Grady Report: What are the current guidelines for the pharmacological management of prostatitis?

The Bottom Line: For healthcare providers, the focus of therapy is symptomatic relief. The first therapeutic measure is often a 4- to 6-week course of a fluoroquinolone, which provides relief in 50% of men and is more efficacious if prescribed soon after symptoms begin. Second-line pharmacotherapy involves anti-inflammatory agents for pain symptoms and alpha-adrenergic receptor antagonists (alpha-blockers) for urinary symptoms. Potentially more effective is pelvic floor training/biofeedback, but randomized controlled trials are needed to confirm this. Third-line agents include 5alpha-reductase inhibitors, glycosaminoglycans, quercetin, cernilton (CN-009) and saw palmetto.  Pain and urinary symptoms can be ameliorated with anti-inflammatories and alpha-blockers.

Summary: CP/CPPS has many clinical presentations and treatment options, with fluoroquinolones as the only FDA-approved first-line agents. Combination therapy of an α-blocker for ≥12 weeks with a fluoroquinolone may be considered a multimodal first-line therapy. Differentiating CP/CPPS from the other NIH prostatitis subtypes helps healthcare professionals design treatment plans that optimize response.

Reference: Murphy AB, et al. “Chronic prostatitis: management strategies.Drugs 2009; 69(1):71-84.

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