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Treatment Response to Conventional and Novel Therapies in Chronic Prostatitis

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Abstract

Chronic prostatitis is a common and poorly understood condition that significantly impacts quality of life. Conventional therapy usually consists of prolonged courses of antibiotics; however, the efficacy of this approach is defined better by clearance of bacteria than by improvement in symptoms. Newer therapies with some evidence for efficacy include α blockers, anti-inflammatory drugs, phytotherapy (quercetin, bee pollen), physiotherapy, neuroleptics, and others with unique actions (finasteride, pentosan polysulfate). The National Institutes of Health Chronic Prostatitis Symptom Index is a validated symptom score that, in preliminary use, appears to be responsive to patient improvement. As more well-designed clinical trials in chronic prostatitis and chronic pelvic pain syndrome come to completion, physicians will be able to make rational treatment choices for patients with this common and frustrating condition.

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References and Recommended Reading

  1. Litwin MS: A review of the development and validation of the National Institutes of Health Chronic Prostatitis Symptom Index. Urology 2002, 60:14–18.

    Article  PubMed  Google Scholar 

  2. 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, 169:580–583.

    Article  PubMed  Google Scholar 

  3. Pfau A: The treatment of chronic bacterial prostatitis. Infection 1991, 19:S160-S164.

    Article  PubMed  Google Scholar 

  4. Barza M, Cuchural G: The penetration of antibiotics into the prostate in chronic bacterial prostatitis. Eur J Clin Microbiol 1984, 3:503–505.

    Article  PubMed  CAS  Google Scholar 

  5. Goto T, Makinose S, Ohi Y, et al.: Diffusion of piperacillin, cefotiam, minocycline, amikacin and ofloxacin into the prostate. Int J Urol 1998, 5:243–246.

    PubMed  CAS  Google Scholar 

  6. Nickel JC, Downey J, Johnston B, et al.: Predictors of patient response to antibiotic therapy for the chronic prostatitis/ chronic pelvic pain syndrome: a prospective multicenter clinical trial. J Urol 2001, 165:1539–1544. The first study to demonstrate that improvement with antibiotic therapy in chronic prostatitis is unrelated to culture results or the presence of inflammation in the seminal fluids.

    Article  PubMed  CAS  Google Scholar 

  7. Weidner W, Ludwig M, Brahler E, Schiefer HG: Outcome of antibiotic therapy with ciprofloxacin in chronic bacterial prostatitis. Drugs 1999, 58:103–106.

    Article  PubMed  CAS  Google Scholar 

  8. Naber KG, Busch W, Focht J: Ciprofloxacin in the treatment of chronic bacterial prostatitis: a prospective, non-comparative multicentre clinical trial with long-term follow-up. Int J Antimicrob Agents 2000, 14:143–149.

    Article  PubMed  CAS  Google Scholar 

  9. Jimenez-Cruz JF, Tormo FB, Gomez JG: Treatment of chronic prostatitis: intraprostatic antibiotic injections under echography control. J Urol 1988, 139:967–970.

    PubMed  CAS  Google Scholar 

  10. Yavascaoglu I, Camlikiyi H, Oktay B, et al.: Percutaneous suprapubic transvesical route: a new and comfortable method of intraprostatic injection. Urol Int 1998, 60:229–234.

    Article  PubMed  CAS  Google Scholar 

  11. Bahk JY, Hyun JS, Lee JY, et al.: Concentration of ofloxacin in canine prostate tissue and prostate fluid after intraprostatic injection of biodegradable sustained-releasing microspheres containing ofloxacin. J Urol 2000, 163:1560–1564.

    Article  PubMed  CAS  Google Scholar 

  12. Barbalias GA, Nikiforidis G, Liatsikos EN: Alpha-blockers for the treatment of chronic prostatitis in combination with antibiotics. J Urol 1998, 159:883–887.

    Article  PubMed  CAS  Google Scholar 

  13. Nickel JC, Alexander R, Anderson R, et al.: Prostatitis unplugged? Prostatic massage revisited. Tech Urol 1999, 5:1–7.

    PubMed  CAS  Google Scholar 

  14. Shoskes DA, Zeitlin SI: Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis. Prostate Cancer Prostatic Dis 1999, 2:159–162.

    Article  PubMed  Google Scholar 

  15. Yavascaoglu I, Oktay B, Simsek U, Ozyurt M: Role of ejaculation in the treatment of chronic non-bacterial prostatitis. Int J Urol 1999, 6:130–134.

