Table of contents
Chronic prostatitis/chronic pelvic pain syndrome
What's new
Updated 2024 EAU guidelines for the diagnosis and management of chronic prostatitis/chronic pelvic pain syndrome.
Background
Overview
Definition
CP/CPPS, also known as primary prostate pain syndrome, is characterized by persistent or recurrent pain in the prostate or perineal area for ≥ 3 of previous 6 months without evidence of UTI.
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Pathophysiology
The pathophysiology of this syndrome is not fully understood, but it is believed to involve dysregulation of neurotransmitters and inflammation. Abnormalities in the regulation of neurotransmitter release and/or abnormal levels of extracellular neurotransmitter concentrations have been implicated in the neuronal foundations of pain disorders. Inflammation, either with the presence of white cells in the prostatic secretions or without, may also play a role.
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Epidemiology
The global prevalence of CP/CPPS is estimated at 2-10%, and is reported to constitute about 14% of male urological outpatients visits.
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Risk factors
Risk factors for CP/CPPS include age, stress, and a history of prostate infections.
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Disease course
Clinically, patients with CP/CPPS typically present with pain in the pelvic area but may also include the perineum, rectum, prostate, penis, testicles, and abdomen. They may also experience urinary symptoms, such as urgency, frequency, hesitancy, and poor or interrupted flow. Pain during ejaculation is also a common symptom.
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Prognosis and risk of recurrence
CP/CPPS can significantly impact the patient's QoL, leading to negative cognitive, behavioral, sexual, or emotional outcomes.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of chronic prostatitis/chronic pelvic pain syndrome are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024), the European Association of Urology (EAU 2024), and the Prostatitis Expert Reference Group (PERG 2015).
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Diagnostic investigations
Medical management
General principles: as per EAU 2024 guidelines, offer multimodal and phenotypically directed treatment options for primary prostate pain syndrome.
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Antibiotic therapy
Alpha-blockers
Pentosan polysulfate
NSAIDs
Other agents
Nonpharmacologic interventions
Psychosocial support
As per PERG 2015 guidelines:
Assess for psychosocial symptoms in both early and late stages of CP/CPPS. Screen for psychological factors if there is a significant suspicion of their contribution to the patient's condition.
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Consider offering CBT along with other treatments in later stages of CP/CPPS to enhance pain management and QoL.
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Alternative and complementary therapies