Chronic prostatitis (chronic pelvic pain syndrome)

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.

CPPS has a prevalence of 2-10% of men, according to literature reviews of population based studies from North America, Finland, Singapore, Japan, and Malaysia.4 A large cross-sectional study suggests the risk increases with age, with …