How is chronic prostatitis treated?

DEAR DOCTOR K:

I have chronic prostatitis. Antibiotics haven’t helped. What other treatment options are there?

DEAR READER:

Prostatitis is an inflammation of the prostate. This walnut-sized gland secretes fluid into semen. Prostatitis is widespread and affects men of all ages. According to a study published in the World Journal of Urology, about two out of every 100 men worldwide suffer from chronic prostatitis.

The type of prostatitis you have — chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) — is the most common type. Yet we don’t know what causes it. Doctors have suspected that a bacterial infection causes the condition, but so far, no clear evidence of a bacterial cause has been found. Other types of infections, such as with viruses, have not been studied very often.

White blood cells, a sign of infection, are usually found in urine and prostate secretions. However, no bacteria are evident. Still, doctors often prescribe antibiotics in case there’s an undetected bacterial infection. But as in your case, such treatment is generally ineffective.

CP/CPPS may result from a cascade of events. The initial event may be an undetected infection (from some sort of microbe that we haven’t discovered yet), or a physical trauma that causes inflammation. Over time, the inflammation leads to heightened pain sensitivity. The condition may extend beyond the prostate. The chronic inflammation may affect the nerves near the prostate gland. This, in turn, could affect bowel, bladder and sexual function. These are all reasonable theories, but they are unproven.

Symptoms of CP/CPPS include:

  • Pain in the lower back and genital area;
  • Having to urinate frequently and urgently (feeling like you can’t hold it in);
  • Burning or painful urination and ejaculation.

Treatment aims to reduce discomfort. Pain medications that reduce inflammation — such as aspirin, ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs) — may help. So may hot baths.

Your doctor may prescribe one or more drugs. Anticholinergic drugs reduce urinary symptoms by decreasing bladder contractions. Alpha blockers relax the muscles at the neck of the bladder, easing the flow of urine. Pregabalin (Lyrica), a drug used to treat fibromyalgia, may reduce pain. (You can see a list of medications for treating chronic prostatitis in the table below.

Myofascial trigger release, a form of massage, and biofeedback have been found in small studies to reduce pain and other symptoms. They might be worth a try.

Finally, three plant-derived substances may help: cernilton, quercetin and saw palmetto berry extract. Studies have been small, but findings have been generally positive.

We have more information on prostatitis in our 2012 Annual Report on Prostate Diseases. (Learn more about this report at AskDoctorK.com, or call 877-649-9457 toll-free to order it.)

Permit me to get on my soapbox for a minute. Why is it that we don’t know the cause or cure for such a common condition? The fraction of total government expenditures spent on research is going down, yet the tools to solve these riddles are in hand. We just need to find the money, as a society, to use those tools.

 

Medications to treat chronic prostatitis

Medication Side effects Comment
Antibiotics
ciprofloxacin (Cipro)
levofloxacin (Levaquin)
ofloxacin (Floxin)
trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim)
Nausea, vomiting, stomach pain, indigestion, diarrhea, upset stomach, and loss of appetite are most common Used to treat bacterial infection (such as in Category I and Category II prostatitis); may also be tried in newly diagnosed men with Category IIIA prostatitis on the assumption that infection is present, even if it can’t be detected
Anticholinergic drugs
oxybutynin (Ditropan)
tolterodine (Detrol)
Dry mouth, blurred vision, dry eyes or nose, dry skin, upset stomach, stomach pain, and headache are most common. Reduce urinary urgency or leakage by decreasing bladder contractions.
Alpha blockers (nonselective)
doxazosin (Cardura)
terazosin (Hytrin)
Dizziness, headache, and fatigue are most common .  Nasal congestion, dry mouth, and swelling in the ankles can also occur . Hypotension (low blood pressure), although rare, may pose a danger for some people. Relax the muscles at the neck of the bladder, easing the flow of urine; should be used carefully by those with hypertension or heart disease.
Alpha blockers (selective)
alfuzosin (Uroxatral)
silodosin (Rapaflo)
tamsulosin (Flomax)
Dizziness, headache, and fatigue are most common. Nasal congestion, dry mouth, and swelling in the ankles can also occur. Like the selective drugs, relax the muscles at the neck of the bladder, easing the flow of urine; but do not lower blood pressure.
Other drugs
pregabalin (Lyrica) Dizziness, dry mouth, swelling in the ankles, blurred vision, weight gain, and problems concentrating can occur. Usually prescribed to treat fibromyalgia, a neurologic condition. Experimental treatment for Category III prostatitis, but may be helpful for relieving pain; insurance coverage unlikely.