Reports from the Field
Searching for gold standard for chronic prostate care
Nearly 2 million American men suffering from prostatitis saw a physician for their condition between 1990 and 1994. The condition is characterized by pelvic area pain and lower urinary tract symptoms. The wide scope of recommended treatments for chronic prostatitis indicates how little is known about the causes, diagnosis, and treatment of the condition, leaving both patients and physicians confused and dissatisfied, according to a recent Annals of Internal Medicine article.
Acute bacterial prostatitis is straightforward to diagnose and treat, say researchers, adding that unfortunately bacterial prostatitis accounts for few cases of prostatitis. Chronic prostatitis is more common and more difficult to diagnose and treat; 90% of all cases are abacterial and of unknown cause. In this study, researchers systematically reviewed studies from 1966 to 1999, contacted experts, and researched other sources to determine if there were reliable diagnostic tests or effective therapies for the condition.
The 19 diagnostic studies reviewed included 1,384 men between 33 and 67 years old. The 14 treatment trials reviewed included 570 men between the ages of 38 and 45 years old and involved the use of finasteride and alpha-blockers, anti-inflammatory medications, antibiotics, and thermal therapy.
Researchers concluded that there were no gold-standard diagnostic tests for chronic abacterial prostatitis, including the widely recommended bacterial localization tests, and that the quality of diagnostic studies was low. The treatment trials were conducted outside the United States and were methodologically weak, small in scope, and did not support the effectiveness of the medications studied. Thermal therapy appeared to have clinically significant benefit, say researchers.
[See: Collins MM, MacDonald R, Wilt TJ. Diagnosis and treatment of chronic abacterial prostatitis: A systematic review. Ann Int Med 2000; 133(5):367-381.]
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