A recent meta-analysis published in the January 5, 2011 edition of JAMA (The Journal of the American Medical Association) is the first study to rigorously examine the current literature on chronic prostatitis and pelvic pain syndromes in men. The authors reviewed 23 studies that compared pharmacologic treatments in men with these disorders to symptom scores (based upon the National Institutes of Health Chronic Prostatitis Symptom Index [NIH-CPSI] and International Prostate Symptom Score [IPSS], quality of life measures, and responses to various pharmacologic treatments versus control groups.
Compared to placebo, all 4 alpha-blockers were all found to offer statistically significant improvements in overall quality of life, decreased pain, and improved voiding symptoms. Those patients who received alpha-blocker therapy or steroidal/non-steroidal anti-inflammatory drugs (NSAIDs) had higher favorable responses with relative risk ratios of 1.6 and 1.8, respectively. Patients who received the 5-alpha reductase inhibitor finasteride or phytotherapies were found to have a mild effect on treatment response rates, pain, and voiding symptoms. Notably, statistical analysis revealed publication bias with alpha-blocker therapies in some of the smaller trials, suggesting an over-reporting of successful results relative to symptomatic improvement. The combination of both alpha-blockers and fluoroquinolone antibiotics yielded the greatest improvement over placebo relative to quality of life and pain scores.
The authors of this meta-analysis concluded that while there are statistically significant benefits to these pharmacologic treatments, they admitted that the sample sizes of most studies were quite small, and effect sizes were modest. Thus, this may have yielded over-estimations in power of reported statistical significance. Risk/benefit ratios of these therapies still need to be evaluated, and additional robust research is needed to further evaluate potential therapies for chronic prostatitis and pelvic pain syndromes in men.
Reference: Anothaisintawee T, Attia J, Nickel JC, et al. Management of chronic prostatitis/chronic pelvic pain syndrome. JAMA 2011;305(1)78-86.