Article type
Year
Abstract
Background: The optimal management of chronic abacterial prostatitis is not known. We systematically reviewed the literature to answer the following two questions about patients with abacterial prostatitis: 1. Are there accurate, reliable tests to diagnose this condition? 2. Are there effective therapies to treat it?
Methods: Studies were identified through a search of MEDLINE (1966-99), the Cochrane Library, bibliographies of identified articles and reviews, and contact with an expert. Diagnostic test articles were included if they were controlled studies; treatment articles were included if they were randomized or controlled trials. There were no language restrictions. Two investigators for each selected article on diagnosis and treatment independently extracted key data on study design features, subject characteristics, diagnostic test and treatment characteristics, and outcomes of the studies.
Results: 19 diagnostic test articles and 14 treatment trials met the inclusion criteria. The disparity between studies did not permit quantitative analysis or pooling of the findings across trials. The diagnostic articles evaluated: infection; inflammation, immunology, and biochemistry; psychological factors; and ultrasonography. There were a total of 1384 men (mean age range 33-67). The treatment trials involved: medications used to treat benign prostatic hyperplasia; anti-inflammatory medications; antibiotics; thermotherapy; and miscellaneous medications. There were a total of 570 enrollees (mean age 38-45). None of the trials were done in the United States.
Conclusions: There was no gold standard diagnostic test for chronic abacterial prostatitis, and the available diagnostic studies were of low methodologic quality. No therapy has been demonstrated to be effective. The treatment trials were few, weak methodologically, and involved small sample sizes. Our results support the following recommendations: 1. The NIH chronic prostatitis classification system should be used for classifying patients and coding diagnoses; 2. Future studies of diagnostic and etiologic tests are needed and should meet methodologic standards, such as the presentation of the sensitivity and specificity of the test; 3. The routine use of antibiotics and alpha blockers for chronic abacterial prostatitis are not supported by existing evidence and deserve further scrutiny. The small studies examining thermal therapy appear to demonstrate benefit of clinical significance and merit further evaluation; 4. Future trials should report important patient characteristics (e.g., race), study design details, assessment measures, and clinical outcomes.
Methods: Studies were identified through a search of MEDLINE (1966-99), the Cochrane Library, bibliographies of identified articles and reviews, and contact with an expert. Diagnostic test articles were included if they were controlled studies; treatment articles were included if they were randomized or controlled trials. There were no language restrictions. Two investigators for each selected article on diagnosis and treatment independently extracted key data on study design features, subject characteristics, diagnostic test and treatment characteristics, and outcomes of the studies.
Results: 19 diagnostic test articles and 14 treatment trials met the inclusion criteria. The disparity between studies did not permit quantitative analysis or pooling of the findings across trials. The diagnostic articles evaluated: infection; inflammation, immunology, and biochemistry; psychological factors; and ultrasonography. There were a total of 1384 men (mean age range 33-67). The treatment trials involved: medications used to treat benign prostatic hyperplasia; anti-inflammatory medications; antibiotics; thermotherapy; and miscellaneous medications. There were a total of 570 enrollees (mean age 38-45). None of the trials were done in the United States.
Conclusions: There was no gold standard diagnostic test for chronic abacterial prostatitis, and the available diagnostic studies were of low methodologic quality. No therapy has been demonstrated to be effective. The treatment trials were few, weak methodologically, and involved small sample sizes. Our results support the following recommendations: 1. The NIH chronic prostatitis classification system should be used for classifying patients and coding diagnoses; 2. Future studies of diagnostic and etiologic tests are needed and should meet methodologic standards, such as the presentation of the sensitivity and specificity of the test; 3. The routine use of antibiotics and alpha blockers for chronic abacterial prostatitis are not supported by existing evidence and deserve further scrutiny. The small studies examining thermal therapy appear to demonstrate benefit of clinical significance and merit further evaluation; 4. Future trials should report important patient characteristics (e.g., race), study design details, assessment measures, and clinical outcomes.