Chronic prostatitis (chronic pelvic pain syndrome)

Correspondence to R Healy [email protected]

What you need to know

• Chronic prostatitis, also known as chronic pelvic pain syndrome, is defined as pelvic pain with variable associated urinary symptoms and sexual dysfunction for at least three months

• Explore important differentials such as urological and rectal cancer, bacterial infection, benign prostatic enlargement, and neurological conditions

• Empower patients with knowledge about the condition and consider psychosocial and quality of life issues early on

A 64 year old man presents with recurrent episodes of perineal and testicular pain associated with urinary frequency. He was previously treated with antibiotics for prostatitis which didn’t help. He is very concerned about what these symptoms could signal and why they keep coming back.

Chronic prostatitis is defined as pelvic pain with variable associated urinary symptoms and sexual dysfunction that occurs for at least three months.¹ It is a common condition that can affect a patient’s quality of life.² The National Institutes of Health have defined four categories of prostatitis (table 1).⁶⁷ Type 3, chronic non-bacterial prostatitis, is the most common, and accounts for almost 90% of all diagnoses.⁶⁸ Chronic prostatitis is also known as chronic pelvic pain syndrome (CPPS) or primary prostate pain syndrome. Recently, bodies such as the European Association of Urology (EAU) are trying to move away from the term chronic prostatitis, as CPPS should be considered separate from acute and chronic bacterial prostatitis and is not associated with active infection.³ In this article, we refer to it as CPPS to avoid confusion with chronic bacterial prostatitis, which is much less common.

Table 1

National Institutes of Health Prostatitis classification 1995⁶⁷

CategoryInterpretation

Type I Acute bacterial prostatitis	Acute bacterial infection
Type II Chronic bacterial prostatitis	Recurrent bacterial infection
Type III Chronic non-bacterial prostatitis or chronic pelvic pain syndrome	No demonstrable infection
Type IIIa Inflammatory	White blood cells in semen, expressed prostatic secretions, or post-prostatic massage urine
Type IIIb Non-inflammatory	No white blood cells in semen, expressed prostatic secretions, or post-prostatic massage urine
Type IV Asymptomatic inflammatory prostatitis	Pathologist may diagnose on prostate biopsy, or white blood cells found in semen of expressed prostatic secretions during evaluation for other disorders

CPPS has a prevalence of 2-10% of men, according to literature...