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Management of chronic prostatitis/chronic pelvic pain syndrome: top 10 tips
1. Chronic prostate infection (category II chronic bacterial prostatitis) can be ruled out by performing a pre and post massage test
Comparing the culture results of the initial urine specimen (first 10 cc) after a vigorous prostate massage to a traditional midstream urine (MSU) taken before the massage is as accurate for diagnosing chronic prostate infection as the traditional 4-glass Meares-Stamey test in more than 95% of patients. This is most effective before antibiotics have been prescribed but can be successful by waiting for a period of time after antibiotic therapy has been completed. The test is positive if the post-massage test cultures any uropathogenic bacteria when the pre-massage specimen is sterile or when the post-massage test cultures at least one log more bacteria than in the pre-massage culture. A diagnosis of chronic prostate infection allows the physician to prescribe long-term antimicrobial therapy (at least 4–6 weeks).
2. There is no clinical rationale to perform microscopic evaluation of prostate-specific specimens in clinical practice
Textbooks and review articles on non-bacterial prostatitis will differentiate cases based on the presence or absence of white blood cells seen on microscopy in the differential urine or expressed prostatic secretion specimens. To date, there is no evidence to prescribe different treatments based on the differentiation of the inflammatory category of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) (category IIIA) from the non-inflammatory (category IIIB). In fact, asymptomatic men without prostatitis-like symptoms also have white blood cells in their expressed prostatic secretions and post-massage urine specimens.
3. The NIH Chronic Prostatitis Symptom Index (NIH-CPSI) saves time and frustration in clinical practice
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