Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. Sept 2014 Jon Rees,1 Mark Abrahams,2 Victor Abu,3 Trevor Allan,4 Andrew Doble,5 Theresa Neale,6 Penny Nixon,7 Maxwell Saxty,8 Sarah Mee,9 Alison Cooper,10 Kirsty Haves,11 and Jenny Lee12 1GP (Chair of Prostatitis Expert Reference Group), Backwell and Nailsea Medical Group, Bristol; 2Pain Consultant, Addenbrooke’s Hospital, Cambridge; 3Clinical Nurse Specialist – Prostate, University College London Hospitals, London; 4Patient Representative; 5Consultant Urologist, Addenbrooke’s Hospital, Cambridge; 6Urology Clinical Nurse Specialist, South Warwickshire Foundation Trust; 7Physiotherapist Specialist, Addenbrooke’s Hospital, Cambridge; 8Cognitive Behavioural Therapist, Addenbrooke’s Hospital, Cambridge; 9Policy and Evidence Manager, Prostate Cancer UK; 10Senior Research Analyst, Prostate Cancer UK; 11Senior Account Manager, Hayward Medical Communications; 12Project Manager, Hayward Medical Communications A quick reference guide version of this guideline can be downloaded from: www.prostatecanceruk.org/prostatitisguideline ENDORSED BY September 2014 1 (due for review September 2017) Page Prostate Cancer UK is a registered charity in England and Wales (1005541) and in Scotland (SC039332). A company limited by guarantee registered number 2653887 (England and Wales). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. Sept 2014 Introduction ..................................................................................................................................................................... 4 Overview ........................................................................................................................................................................ 4 Guideline objectives ...................................................................................................................................................... 5 Guideline population ...................................................................................................................................................... 6 Methods ............................................................................................................................................................................ 7 Prostatitis Expert Reference Group ............................................................................................................................... 7 Literature search ............................................................................................................................................................ 7 Search protocol .......................................................................................................................................................... 7 Level of evidence ....................................................................................................................................................... 8 Delphi panel ................................................................................................................................................................... 8 Process ...................................................................................................................................................................... 8 Results ....................................................................................................................................................................... 9 Priorities for implementation ....................................................................................................................................... 10 Management recommendations – initial presentation .............................................................................................. 11 Introduction .................................................................................................................................................................. 11 Signs and symptoms ................................................................................................................................................... 11 Clinical assessment and diagnosis ............................................................................................................................. 16 Patient history .......................................................................................................................................................... 16 Patient communications ........................................................................................................................................... 18 Physical examinations ............................................................................................................................................. 18 Investigations ........................................................................................................................................................... 19 Diagnosis ................................................................................................................................................................. 23 Referral to a specialist setting .................................................................................................................................. 23 Treatment strategies .................................................................................................................................................... 23 Alpha-blockers ......................................................................................................................................................... 23 Antibiotics ................................................................................................................................................................. 25 Pain relief ................................................................................................................................................................. 29 5-alpha-reductase inhibitors .................................................................................................................................... 30 Combination/multimodal therapy ............................................................................................................................. 31 Management recommendations – follow-up .............................................................................................................. 33 Referral for specialist assessment and management ................................................................................................. 33 2 Treatment strategies .................................................................................................................................................... 33 Pain relief ................................................................................................................................................................. 33 Page Prostate Cancer UK is a registered charity in England and Wales (1005541) and in Scotland (SC039332). A company limited by guarantee registered number 2653887 (England and Wales). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. Sept 2014 Specialist physiotherapy .......................................................................................................................................... 36 Phytotherapy ............................................................................................................................................................ 38 Cognitive behavioural therapy and psychotherapy .................................................................................................. 38 Surgical intervention ................................................................................................................................................ 39 Research recommendations ........................................................................................................................................ 40 Acknowledgements ...................................................................................................................................................... 41 Updating the guideline ................................................................................................................................................. 41 Conflicts of interest ...................................................................................................................................................... 41 Comments or feedback ................................................................................................................................................ 41 References ..................................................................................................................................................................... 42 Appendix A – Relevant supporting information ........................................................................................................ 48 Appendix B – Prostatitis Expert Reference Group Members ................................................................................... 49 Supplementary Appendix 1 – Literature review protocol ........................................................................................