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Multidisciplinary approach to prostatitis.

Vittorio Magri1, Matteo Boltri, Tommaso Cai

  • 1ASST Nord Milano. alberto.trinchieri@gmail.com.

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This research reviews prostatitis classifications and treatments, highlighting chronic inflammation

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Area of Science:

  • Urology and Infectious Diseases: Focuses on the clinical and microbiological aspects of prostatitis.

Background:

  • Modern prostatitis research builds upon Stamey's work, leading to NIH classifications: acute bacterial prostatitis, chronic bacterial prostatitis, Chronic Pelvic Pain Syndrome (CPPS), and asymptomatic prostatitis.
  • Chronic inflammation is a key factor in benign prostatic hyperplasia (BPH) and prostatitis progression, with links to prostate cancer risk.
  • The UPOINT system, expanded to UPOINTS, categorizes patients for targeted treatments, addressing urinary, psychosocial, organ-specific, infection, neurological, sexual, and muscle tension domains.

Purpose of the Study:

  • To provide a comprehensive overview of prostatitis, including its classification, diagnostic methods, and therapeutic strategies.
  • To discuss the role of inflammation, microbial pathogens, and emerging diagnostic and treatment modalities in prostatitis management.

Main Methods:

  • Review of established clinical research principles, NIH and UPOINTS classifications.
  • Analysis of diagnostic imaging techniques such as prostatic ultrasound and multiparametric MRI (mpMRI).
  • Examination of microbiological investigations, including bacterial culture, molecular methods for STI agents, and next-generation analyses (cytokines, immune cells, epigenetics).

Main Results:

  • Enterobacteriaceae and Enterococci are common pathogens; Chlamydia trachomatis and Mycoplasma genitalium are implicated in chronic bacterial prostatitis.
  • Antimicrobials are first-line treatments, with specific agents recommended for acute and chronic bacterial prostatitis, including fluoroquinolones, macrolides, and tetracyclines.
  • Multimodal therapy combining alpha-blockers, antibiotics, and anti-inflammatories shows improved symptom control; phytotherapy and probiotics offer alternative or complementary approaches.

Conclusions:

  • Effective prostatitis management requires accurate classification, appropriate diagnostic work-up, and tailored therapeutic strategies, including antimicrobials, anti-inflammatories, and lifestyle interventions.
  • Further research into novel therapeutic targets, biomarkers, and the gut-prostate axis is warranted to improve patient outcomes and quality of life.