Cochrane for Clinicians

Putting Evidence into Practice

Alternative Interventions for Chronic Prostatitis/Chronic Pelvic Pain Syndrome in Men


Am Fam Physician. 2019 Jun 1;99(11):677-678.

Clinical Question

Are nonpharmacologic therapies safe and effective for men with long-standing pelvic pain and lower urinary tract symptoms, also known as chronic prostatitis/chronic pelvic pain syndrome?

Evidence-Based Answer

In men with chronic pelvic pain and urinary dysfunction who have not responded to standard medical management, extracorporeal shock wave therapy reduces symptoms and increases quality of life. Acupuncture may also provide benefit to some patients.1 (Strength of Recommendation: B, based on limited-quality patient-oriented evidence.)

Circumcision, transrectal thermotherapy, and physical activity demonstrated a statistically but not clinically significant reduction in symptoms. It is unclear whether lifestyle modifications or prostatic massage provides any benefit. Most nonpharmacologic interventions are not associated with an increased risk of adverse events.1 (Strength of Recommendation: B, based on limited-quality patient-oriented evidence.)

Practice Pointers

Prostatitis is a common disorder affecting 10% to 14% of men in the United States, and it accounts for 1% of primary care visits each year.2,3 Chronic prostatitis/chronic pelvic pain syndrome, defined as pelvic pain and lower urinary tract symptoms lasting more than three months, is a diagnosis of exclusion and comprises most cases. Men typically present with pain in the lower abdomen, perineum, testicles, or penis, as well as urinary symptoms and sexual dysfunction, including ejaculatory pain. The variety of presentations likely reflects the unclear etiology of this disease. As such, there is no standard first-line pharmacologic intervention. Antibiotics, nonsteroidal anti-inflammatory drugs, pregabalin (Lyrica), alpha blockers, and 5-alpha reductase inhibitors are most commonly used, and response to medical management is often limited.

This Cochrane review of 38 randomized controlled trials involving 3,290 men evaluated the effectiveness of several nonpharmacologic interventions for chronic pr

Author disclosure: No relevant financial affiliations.


show all references

1. Franco JV, Turk T, Jung JH, et al. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev. 2018;(5):CD012551....

2. Bajpayee P, Kumar K, Sharma S, et al. Prostatitis: prevalence, health impact and quality improvement strategies. Acta Poloniae Pharmaceutica. 2012;69(4):571–579.

3. Collins MM, Stafford RS, O'Leary MP, et al. How common is prostatitis? A national survey of physician visits. J Urol. 1998;159(4):1224–1228.

4. Magistro G, Waenlaher FM, Grabe M, et al. Contemporary management of chronic prostatitis/chronic pelvic pain syndrome. European Urol. 2016;69(2):286–297.



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