eMedicine Specialties > Urology > Infections and Related Inflammatory Conditions
Nonbacterial Prostatitis: Follow-up
Updated: Mar 18, 2008
Follow-up
Further Outpatient Care
- If symptoms resolve, patients do not need routine reevaluation. If symptoms do not resolve, periodic reevaluation should be considered. If older than 50 years, the patient should have an annual examination, including a rectal examination and PSA test.
Inpatient & Outpatient Medications
- See Medication.
Prognosis
- Prognosis is good if a definitive cause of symptoms can be identified and an effective treatment regimen started.
Patient Education
- Patients should be instructed to try to limit stress in their lives, which may exacerbate symptoms.
- Some urologists, the author included, also recommend frequent ejaculation to prevent a buildup or stasis of secretions within the prostate, thus avoiding inflammation and prostatitis symptoms.
- In addition, patients should be told that certain foods (see Diet) may cause more irritation; and, with a little experimenting, they can determine which foods to avoid or limit.
- For excellent patient education resources, visit eMedicine's Men's Health Center and Prostate Health Center. Also, see eMedicine's patient education articles Prostate Infections and Erectile Dysfunction.
Miscellaneous
Medicolegal Pitfalls
- Failing to consider bladder cancer as a cause for irritative voiding symptoms is a serious pitfall because bladder cancer can be cured if diagnosed in the early stages; a delay in diagnosis can result in the development of metastatic disease.
Special Concerns
- The goal of the new NIH classification system was to try to classify prostatitis into distinct categories to help stimulate research on the causes of this enigmatic disease. Research into the causes of prostatitis in its myriad forms is still at an early stage, and new discoveries of the etiologies of the symptom complex will no doubt lead to more successful treatments.
- See image below for a treatment algorithm.
Treatment algorithm for nonbacterial prostatitis.
- Nonbacterial prostatitis can be a very time consuming and difficult disease to treat. A typical patient the author sees presents with a constellation of symptoms consistent with prostatitis. In the initial office setting, the patient is given a copy of the NIH-CPSI (see image below) to complete. If the patient has normal findings after urinalysis, a rectal examination with prostatic massage and evaluation of the EPS is performed. If evidence of inflammation is present (>10 WBCs per high-power field), a trial of antibiotics is administered, along with alpha-blockers and instructions to ejaculate every 3 days. A postmassage urine culture may be sent for analysis. If the EPS culture results are negative, then the same treatment is applied minus the antibiotics. A PSA blood test is not sent at this time because the massage may skew the results.
Nonbacterial prostatitis. National Institutes of Health Chronic Prostatitis Symptom Index.
- Patients are usually seen again after 1 month, symptoms are reevaluated, and another NIH-CPSI form is completed. If symptoms have resolved, antibiotics are stopped. Alpha-blockers may be continued at the discretion of the treating physician. Patients with continued symptoms undergo a second prostate massage and EPS evaluation. If inflammation is still present, a full 6-week course of antibiotics is prescribed.
- Upon reevaluation at 2 months, symptoms are reviewed again. For patients with continued inflammation and symptoms, other causes are sought such as reflux of urine into the prostate, which may be indicative of a urethral stricture or enlargement of the prostate. If either process is suggested, a uroflow examination and/or retrograde urethrogram is performed. If the findings from these are normal, he may have increased pelvic floor tension and a trial of Valium or baclofen may be initiated. If these agents are unsuccessful, referral to a PM&R specialist or treatment with TUMT may be effective.
- Medications that may be effective at this point are NSAIDs, Cernilton (ie, for their anti-inflammatory qualities), and quercetin. If urinary urgency and frequency are a problem, anticholinergic medicines may be prescribed. Also, do not forget to order a cytology examination to help exclude bladder cancer. If pain with urination is a problem, consider interstitial cystitis.
- The stress level of the individual should also be evaluated, and referral to a psychologist may be initiated if needed.
More on Nonbacterial Prostatitis |
| Overview: Nonbacterial Prostatitis |
| Differential Diagnoses & Workup: Nonbacterial Prostatitis |
| Treatment & Medication: Nonbacterial Prostatitis |
 Follow-up: Nonbacterial Prostatitis |
| Multimedia: Nonbacterial Prostatitis |
| References |
| Further Reading |
| « Previous Page | Next Page » |
References
Chen R, Nickel JC. Acupuncture ameliorates symptoms in men with chronic prostatitis/chronic pelvic pain syndrome. Urology. Jun 2003;61(6):1156-9; discussion 1159. [Medline].
Anderson RU, Wise D, Sawyer T, Chan C. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. Jul 2005;174(1):155-60. [Medline].
