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Pharmacotherapy for Chronic Prostatitis/Pelvic Pain

Researchers tested antibiotic, -blocker, and combination therapy in a randomized placebo-controlled trial.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is common, but the cause often is unknown, and treatment usually is unsuccessful. In a North American trial, researchers enrolled 196 men at 10 urology outpatient clinics; all men had pelvic pain or discomfort for at least 3 months, but none had known genitourinary infections or cancers, prior prostate or bladder surgery, or inflammatory-bowel disease. Subjects were assigned randomly to receive the -blocker tamsulosin (Flomax; 0.4 mg once daily), ciprofloxacin (500 mg twice daily), both drugs, or matching placebo for 6 weeks.

At 6 weeks, the groups did not differ significantly in pain, urinary symptoms, or quality of life, as assessed with a validated chronic prostatitis symptom index.

Comment: In 2000, the National Institutes of Health reached a consensus on how to categorize cases of chronic prostatitis (Journal Watch Nov 3 2000). At that time, no clear evidence existed that pharmacotherapy was helpful for CP/CPPS (Journal Watch Sep 26 2000). Data from the current, well-conducted study show that neither antibiotics nor -blockers -- or at least not 6-week courses of ciprofloxacin or tamsulosin -- help patients with CP/CPPS. An editorialist notes that the results for the antibiotic confirm prior findings, but that two earlier studies of -blockers (one lasting for 6 weeks, the other for 6 months) showed those drugs to be effective. Therefore, -blockers still might have a role in CP/CPPS treatment.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine November 9, 2004

Citation(s):

Alexander RB et al. Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: A randomized, double-blind trial. Ann Intern Med 2004 Oct 19; 141:581-9.

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• Medline abstract (Free)

Weidner W. Treating chronic prostatitis: Antibiotics no, -blockers maybe. Ann Intern Med 2004 Oct 19; 141:639-40.

• Original article (Subscription may be required)
• Medline abstract (Free)