KISS: Chronic Prostatitis | NB Medical

KISS: Chronic Prostatitis

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Based on Prostatitis Expert Group Consensus Guideline & BMJ2023;383:e073908 & MHRA 2023

There are two types of chronic prostatitis:

  • Chronic bacterial prostatitis (CBP)
    • The minority: 10% of men with chronic prostatitis, characterized by recurrent or relapsing symptoms with lower UTI symptoms and a positive MSU culture result
  • Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)
    • The vast majority: 90% of cases, and there is no proven bacterial infection, it is also known as chronic pelvic pain syndrome and internationally is sometimes called Prostate Pain Syndrome
    • Definition: > 3/12 of pain in the perineum or pelvic floor associated with lower urinary tract symptoms (LUTs) and sexual dysfunction (erectile dysfunction, painful ejaculation or post-ejaculatory discomfort)

Assessment: After full history and examination, consider important potential differentials (e.g. UTI, prostatic abscess, rectal or urological malignancy, BPH, urethral stricture etc) and investigate to exclude appropriately

  • Digital rectal examination: prostate may be enlarged, tender or normal
  • Urine dipstick and culture
  • Consider based on clinical judgement, potential differentials and patient choice the need for further investigation including for example STI testing, PSA, renal function and USS


  • Chronic prostatitis/chronic pelvic pain syndrome CP/CPPS
    • Reassurance & explanation. The good news is, observational research shows that symptoms do improve over time in most men Patient information
    • Manage according to which symptom domain in the patient is dominant i.e. urogenital pain, LUTs, sexual dysfunction or psychosocial distress
    • Pain relief: paracetamol +/-NSAIDs, do not prescribe opioids
      • Consider neuropathic pain treatment (e.g. amitriptyline or gabapentinoid) if neuropathic pain is suspectedConsider a stool softener e.g. docusate or lactulose if defecation is painful
  • Chronic prostatitis/chronic pelvic pain syndrome CP/CPPS continued:
    • LUTs: offer a 6-week trial of an alpha-blocker e.g. tamsulosin, but do not continue if there is no benefit
    • Antibiotics
      • There is a lack of evidence for CPPS, but consensus expert opinion is to offer a single 4 to 6-week trial of antibiotics if symptoms have been present for < 6 months; antibiotic options are
        • Quinolone e.g. ciprofloxacin 500mg bd or ofloxacin 200mg bd
          • BUT be aware of the potentially serious adverse events with fluoroquinolones, especially in patients aged over 60, with renal impairment or immune suppression MHRA 2023; warn patients Patient Information and advise to stop at the first sign of a serious adverse reaction e.g. tendon, joint or muscle pain
        • Trimethoprim 200mg bd if quinolones are not tolerated or contraindicated
      • Repeated courses of antibiotics should be avoided if there is no obvious symptomatic benefit from infection control or positive cultures
    • Consider referral for pelvic floor physiotherapy, stress management and CBT
    • Refer to urology if diagnostic doubt or troublesome symptoms persist, ideally for multi-disciplinary team management
  • Chronic bacterial prostatitis
    • Relapsing symptoms with positive bacterial cultures, refer to urology for specialist assessment
    • While awaiting referral, prescribe a single course of antibiotics for 4 to 6 weeks
      • Quinolone e.g. ciprofloxacin 500mg bd or ofloxacin 200mg bd
      • Trimethoprim 200mg bd if quinolones are not tolerated or contraindicated
Published on 10th January 2024

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