Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome

Prostatitis is a common condition which can affect men of all ages; however, it is more frequently experienced in younger men with an initial onset around 40 years of age. The two main presenting clinical features of prostatitis are lower urinary tract symptoms and pelvic pain. Other symptoms might include obstructive or irritative voiding symptoms, ejaculatory pain, and hematospermia. A diagnosis is
usually based on the man's history, physical examination, urinalysis, and the two‐ or four‐glass test (also known as obtaining urine specimens before, during, and after prostatic massage). Further investigations may also be performed when considering the differential diagnosis. Prostatitis can result in a significant reduction in quality of life (QOL) and pain can be associated with sexual dysfunction in men. Prostatitis can be classified as four distinct types, namely, type I acute prostatitis, type II chronic bacterial prostatitis, type III chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and type IV asymptomatic prostatitis. It is unclear whether type III can be linked in all cases to prostatic involvement therefore the alternate denomination CPPS is used in clinical practice. Furthermore, CP/CPPS is further sub-classified as type IIIa (inflammatory), and type IIIb (noninflammatory) which is dependent on the presence of inflammatory cells in prostatic secretions. CP/CPPS is considered when pelvic pain is present for at least three of the preceding 6 months with no other identifiable causes determined.