Clinical Question: Is terazosin (Hytrin) effective for the treatment of chronic prostatitis/chronic pelvic pain?

Setting: Outpatient (specialty)

Study Design: Randomized controlled trial (double-blinded)

Synopsis: Many treatments of unproved benefit are available for the management of chronic prostatitis/chronic pelvic pain in men, creating frustration in patients and clinicians. A total of 100 men, 20 to 50 years of age, who met the National Institutes of Health (NIH) criteria for chronic prostatitis/chronic pelvic pain were recruited from a diverse population in northern Malaysia. Exclusion criteria included previous treatment with alpha agonists and evidence of bacterial prostatitis or urinary tract infection.

Subjects were randomly assigned in double-blind fashion (uncertain allocation concealment) to receive terazosin (dosage of 1 mg initially, titrated to 5 mg daily) or matched placebo for 14 weeks. Eighty-six percent of patients were available for follow-up. Outcomes were assessed by patient self-report using verified NIH pain and quality-of-life scoring systems.

Based on intention-to-treat analysis, 60 percent of patients in the terazosin group (compared with 36 percent in the placebo group) had a greater than 50 percent reduction in baseline pain scores (P =.03; number needed to treat = four). Median quality-of-life scores also were significantly improved in the terazosin group compared with the placebo group (56 percent and 36 percent, respectively, responded “delighted to mostly satisfied” with treatment). Although more side effects were reported in the terazosin group, no patient withdrew secondary to side effects.

Bottom Line: Terazosin is effective for reducing pain and improving the quality of life in men 20 to 50 years of age with chronic prostatitis/chronic pelvic pain. It must be noted that patients with an infectious cause for their pain were excluded from the study. (Level of Evidence: 1b-)