Chronic prostatitis/chronic pelvic pain syndrome: The biomedical model has failed! So what's next?

Prostatitis, particularly the chronic condition not associated with a bacterial etiology, is a common urologic condition. This "disease" is the most common diagnosis seen in urology outpatient practice in men under 50 years of age and is the third most common in men over age 50, representing between 3% and 12% of male urology visits. Between 2% and 9% of men have recently experienced prostatitis-like symptoms, and up to 16% have received a diagnosis of prostatitis.

Until several years ago, urologists only had clinical trial data that provided reliable evidence to treat bacterial prostatitis. The vast majority of patients previously diagnosed with nonbacterial prostatitis and/or prostatodynia, now referred to as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), were managed with strategies that evolved from dogma, tradition, anecdotal experience, and results from a few small uncontrolled clinical series. The recent consensus-derived definition and classification of the prostatitis syndromes and the development of a validated outcome measure—the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), which has been proven to be useful in clinical research trials and clinical practice—have led to a literal tsunami of peer-reviewed published evidence that provides the potential for better management of patients with CP/ CPPS.

Despite this recent rising tide of research, the traditional biomedical model that has driven our understanding of the etiology, diagnosis, and management of CP/CPPS has not yielded the hoped-for breakthrough in treating this condition. This article outlines the most up-to-date information from recently published clinical trials and documents that our traditional treatment modalities, at best, lead to only modest symptom improvement in some patients. The article further describes:

• where our traditional etiologic model may not be correct,
• how our new understanding of the pathogenesis of CP/CPPS may eventually lead to more effective treatment strategies, and
• what the research community is currently doing with this new understanding.

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