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Clinical Decisionmaking

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Routine use of antibiotics and alpha-blockers to treat chronic prostatitis is not supported by evidence

Almost 2 million U.S. men suffering from prostatitis saw a doctor for their condition between 1990 and 1994. Chronic prostatitis is typically characterized by pelvic area pain and lower urinary tract symptoms. Unfortunately, the wide scope of recommended treatments for chronic prostatitis indicates how little is known about what causes the condition and how to diagnose and treat it.

Chronic prostatitis often results in physician frustration, patient confusion and dissatisfaction, variable thresholds for referral, and potentially inappropriate antibiotic use. In fact, the routine use of antibiotics and alpha-blockers to treat chronic prostatitis is not supported by the existing evidence, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS08397).

Although acute bacterial prostatitis is relatively straightforward to diagnose and treat, it accounts for few cases of prostatitis. Chronic prostatitis is much more common, is more difficult to diagnose and treat, and 90 percent of cases are abacterial (that is, untreatable by antibiotics) and of unknown cause. Optimal management of chronic abacterial prostatitis is not known. In this study, the researchers systematically reviewed studies from 1966 to 1999, contacted experts, and researched other sources to determine if there were reliable diagnostic tests or effective therapies for the condition. The 19 diagnostic test studies included 1,384 men (mean age, 33 to 67 years). The 14 treatment trials included 570 men (mean age 38 to 45 years) and involved use of finasteride and alpha-blockers, anti-inflammatory medications, antibiotics, and thermal therapy.

The researchers concluded that there was no gold-standard diagnostic test for chronic abacterial prostatitis, including the widely recommended bacterial localization test, and that the methodologic quality of diagnostic studies was low. The few treatment trials were conducted outside the United States. They were methodologically weak, small in scope, and did not support the effectiveness of the medications studied. Thermal therapy appeared to have clinically significant benefit, but further evaluation is needed.

See "Diagnosis and treatment of chronic abacterial prostatitis: A systematic review," by Mary McNaughton Collins, M.D., M.P.H., Roderick Macdonald, M.S., and Timothy J. Wilt, M.D., M.P.H., in the September 5, 2000 Annals of Internal Medicine 133(5), pp. 367-381.

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