Controversies in chronic abacterial prostatitis/pelvic pain syndrome

Chronic abacterial prostatitis (or prostatitis Category III according to the National Institutes of Health terminology) is subject to re-evaluation. Organizations such as the International Continence Society, the International Association for the Study of Pain and the European Association of Urology have been involved in a continuous endeavour to design a more accurate taxonomy system. The term prostate pain syndrome (PPS), as a subcategory of chronic pelvic pain syndromes, has recently been suggested as the most relevant. This condition is common, very bothersome and enigmatic. Symptoms are usually prolonged and, generally speaking, treatment results are unsatisfactory. During the last decade, research has focused on the distress caused by the condition, but although our knowledge has certainly increased there have been no real breakthroughs; controversies and many unanswered questions remain. Examples of pertinent issues are as follows: the criteria that need to be fulfilled for a diagnosis; the significance or lack of significance of leucocytes in expressed prostatic secretion; and the association between erectile dysfunction and PPS. The fundamental question remains: is the prostate really involved in the majority of men with PPS? This article focuses on some of the controversies.