[Therapy of prostatitis syndrome]

The chronic prostatitis syndrome is a multifactorial disease of mainly unknown etiology. Quite different therapeutic options are therefore recommended. According to the new NIH classification only in acute and chronic bacterial prostatitis pathogens can be cultured. A long-term antimicrobial therapy, mainly with fluoroquinolones, is therefore recommended. Most of the patients, however, suffer from a chronic pelvic pain syndrome (CPPS) which can be subdivided into an inflammatory and a non-inflammatory CPPS. Whether the inflammatory CPPS is an infectious disease, remains uncertain. An antibiotic therapy therefore is not the first choice. Several patients, however, have been improved by such a therapy, especially in combination with alpha-receptor blockers. In case of proven or suspected functional obstruction of the bladder neck long-term treatment with relatively high dosages of alpha-receptor blockers is recommended. In case of failure other treatment modalities, including psychosomatics, may be applied, of which usually only results of sporadic reports but not of controlled studies are available. It is important, however, to keep the patient fully informed about the diagnostic and therapeutic problems not to interfere with a trustful therapist-patient relationship.