Harvard Perspectives on Prostate Disease

Chronic nonbacterial prostatitis (chronic pelvic pain syndrome)

Current options for dealing with the most common form of prostatitis

Chronic nonbacterial prostatitis (also known as chronic pelvic pain syndrome) is an all-too-common male genitourinary condition characterized by episodes of pain and discomfort that come and go unpredictably. It may also involve inflammation and difficulties with urination. Although not life-threatening, chronic pelvic pain syndrome has the power to stop a sufferer dead in his tracks "" degrading the quality of his personal and work lives and leaving him confounded and depressed.

Of the four categories of prostatitis defined by the National Institutes of Health (see Table 1), chronic pelvic pain syndrome is most common, accounting for about 90% of all cases. It's also notorious for being the most difficult type of prostatitis to live with. A major difficulty is that in most instances, doctors are unable to definitively diagnose the condition and confidently identify a causative agent. Not surprisingly, with so little to go on, treatment is empiric "" guided by a doctor's clinical experience and instincts rather than hard evidence of what actually works. When they have prescribed standard treatments only to have patients experience little or merely temporary relief, many practitioners don't know what to do next for chronic pelvic pain syndrome, other than to keep cycling through the same standard treatment options.

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