Diagnosis and treatment of chronic abacterial prostatitis: A systematic review

Purpose: The optimal management of chronic abacterial prostatitis is not kn own. A systematic review of the literature was done to answer the following questions: Are there accurate, reliable tests to diagnose chronic abacteri al prostatitis? Are there effective therapies for it? Data Sources: Studies were identified by searching MEDLINE (1966 to 1999), the Cochrane Library, and bibliographies of identified articles and reviews and by contacting an expert. Study Selection: Diagnostic test articles were included if they reported on controlled studies; treatment articles were included if they reported on r andomized or controlled trials. No language restrictions were applied. Data Extraction: For each selected article, two investigators independently extracted key data on study design, patient characteristics, diagnostic te st or treatment characteristics, and outcomes. Data Synthesis: 19 diagnostic test articles and 14 treatment trials met the inclusion criteria. The disparity among studies in design, interventions, and other factors precluded quantitative analysis or pooling of the finding s. Diagnostic test articles included 1384 men (mean age, 33 to 67 years) an d evaluated infection; inflammation, immunology, and biochemistry; psycholo gical factors; and ultrasonography. Treatment trials included 570 men (mean age, 38 to 45 years) and evaluated medications used to treat benign prosta tic hyperplasia, anti-inflammatory drugs, antibiotics, thermotherapy, and m iscellaneous medications. No trial was done in the United States. Conclusions: There is no gold-standard diagnostic test for chronic abacteri al prostatitis, and the methodologic quality of available studies of diagno stic tests is low. The few treatment trials are methodologically weak and i nvolved small samples. The routine use of antibiotics acid alpha-blockers t o treat chronic abacterial prostatitis is not supported by the existing evi dence.