It is often associated with symptoms of LUTS (e.g., hesitancy, weak stream) or irritative voiding symptoms on voiding without evidence of a UTI. Men will complain of pain following orgasm/ejaculation. The symptoms usually remain stable or improve slightly over time, but some men have large fluctuations in the severity of symptoms that can be quite debilitating. The NIH Chronic Prostatitis Symptom Index (NIH-CPSI), nine-item questionnaire is useful in assessing baseline symptoms and responses to therapy. Total scores range from 0 to 43 points, with higher scores indicating more severe symptoms. A reduction of 4 to 6 points is significant. Initial treatment for CPPS is an α1-adrenergic receptor antagonists (alpha blocker). However, efficacy with most alpha-blockers has been inconclusive.
This pilot study by J. Curtis Nickel and colleagues is promising as it shows the possible benefit of a highly selective α1-adrenergic receptor agent, silodosin. This study used silodosin, at 4 and 8 mg. once daily. Results indicated that patients who received 4 mg silodosin experienced a significant decrease in total NIH-CPSI score compared to those who received placebo with decreases in total NIH-CPSI scores higher with 8 mg silodosin than placebo (not statistically significant). There was overall decrease in LUTS and an improvement in quality of life, specifically physical activity.
Nickel JC, O'Leary MP, Lepor H, Caramelli KE, Thomas H, Hill LA, Hoel GE
J Urol. 2011 Jul;186(1):125-31