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Chronic Prostatitis: Diagnosis and Treatment Unclear

Chronic bacterial and abacterial prostatitis, benign prostatic hypertrophy, and pelvic pain syndrome in men are difficult to diagnose and easily can be confused with one another. Yet, selecting successful treatments for these conditions -- for example, antibiotics or agents to relieve bladder outlet obstruction -- depends at least in part on accurate diagnosis. These researchers systematically reviewed the literature for evidence regarding the accurate diagnosis and effective treatment of abacterial prostatitis (i.e., purulence but no identified infection).

In general, the 19 diagnosis studies and 14 treatment studies identified were small and of low methodologic quality. No reference standard for clinical testing could be identified, although the use of pre- and post-prostatic massage urine specimens was 91 percent sensitive and specific for prostatitis when compared with the commonly used 4-sample test (initial, midstream, and post-massage urine specimens plus a post-massage prostatic secretion sample). Depressive symptoms, as well as coagulase-negative staphylococci and inflammatory and immunologic markers in prostatic secretions, were more common in patients with prostate pain. However, neither these features nor ultrasonography were adequate to diagnose abacterial prostatitis. Only 1 study of antibiotic treatment was identified; it showed no benefit. Studies of alpha-blockers, finasteride, and thermotherapy have yielded conflicting results.

Comment: Clearly, high-quality research is needed for physicians to better understand diagnosis and treatment of chronic abacterial prostatitis. In the meantime, the routine use of pharmacotherapy does not appear to be warranted.

— R Saitz

Published in Journal Watch General Medicine September 26, 2000

Citation(s):

McNaughton Collins M et al. Diagnosis and treatment of chronic abacterial prostatitis: A systematic review. Ann Intern Med 2000 Sep 5 133 367-381.

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