Chronic prostatitis: Current concepts

Chronic prostatitis (CP) is a common condition. It causes significant suffering to the patients and constitutes a sizeable workload for the urologists. The purpose of this review is to describe the currently accepted concepts regarding the aspects of CP.

Materials and Methods: Relevant papers on the epidemiology, etiology, diagnosis, evaluation and management of CP were identified through a search of MEDLINE using text terms "prostatitis", "chronic prostatitis" and "chronic pelvic pain syndrome". The list of articles thus obtained was supplemented by manual search of bibliographies of the identified articles and also by exploring the MEDLINE option "Related Articles".

Results: The salient points of the relevant articles on each aspect of CP have been summarized in the form of a non-systematic narrative review.

Conclusion: Chronic prostatitis is caused by a variety of infective and non-infective factors and is characterized by a rather long remitting and relapsing clinical course. The diagnosis is based on symptoms comprising pain and nonspecific urinary and/or ejaculatory disturbances and microbiological tests to localize bacteria and/or leucocytes in segmented urinary tract specimens. The contemporary classification was proposed by the National Institutes of Health/National Institute of Diabetes Digestive Kidney Diseases (NIH/NIDDK). National Institutes of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) is the patient evaluation tool used extensively in clinical practice and research. Management should be individualized, multimodal and of an appropriate duration.

Chronic prostatitis (CP) is a common, yet poorly understood condition. It spells misery not only for the patients who have to suffer, but also for the urologists looking after them. They often find themselves running out of ideas when faced with this difficult problem, as there are few effective treatment options available at their disposal. Research in this field in the last few years has centered on the generation of a new classification system and a symptom score to evaluate patients with. It is expected that better categorization of patients will result in more individualized use of the existing treatment modalities, some of which have recently been tested in a randomized controlled setting. The purpose of this update is to familiarize the reader with the currently accepted concepts in a continuously evolving area.

The term chronic prostatitis should be considered a misnomer in that the entity may not necessarily be inflammatory or exclusively prostatic in origin. Bearing in mind this caveat, CP can be defined as a clinical syndrome characterized by pain in the perineum, pelvis, suprapubic area or the external genitalia, with a variable degree of voiding and/or ejaculatory disturbance.

Epidemiology

Prostatitis is a significant health problem with prevalence rates of 11-16%. [2],[3] More than 2 million consultations for prostatitis are required every year in the United States [4] and each Canadian urologist treats about 262 such patients every year. [5] Prostatitis is the most common reason for men under 50 to consult a urologist [4] and indeed it generates more physician visits than benign prostatic hyperplasia or prostate cancer in the United States. [6] It has a significant impact on the quality of life (QoL) comparable to active Crohn's disease or a recent myocardial infarction. [7] Up to 50% of men may be affected by it at some stage of their lives.