Diagnosis and Treatment of Chronic Abacterial Prostatitis

Diagnosis and Treatment of Chronic Abacterial Prostatitis

A Systematic Review

From Massachusetts General Hospital, Boston, Massachusetts; and the Veterans Affairs Coordinating Center of the Cochrane Review Group in Prostate Diseases and Urologic Malignancies and the Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota.

Abstract

Purpose: The optimal management of chronic abacterial prostatitis is not known. A systematic review of the literature was done to answer the following questions: Are there accurate, reliable tests to diagnose chronic abacterial prostatitis? Are there effective therapies for it?

Data Sources: Studies were identified by searching MEDLINE (1966 to 1999), the Cochrane Library, and bibliographies of identified articles and reviews and by contacting an expert.

Study Selection: Diagnostic test articles were included if they reported on controlled studies; treatment articles were included if they reported on randomized or controlled trials. No language restrictions were applied.

Data Extraction: For each selected article, two investigators independently extracted key data on study design, patient characteristics, diagnostic test or treatment characteristics, and outcomes.

Data Synthesis: 19 diagnostic test articles and 14 treatment trials met the inclusion criteria. The disparity among studies in design, interventions, and other factors precluded quantitative analysis or pooling of the findings. Diagnostic test articles included 1384 men (mean age, 33 to 67 years) and evaluated infection; inflammation, immunology, and biochemistry; psychological factors; and ultrasonography. Treatment trials included 570 men (mean age, 38 to 45 years) and evaluated medications used to treat benign prostatic hyperplasia, anti-inflammatory drugs, antibiotics, thermotherapy, and miscellaneous medications. No trial was done in the United States.

Conclusions: There is no gold-standard diagnostic test for chronic abacterial prostatitis, and the methodologic quality of available studies of diagnostic tests is low. The few treatment trials are methodologically weak and involved small samples. The routine use of antibiotics and α-blockers to treat chronic abacterial prostatitis is not supported by the existing evidence.

Article and Author Information

Acknowledgments: The authors thank J. Curtis Nickel, MD, and Robert H. Fletcher, MD, MSc, for critical review of an earlier version of the manuscript.
Grant Support: In part by grants from the Agency for Healthcare Research and Quality (HS 08397); the National Institute for Diabetes and Digestive and Kidney Diseases, National Institutes of Health (DK53736); and the Department of Veterans Affairs Health Services Research and Development Service.
Requests for Single Reprints: Timothy J. Wilt, MD, MPH, Veterans Affairs Coordinating Center for the Cochrane Review Group In Prostate Diseases and Urologic Malignancies, Veterans Affairs Medical Center, Center for Chronic Disease Outcomes Research (111-0), One Veterans Drive, Minneapolis, MN 55417; e-mail, tim.wilt{at}med.va.gov.
Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
Current Author Addresses: Dr. McNaughton Collins: General Medicine Unit, Massachusetts General Hospital, 50 Staniford Street, Ninth Floor, Boston, MA 02114.
Mr. MacDonald: Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center (111-0), One Veterans Drive, Minneapolis, MN 55417.
Dr. Wilt: Section of General Internal Medicine and the Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center (111-0), One Veterans Drive, Minneapolis, MN 55417.