. Author manuscript; available in PMC: 2017 Oct 1.

Published in final edited form as: Mayo Clin Proc. 2016 Oct;91(10):1471–1486. doi: 10.1016/j.mayocp.2016.08.011

Table 4. Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome.

Category	Examples	Evidence Strength^a	Comments
Oral pharmacotherapy
Antibiotics	Ciprofloxacin, levofloxacin, tetracycline	A⁵	Initial treatment often includes a 4-6 week course of antibiotics Consider repeating antibiotics only in patients who have positive urine cultures or partially respond to the first course
α-blockers	Uroselective: tamsulosin, alfuzosin, doxazosin Others: terazosin, silodosin	A⁵	More effective against lower urinary tract symptoms than pain Uroselective agents have a lower risk of orthostatic hypotension and syncope
Phytotherapy	Rye pollen extract, quercetin	B⁵⁹	Should be considered for patients with inadequate symptom control to initial antibiotics, α-blockers and analgesics⁶
Analgesics	Acetaminophen, NSAIDs	C⁶⁰	Avoid narcotics
Neuromodulators	Amitriptyline, gabapentinoids (eg, pregabalin or gabapentin), SNRIs (eg, duloxetine)	B⁶¹	Early use of neuromodulating agents in pain of neuropathic origin
Hormonal agents	Finasteride, dutasteride, mepartricin	C⁶²	Not recommended as monotherapy Hormonal agents considered only if benign prostatic hypertrophy is coexistent
5-phosphodiesterase inhibitors	Sildenafil, mirodenafil, tadalafil	C⁶³	Coexisting erectile dysfunction
Adjunct approaches
Physical therapy and acupuncture	Pelvic floor biofeedback Trigger-point injection Percutaneous/transcutaneous tibial nerve stimulation(PTNS) Electroacupuncture Aerobic exercise	C⁶⁴	Pain or tenderness in the lower abdominal or pelvic musculature Pelvic floor physical therapy not only improved overall symptoms but also improved sexual dysfunction
Surgical approaches
Sacral nerve stimulation	Sacral neuromodulation (InterStim; Medtronic)	C⁶⁵	Efficacy unknown
Surgery	Prostatectomy Transurethral resection of the prostate (TURP) Transrectal high-intensity focused ultrasound (HIFU) Transurethral needle ablation (TUNA) of the prostate Transurethral microwave thermotherapy (TUMT)	D⁶⁶	Efficacy unknown

Abbreviations: NSAID, nonsteroidal antiinflammatory drug; SNRI, serotonin-norepinephrine reuptake inhibitor.

Level A: meta-analysis of well-designed randomized controlled trials; B: at least 1 well-designed randomized controlled trial; C: at least 1 well-designed observational study; D: case series.