    Article  PubMed  CAS  Google Scholar 

  16. Miller HC: Stress prostatitis. Urology 1988, 32:507–510.

    Article  PubMed  CAS  Google Scholar 

  17. Mutlu N, Mutlu B, Culha M, et al.: The role of Chlamydia trachomatis in patients with non-bacterial prostatitis. Int J Clin Pract 1998, 52:540–541.

    PubMed  CAS  Google Scholar 

  18. Taylor-Robinson D: Mycoplasma genitalium: an update. Int J STD AIDS 2002, 13:145–151.

    Article  PubMed  Google Scholar 

  19. Potts JM, Sharma R, Pasqualotto F, et al.: Association of ureaplasma urealyticum with abnormal reactive oxygen species levels and absence of leukocytospermia. J Urol 2000, 163:1775–1778.

    Article  PubMed  CAS  Google Scholar 

  20. Kaplan SA, Santarosa RP, D’Alisera PM, et al.: Pseudodyssynergia (contraction of the external sphincter during voiding) misdiagnosed as chronic nonbacterial prostatitis and the role of biofeedback as a therapeutic option. J Urol 1997, 157:2234–2237.

    Article  PubMed  CAS  Google Scholar 

  21. Mayo ME, Ross SO, Krieger JN: Few patients with “chronic prostatitis” have significant bladder outlet obstruction. Urology 1998, 52:417–421.

    Article  PubMed  CAS  Google Scholar 

  22. Neal DE Jr, Moon TD: Use of terazosin in prostatodynia and validation of a symptom score questionnaire. Urology 1994, 43:460–465.

    Article  PubMed  Google Scholar 

  23. Lacquaniti S, Destito A, Servello C, et al.: Terazosine and tamsulosin in non bacterial prostatitis: a randomized placebo-controlled study. Arch Ital Urol Androl 1999, 71:283–285.

    PubMed  CAS  Google Scholar 

  24. de la Rosette JJ, Karthaus HF, van Kerrebroeck PE, et al.: Research in ‘prostatitis syndromes’: the use of alfuzosin (a new alpha 1-receptor-blocking agent) in patients mainly presenting with micturition complaints of an irritative nature and confirmed urodynamic abnormalities. Eur Urol 1992, 22:222–227.

    PubMed  Google Scholar 

  25. Ishigooka M, Nakada T, Hashimoto T, et al.: Spinal substance P immunoreactivity is enhanced by acute chemical stimulation of the rat prostate. Urology 2002, 59:139–144.

    Article  PubMed  Google Scholar 

  26. Pontari, MA: Inflammation and anti-inflammatory therapy in chronic prostatitis. Urology 2002, 60:29–33.

    Article  Google Scholar 

  27. Nadler RB, Koch AE, Calhoun EA, et al.: Il-1beta and TNFalpha in prostatic secretions are indicators in the evaluation of men with chronic prostatitis. J Urol 2000, 164:214–218.

    Article  PubMed  CAS  Google Scholar 

  28. Shahed AR, Shoskes DA: Oxidative stress in prostatic fluid of patients with chronic pelvic pain syndrome: correlation with gram positive bacterial growth and treatment response. J Androl 2000, 21:669–675.

    PubMed  CAS  Google Scholar 

  29. Shahed AR, Shoskes DA: Correlation of beta-endorphin and prostaglandin e2 levels in prostatic fluid of patients with chronic prostatitis with diagnosis and treatment response. J Urol 2001, 166:1738–1741.

    Article  PubMed  CAS  Google Scholar 

  30. John H, Barghorn A, Funke G, et al.: Noninflammatory chronic pelvic pain syndrome: immunological study in blood, ejaculate and prostate tissue. Eur Urol 2001, 39:72–78. This study demonstrates the presence of inflammation in patients with CPPS, even if conventional microscopy of EPS is negative.

    Article  PubMed  CAS  Google Scholar 

  31. Galley HF, Dhillon JK, Paterson RL, Webster NR: Effect of ciprofloxacin on the activation of the transcription factors nuclear factor kappaB, activator protein-1 and nuclear factor-interleukin-6, and interleukin-6 and interleukin-8 mRNA expression in a human endothelial cell line. Clin Sci (Lond) 2000, 99:405–410.

    Article  CAS  Google Scholar 

  32. Canale D, Scaricabarozzi I, Giorgi P, et al.: Use of a novel non-steroidal anti-inflammatory drug, nimesulide, in the treatment of abacterial prostatovesiculitis. Andrologia 1993, 25:163–166.

    Article  PubMed  CAS  Google Scholar 

  33. Bates S, Talbot M: Short course oral prednisolone therapy in chronic abacterial prostatitis and prostatodynia: case reports of three responders and one nonresponder. Sex Transm Infect 2000, 76:398–399.