[Guideline] Association of Genitourinary Medicine, Medical Society for the Study of Venereal Diseases. National guideline for the management of prostatitis. Clinical Effectiveness Group (Association of Genitourinary Medicine and the Medical Society for the Study of Venereal Diseases). Sex Transm Infect. Aug 1999;75 Suppl 1:S46-50. [Medline].
Barbalias GA, Nikiforidis G, Liatsikos EN. Alpha-blockers for the treatment of chronic prostatitis in combination with antibiotics. J Urol. Mar 1998;159(3):883-7. [Medline].
Bassotti G, Whitehead WE. Biofeedback, relaxation training, and cognitive behaviour modification as treatments for lower functional gastrointestinal disorders. QJM. Aug 1997;90(8):545-50. [Medline].
Bjerklund Johansen TE, Grüneberg RN, Guibert J, Hofstetter A, Lobel B, Naber KG, et al. The role of antibiotics in the treatment of chronic prostatitis: a consensus statement. Eur Urol. Dec 1998;34(6):457-66. [Medline].
Britton JJ, Carson CC. Prostatitis. In: AUA Update Series. Vol 17. 1998:154-9.
Collins MM, Stafford RS, O'Leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol. Apr 1998;159(4):1224-8. [Medline].
Forrest JB, Schmidt S. Interstitial cystitis, chronic nonbacterial prostatitis and chronic pelvic pain syndrome in men: a common and frequently identical clinical entity. J Urol. Dec 2004;172(6 Pt 2):2561-2. [Medline].
Kaplan SA, Santarosa RP, D'Alisera PM, Fay BJ, Ikeguchi EF, Hendricks J, et al. Pseudodyssynergia (contraction of the external sphincter during voiding) misdiagnosed as chronic nonbacterial prostatitis and the role of biofeedback as a therapeutic option. J Urol. Jun 1997;157(6):2234-7. [Medline].
Kaplan SA, Volpe MA, Te AE. A prospective, 1-year trial using saw palmetto versus finasteride in the treatment of category III prostatitis/chronic pelvic pain syndrome. J Urol. Jan 2004;171(1):284-8. [Medline].
Krieger JN, Nyberg L, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. Jul 21 1999;282(3):236-7. [Medline].
Litwin MS, McNaughton-Collins M, Fowler FJ Jr, Nickel JC, Calhoun EA, Pontari MA, et al. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network. J Urol. Aug 1999;162(2):369-75. [Medline].
Nickel JC, Downey J, Hunter D, Clark J. Prevalence of prostatitis-like symptoms in a population based study using the National Institutes of Health chronic prostatitis symptom index. J Urol. Mar 2001;165(3):842-5. [Medline].
Nickel JC, Downey J, Johnston B, Clark J. Predictors of patient response to antibiotic therapy for the chronic prostatitis/chronic pelvic pain syndrome: a prospective multicenter clinical trial. J Urol. May 2001;165(5):1539-44. [Medline].
Nickel JC, Sorensen R. Transurethral microwave thermotherapy for nonbacterial prostatitis: a randomized double-blind sham controlled study using new prostatitis specific assessment questionnaires. J Urol. Jun 1996;155(6):1950-4; discussion 1954-5. [Medline].
Schneider H, Ludwig M, Horstmann A, et al. The efficacy of cernilton in patients with chronic pelvic pain syndrome (CP/CPPS) type NIH III: a randomized prospective, double blind, placebo controlled study. J Urol. 2006;175(suppl);34:Abstract 105.
Shoskes DA, Shahed A. Presence of Bacterial Signal in Expressed Prostatic Secretions Predicts Response to Antibiotic Therapy in Men with the Chronic Pelvic Pain Syndrome. J Urol. 2000;163(4 Suppl):99.
Sinaki M, Merritt JL, Stillwell GK. Tension myalgia of the pelvic floor. Mayo Clin Proc. Nov 1977;52(11):717-22. [Medline].
Spaine DM, Mamizuka EM, Cedenho AP. Microbiological Aerobic Studies of the Normal Male Urethra. J Urol. 1998;161(4 Suppl):33.
Whitehead WE, Wald A, Diamant NE, Enck P, Pemberton JH, Rao SS. Functional disorders of the anus and rectum. Gut. Sep 1999;45 Suppl 2:II55-9. [Medline].
Keywords
nonbacterial prostatitis, chronic pelvic pain syndrome, CPPS, prostatodynia, abacterial prostatitis, noninflammatory chronic pelvic pain syndrome, noninflammatory CPPS, inflammatory chronic pelvic pain syndrome, inflammatory CPPS, asymptomatic inflammatory prostatitis, prostate pain, prostatitis symptom complex, chronic prostatitis symptom index, CPSI, irritative urologic symptoms, obstructive urologic symptoms
