Current Management of Male Chronic Pelvic Pain Syndromes

The term prostatitis denotes a combination of infectious conditions (acute and chronic bacterial prostatitis), chronic pelvic pain syndrome (CPPS) and asymptomatic inflammation, of which most of them are CPPS. In spite of many years of investigation, the cause of CPPS remains elusive and can be multifactorial. Different factors have been proposed in the etiopathogenesis of CPPS, including viral infection, psychological stress effects, hormonal and neural factor, T-cell recognition of prostatic peptides, and possibly autoimmune diseases. However, a universally effective, reliable and lasting beneficial treatment of the CP/CPPS remains uncertain. A wide variety of treatments have been applied to CPPS patients, including alpha-blockers, antimicrobial therapy, nonsteroidal anti-inflammatory medicine, heat therapy and local infiltration therapies. Treatment is clinically based on optimal symptomatic relief and pain control. Psychological factors can also affect the development of chronic pain and treatment outcomes. Psychological distress comes from both persistent pelvic pain and worrying about tissue damage or malignancy development. It is important to inform patients about the variety of potential therapies and to develop a trusting relationship with them. Additional studies in the understanding of the etiologies of CP/CPPS and the establishment of treatment strategies are urgently needed.