    Article  PubMed  CAS  Google Scholar 

  34. Talbot M, Bates S: Variability of the symptoms of chronic abacterial prostatitis/chronic pelvic pain syndrome during intermittent therapy with rectal prednisolone foam for ulcerative colitis. Int J STD AIDS 2001, 12:752–753.

    Article  PubMed  CAS  Google Scholar 

  35. Palapattu GS, Shoskes DA: Resolution of the chronic pelvic pain syndrome after renal transplantation. J Urol 2000, 164:127.

    Article  PubMed  CAS  Google Scholar 

  36. Wedren H: Effects of sodium pentosanpolysulphate on symptoms related to chronic non-bacterial prostatitis: a doubleblind randomized study. Scand J Urol Nephrol 1987, 21:81–88.

    Article  PubMed  CAS  Google Scholar 

  37. Nickel JC, Johnston B, Downey J, et al.: Pentosan polysulfate therapy for chronic nonbacterial prostatitis (chronic pelvic pain syndrome category IIIA): a prospective multicenter clinical trial. Urology 2000, 56:413–417.

    Article  PubMed  CAS  Google Scholar 

  38. Chiang G, Patra P, Letourneau R, et al.: Pentosanpolysulfate inhibits mast cell histamine secretion and intracellular calcium ion levels: an alternative explanation of its beneficial effect in interstitial cystitis. J Urol 2000, 164:2119–2125.

    Article  PubMed  CAS  Google Scholar 

  39. Shoskes DA: Phytotherapy in chronic prostatitis. Urology 2002, 60:35–37.

    Article  PubMed  Google Scholar 

  40. Rugendorff EW, Weidner W, Ebeling L, Buck AC: Results of treatment with pollen extract (Cernilton N) in chronic prostatitis and prostatodynia. Br J Urol 1993, 71:433–438.

    Article  PubMed  CAS  Google Scholar 

  41. Hollman PC, Katan MB: Bioavailability and health effects of dietary flavonols in man. Arch Toxicol Suppl 1998 20:237–248.

    PubMed  CAS  Google Scholar 

  42. Guardia T, Rotelli AE, Juarez AO, Pelzer LE: Anti-inflammatory properties of plant flavonoids: effects of rutin, quercetin and hesperidin on adjuvant arthritis in rat. Farmaco 2001, 56:683–687.

    Article  PubMed  CAS  Google Scholar 

  43. Sato M, Miyazaki T, Kambe F, et al.: Quercetin, a bioflavonoid, inhibits the induction of interleukin 8 and monocyte chemoattractant protein-1 expression by tumor necrosis factor-alpha in cultured human synovial cells. J Rheumatol 1997, 24:1680–1684.

    PubMed  CAS  Google Scholar 

  44. Shoskes DA: Use of the bioflavonoid quercetin in patients with longstanding chronic prostatitis J Am Neutraceutic Assoc 1999, 2:18–21.

    Google Scholar 

  45. 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, 54:960–963.

    Article  PubMed  CAS  Google Scholar 

  46. Nadler RB: Bladder training biofeedback and pelvic floor myalgia. Urology 2002, 60:42–43.

    Article  PubMed  Google Scholar 

  47. Holroyd KA, O’Donnell FJ, Stensland M, et al.: Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA 2001, 285:2208–2215.

    Article  PubMed  CAS  Google Scholar 

  48. Covington EC: Anticonvulsants for neuropathic pain and detoxification. Cleve Clin J Med 1998, 65(suppl 1):SI21-S129.

    PubMed  Google Scholar 

  49. Heughan CE, Sawynok J: The interaction between gabapentin and amitriptyline in the rat formalin test after systemic administration. Anesth Analg 2002, 94:975–980.

    Article  PubMed  CAS  Google Scholar 

  50. Shoskes DA, Hakim L, Ghoniem G, Jackson CL: Long-term results of multi-modal therapy for chronic prostatitis/chronic pelvic pain syndrome. J Urol 2003, 169:1406–1410.

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Urology, Section of Renal Transplantation, ClevelandClinic Florida, 2950 Cleveland Clinic Blvd, 33331, Weston, FL, USA

    Daniel A. Shoskes MD, MSc

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Shoskes, D.A. Treatment Response to Conventional and Novel Therapies in Chronic Prostatitis. Curr Urol Rep 4, 311–315 (2003). https://doi.org/10.1007/s11934-003-0091-2

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  • DOI: https://doi.org/10.1007/s11934-003-0091-2

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