An evidence-based approach to the treatment of prostatitis: is it possible?

The classification of prostatitis has been re-evaluated, and the National Institutes of Health (NIH) has defined the separate groups more thoroughly. Furthermore, the development of the NIH chronic prostatitis symptom index (CPSI) has allowed the symptoms to be measured and the effect of interventions calculated. A search of the literature finds that the quality of treatment trials in prostatitis is poor and the level of evidence for many of the existing strategies is lacking; there is a total absence of any meta-analyses of randomized controlled trials (level 1a). The bulk of literature consists of small descriptive studies (level III) or opinions from respected authorities (level IV). The advent of the NIH-CPSI has provided the opportunity for well-designed trials to be performed where the symptom outcomes can be quantified. This opportunity will be of greatest value in type III prostatitis where symptom amelioration is the main target of therapy and a number of treatment options abound.