To assess the effects of pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) PATIENTS AND METHODS: We performed a comprehensive search using multiple databases, trial registries, grey literature and conference proceedings with no restrictions on the language of publication or publication status. The date of the latest search of all databases was July 2019. We included randomised controlled trials. Inclusion criteria were men with a diagnosis of CP/CPPS. We included all available pharmacological interventions. Two review authors independently classified studies and abstracted data from the included studies, performed statistical analyses and rated quality of evidence (QoE) according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. The primary outcomes were prostatitis symptoms and adverse events. The secondary outcomes were sexual dysfunction, urinary symptoms, quality of life, anxiety and depression.
We included 99 unique studies in 9119 men with CP/CPPS, with assessments of 16 types of pharmacological interventions. Most of our comparisons included short-term follow-up information. The median age of the participants was 38 years. Most studies did not specify their funding sources; 21 studies reported funding from pharmaceutical companies. We found low- to very low-quality evidence that alpha blockers may reduce prostatitis symptoms based on a reduction in NIH-CPSI scores of more than two (but less than eight) with an increased incidence of minor adverse events such as dizziness and hypotension Moderate- to low-quality evidence indicates that 5-alpha reductase inhibitors, antibiotics, anti-inflammatories, and phytotherapy probably cause a small decrease in prostatitis symptoms and may not be associated with a greater incidence of adverse events. Intraprostatic BTA injection may cause a large reduction in prostatitis symptoms with procedure-related adverse events (haematuria), but pelvic floor muscle BTA injection may not have the same effects (low-quality evidence). Allopurinol may also be ineffective for the reduction of prostatitis symptoms (low-quality evidence). We assessed a wide range of interventions involving traditional Chinese medicine; low-quality evidence showed they may reduce prostatitis symptoms without an increased incidence in adverse events. Moderate- to high-quality evidence indicates that the following interventions may be ineffective for the reduction of prostatitis symptoms: anticholinergics, OM-89, pentosan, and pregabalin. Low- to very low-quality evidence indicates that antidepressants and tanezumab may be ineffective for the reduction of prostatitis symptoms. Low-quality evidence indicates that mepartricin and phosphodiesterase inhibitors may reduce prostatitis symptoms, without an increased incidence in adverse events.
Based on the findings of low to very low-quality evidence, this review found that some pharmacological interventions such as alpha blockers may reduce prostatitis symptoms with an increased incidence of minor adverse events such as dizziness and hypotension. Other interventions may cause a reduction in prostatitis symptoms without an increased incidence of adverse events while others were found ineffective.
BJU international. 2020 Jan 03 [Epub ahead of print]
Juan Va Franco, Tarek Turk, Jae Hung Jung, Yu-Tian Xiao, Stanislav Iakhno, Federico Ignacio Tirapegui, Virginia Garrote, Valeria Vietto
Argentine Cochrane Centre, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina., Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic., Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea, South., Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China., University of Tromso, Tromsdalen, Norway., Urology Division, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina., Biblioteca Central, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina., Family and Community Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.