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Men with chronic pelvic or perineal pain are often labeled as having “chronic prostatitis.” Such patients usually have no demonstrable bacterial infection, and they may or may not have white blood cells in expressed prostatic secretions or in urine. Do these patients really have prostatic inflammation?
An ongoing randomized trial happens to afford an opportunity to address this question: Men with prostate-specific antigen levels between 2.5 and 10 ng/mL and no evidence of cancer on prostate biopsy are receiving a 5α-reductase inhibitor or placebo, to determine whether the drug prevents prostate cancer. At baseline, all men undergo prostate biopsies and complete a standardized questionnaire called the chronic prostatitis symptom index.
Biopsy results and symptom scores were available for 5597 patients. Among patients with chronic prostatitis-like pain symptoms, 77% had chronic inflammation on prostate biopsy; among those without symptoms, 79% had chronic inflammation on biopsy. Moreover, the distributions of patients with mild, moderate, or marked inflammation on biopsy were virtually identical in the symptomatic and asymptomatic patient groups.
Nickel JC et al. Examination of the relationship between symptoms of prostatitis and histological inflammation: Baseline data from the REDUCE chemoprevention trial. J Urol 2007 Sep; 178:896.
Comment
This study convincingly demonstrates that chronic pelvic pain in men is not associated with histologic evidence of chronic prostatic inflammation. By inference, antibiotic or anti-inflammatory drug therapy ought to be ineffective in this syndrome — unless the symptoms are caused by infection or inflammation elsewhere. Indeed, in randomized trials, quinolone antibiotics have generally shown no benefit.