Loading...
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by pelvic pain or discomfort and urinary dysfunction, sexual dysfunction, or both for at least 3 of the prior 6 months; this diagnosis usually is made after a wide range of structural and infectious causes have been excluded. Many treatments have been suggested, but most treatment trials have been small and underpowered. In a meta-analysis of 262 randomized controlled trials of various treatments for CP/CPPS, investigators indentified 23 — with a total enrollment of about 2300 patients — that met inclusion criteria.
In pooled comparisons, either α-blockers (i.e., tamsulosin, doxazosin, or terazosin), antibiotics (mostly quinolones), or both in combination resulted in statistically significant but clinically modest attenuation of symptoms (e.g., total symptoms, pain, voiding, quality of life).
Anothaisintawee T et al. Management of chronic prostatitis/chronic pelvic pain syndrome: A systematic review and network meta-analysis. JAMA 2011 Jan 5; 305:78. (http://dx.doi.org/10.1001/jama.2010.1913)
Comment
These results confirm the experience of most clinicians who find that patients get little benefit from any specific approach to CP/CPPS. The findings were statistically significant but barely reached a level considered to be clinically important. The authors also found some evidence for publication bias of positive studies of α-blocker benefit. The positive findings for antibiotics are somewhat puzzling because patients with infection were excluded, but quinolones do have anti-inflammatory and analgesic effects.