Chronic Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome
It has been widely reported that more than 90 percent of men with prostatitis meet the criteria for chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CNP/CPPS).
"Like many such poorly understood conditions, CNP/CPPS remains a challenging syndrome. Patients usually have symptoms consistent with prostatitis, such as painful ejaculation or pain in the penis, testicles or scrotum. They may complain of low back pain, rectal or perineal pain, or even pain along the inner aspects of the thighs. They often have irritative or obstructive urinary symptoms and decreased libido or impotence. As a rule, these patients do not have recurrent urinary tract infections. The physical examination is usually unremarkable, but patients may have a tender prostate."
Information presented at the NIH consensus conference added asymptomatic prostatitis as a new category, partly because of the widespread use of the prostate-specific antigen (PSA) test.
Clearly, symptomatic bacterial prostatitis can elevate the PSA test to abnormal levels. Asymptomatic prostatitis may also elevate the PSA level. In addition, patients who are being evaluated for other prostatic disease may be found on biopsy to have prostatitis. There are no studies elucidating the natural history or appropriate therapy of this condition. It does appear that PSA levels return to normal four to six weeks after a 14-day course of antibiotics.23 Treatment is routinely recommended only in patients with chronic asymptomatic prostatitis known to elevate the PSA level. In these patients, it may be prudent to treat before drawing subsequent PSA samples.
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