel JC. Clinical evaluation of the man with chronic prostatitis/chronic pelvic pain syndrome. Urology 2002; 60:20.
- Litwin MS, McNaughton-Collins M, Fowler FJ Jr, et al. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network. J Urol 1999; 162:369.
- Anothaisintawee T, Attia J, Nickel JC, et al. Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis. JAMA 2011; 305:78.
- Dalhoff A, Shalit I. Immunomodulatory effects of quinolones. Lancet Infect Dis 2003; 3:359.
- Giannantoni A, Porena M, Gubbiotti M, et al. The efficacy and safety of duloxetine in a multidrug regimen for chronic prostatitis/chronic pelvic pain syndrome. Urology 2014; 83:400.
- Nickel JC, Roehrborn C, Montorsi F, et al. Dutasteride reduces prostatitis symptoms compared with placebo in men enrolled in the REDUCE study. J Urol 2011; 186:1313.
- 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; 54:960.
- Wagenlehner FM, Schneider H, Ludwig M, 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; 56:544.
- De Rose AF, Gallo F, Giglio M, Carmignani G. Role of mepartricin in category III chronic nonbacterial prostatitis/chronic pelvic pain syndrome: a randomized prospective placebo-controlled trial. Urology 2004; 63:13.
- Oh-oka H, Yamada T, Noto H, et al. Effect of carbazochrome sodium sulfonate on refractory chronic prostatitis. Int J Urol 2014; 21:1162.
- Wu LX, Liang CZ, Hao ZY, et al. [Epidemiological study of chronic prostatitis patients with depression symptoms]. Zhonghua Nan Ke Xue 2006; 12:583.
- Naliboff BD, Stephens AJ, Afari N, et al. Widespread Psychosocial Difficulties in Men and Women With Urologic Chronic Pelvic Pain Syndromes: Case-control Findings From the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network. Urology 2015; 85:1319.
- Nickel JC, Mullins C, Tripp DA. Development of an evidence-based cognitive behavioral treatment program for men with chronic prostatitis/chronic pelvic pain syndrome. World J Urol 2008; 26:167.
- Lee SH, Lee BC. Use of acupuncture as a treatment method for chronic prostatitis/chronic pelvic pain syndromes. Curr Urol Rep 2011; 12:288.
- Küçük EV, Suçeken FY, Bindayı A, et al. Effectiveness of acupuncture on chronic prostatitis-chronic pelvic pain syndrome category IIIB patients: a prospective, randomized, nonblinded, clinical trial. Urology 2015; 85:636.
- Anderson RU, Wise D, Sawyer T, Chan C. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol 2005; 174:155.
- Anderson RU, Wise D, Sawyer T, et al. 6-day intensive treatment protocol for refractory chronic prostatitis/chronic pelvic pain syndrome using myofascial release and paradoxical relaxation training. J Urol 2011; 185:1294.
- Touma NJ, Nickel JC. Prostatitis and chronic pelvic pain syndrome in men. Med Clin North Am 2011; 95:75.
- Leskinen MJ, Kilponen A, Lukkarinen O, Tammela TL. Transurethral needle ablation for the treatment of chronic pelvic pain syndrome (category III prostatitis): a randomized, sham-controlled study. Urology 2002; 60:300.