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Diagnostic and Management Strategies for Patients with Chronic Prostatitis and Chronic Pelvic Pain Syndrome

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Abstract

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common and often heterogenous condition that can have severe consequences on patient quality of life. In this review, we describe the pathophysiology, diagnostic work-up, and treatment of patients with CP/CPPS incorporating the most recent literature. Studies have demonstrated that CP/CPPS involves a complex pathophysiology, including infectious, immunologic, neurologic, endocrinologic, and psychologic etiologies, with frequent intersections between the different entities. Despite robust research assessing a variety of therapeutics targeting these etiologies, clinical trials have failed to identify an empiric treatment strategy applicable specifically to older adult male patients with CP/CPPS. As such, it can be challenging to manage older male patients with this condition. The advent of clinical phenotyping of patients with CP/CPPS has led to advances in tailored management strategies. Monomodal therapy has been largely unsuccessful because of the unclear and complex etiology of CPPS. As a result, CP/CPPS therapy has transitioned to a multimodal approach, including both pharmacologic and non-pharmacologic therapies. The best studied pharmacologic therapies include antibiotics, alpha-blockers, anti-inflammatory and immunomodulatory agents, phytotherapies, phosphodiesterase inhibitors, hormonal agents, neuromodulatory agents, and antidepressants. The best studied non-pharmacological therapies include pelvic floor physical therapy, myofascial trigger point release, acupuncture and electroacupuncture, psychological support and biofeedback, and electrocorporeal shockwave therapy and local thermotherapy.

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  1. Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA

    Vanessa N. Pena, Noah Engel, Andrew T. Gabrielson, Matthew J. Rabinowitz & Amin S. Herati

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Vanessa N. Pena: Conceptualization, Methodology, Investigation, Resources, Data Curation, Writing - Original Draft, Supervision, Project Administration; Noah Engel: Investigation, Resources, Data Curation, Writing - Review & Editing, Visualization, Project Administration; Andrew T. Gabrielson: Conceptualization, Methodology, Investigation, Resources, Data Curation, Writing - Original Draft, Project Administration; Matthew J. Rabinowitz: Resources, Writing - Review & Editing; Amin S. Herati: Conceptualization, Methodology, Resources, Writing - Review & Editing, Supervision, Project Administration, Funding Acquisition.

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Pena, V.N., Engel, N., Gabrielson, A.T. et al. Diagnostic and Management Strategies for Patients with Chronic Prostatitis and Chronic Pelvic Pain Syndrome. Drugs Aging 38, 845–886 (2021). https://doi.org/10.1007/s40266-021-00890-2

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