Alfuzosin and Symptoms of Chronic Prostatitis–Chronic Pelvic Pain Syndrome

Nickel, J. Curtis; Krieger, John N.; McNaughton-Collins, Mary; Anderson, Rodney U.; Pontari, Michel A.; Shoskes, Daniel A.; Litwin, Mark S.; Alexander, Richard B.; White, Paige; Berger, Richard E.; Nadler, Robert B.; O’Leary, Michael P.; Liong, Men Long; Zeitlin, Scott I.; Chuai, Shannon; Landis, J. Richard; Kusek, John W.; Nyberg, Leroy M.; Schaeffer, Anthony J.

doi:10.1056/nejmoa0803240

Cited by 157 publications

(118 citation statements)

References 34 publications

(48 reference statements)

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“…Notably, two of the larger, placebo-controlled trials that evaluated tamsulosin (n = 196) [53] and alfuzosin (n = 272) [57] failed to show any significant difference in total NIH-CPSI scores, the only outcome achieving statistical significance being the score for ejaculation on the Male Sexual Health Questionnaire (P = 0.04) in the alfuzosin trial. Possible reasons include the short treatment duration (≤12 weeks) and/or inclusion of refractory patients with previous exposure to a-blockers [57] Antibiotics CBP Despite the widespread use of antibiotics in patients with CBP and CP/CPPS, evidence in a CBP population primarily exists within RCTs or retrospective comparative trials lacking placebo control. Microbiological eradication rates were 40-77% for ciprofloxacin [65][66][67], 75% for levofloxacin [65], 80% for azithromycin [66,68,69], 77% for doxycycline [68], 80% for clarithromycin [69], and 62-77% for azithromycin + ciprofloxacin (depending on ciprofloxacin dose) [70].…”

Section: A-adrenergic Antagonistsmentioning

confidence: 99%

“…In all, 10 placebo-controlled RCTs (n = 58-272) were identified that evaluated a-adrenergic antagonists (tamsulosin [53][54][55], alfuzosin [56,57], doxazosin [58,59], terazosin [60,61] and silodosin [62]) in CBP and CP/CPPS. Most (eight) showed positive results, with significant differences vs placebo in NIH-CPSI total, urinary symptom, pain, and/or QoL scores [54][55][56][57]59,60], or in scores using other validated symptom scoring tools [58,61].…”

Section: A-adrenergic Antagonistsmentioning

confidence: 99%

“…Most (eight) showed positive results, with significant differences vs placebo in NIH-CPSI total, urinary symptom, pain, and/or QoL scores [54][55][56][57]59,60], or in scores using other validated symptom scoring tools [58,61]. However, there was heterogeneity in primary endpoints, patient eligibility criteria (e.g.…”

Section: A-adrenergic Antagonistsmentioning

confidence: 99%

“…However, another recent systematic review questioned the clinical significance of these reductions [64]. Notably, two of the larger, placebo-controlled trials that evaluated tamsulosin (n = 196) [53] and alfuzosin (n = 272) [57] failed to show any significant difference in total NIH-CPSI scores, the only outcome achieving statistical significance being the score for ejaculation on the Male Sexual Health Questionnaire (P = 0.04) in the alfuzosin trial. Possible reasons include the short treatment duration (≤12 weeks) and/or inclusion of refractory patients with previous exposure to a-blockers [57] Antibiotics CBP Despite the widespread use of antibiotics in patients with CBP and CP/CPPS, evidence in a CBP population primarily exists within RCTs or retrospective comparative trials lacking placebo control.…”

Section: A-adrenergic Antagonistsmentioning

confidence: 99%

See 3 more Smart Citations

Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline

Rees

Abrahams

Doble³

et al. 2015

BJU International

220

176

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ObjectivesTo improve awareness and recognition of chronic bacterial prostatitis (CBP) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) among non-specialists and patients. To provide guidance to healthcare professionals treating patients with CBP and CP/CPPS, in both non-specialist and specialist settings. To promote efficient referral of care between nonspecialists and specialists and the involvement of the multidisciplinary team (MDT). Patients and MethodsThe guideline population were men with CBP or CP/CPPS (persistent or recurrent symptoms and no other urogenital pathology for ≥3 of the previous 6 months). Consensus recommendations for the guidelines were based on a search to identify literature on the diagnosis and management of CBP and CP/CPPS (published between 1999 and February 2014). A Delphi panel process was used where high-quality, published evidence was lacking. ResultsCBP and CP/CPPS can present with a wide range of clinical manifestations. The four main symptom domains are urogenital pain, lower urinary tract symptoms (LUTSvoiding or storage symptoms), psychological issues and sexual dysfunction. Patients should be managed according to their individual symptom pattern. Options for first-line treatment include antibiotics, a-adrenergic antagonists (if voiding LUTS are present) and simple analgesics. Repeated use of antibiotics, such as quinolones, should be avoided if there is no obvious symptomatic benefit from infection control or cultures do not support an infectious cause. Early use of treatments targeting neuropathic pain and/or referral to specialist services should be considered for patients who do not respond to initial measures. An MDT approach (urologists, pain specialists, nurse specialists, specialist physiotherapists, general practitioners, cognitive behavioural therapists/psychologists, and sexual health specialists) is recommended. Patients should be fully informed about the possible underlying causes and treatment options, including an explanation of the chronic pain cycle. ConclusionChronic prostatitis can present with a wide variety of signs and symptoms. Identification of individual symptom patterns and a symptom-based treatment approach are recommended. Further research is required to evaluate management options for CBP and CP/CPPS.

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Section: A-adrenergic Antagonistsmentioning

confidence: 99%

Section: A-adrenergic Antagonistsmentioning

confidence: 99%

Section: A-adrenergic Antagonistsmentioning

confidence: 99%

Section: A-adrenergic Antagonistsmentioning

confidence: 99%

See 2 more Smart Citations

Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline

Rees

Abrahams

Doble³

et al. 2015

BJU International

220

176

View full text Add to dashboard Cite

show abstract

“…However, according to a multicenter research performed at two places, their results presented the opposite. According to research done by Alexander et al, the NIH-CPSI score for 6-weeks of tamsulosin treatment did not show any improvement and in another large scaled research done on alfuzosin, it was reported that the advantage of alpha blocker was not represented and the symptom was not improved [17].…”

Section: Monotherapymentioning

confidence: 96%

Recent trend of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) management

Lee

2017

Hanyang Med Rev

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Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition. However, many of the traditional therapies like monotherapy used in clinical practice fail to show efficacy. There is no one particular treatment to be recommended as monotherapy for CP/CPPS. The new concept of treatment which is 'UPOINT' is introduced. The major barrier in treating men with CP/CPPS is the heterogenous nature of this syndrome. In order to treat appropriately, the patient should be evaluated individually to assess the nature of symptoms. To evaluate patients with chronic urologic pelvic pain, a six-point clinical phenotyping system has been developed. The clinical domains are urinary symptoms, psychosocial dysfunction, organ specific findings, infection, neurologic/systemic, and tenderness of muscles, which produces the acronym 'UPOINT' . This clinical phenotyping system may provide a useful and clinically relevant framework for multimodal therapy for the treatment of CP/CPPS. However, the concept of UPOINT needs randomization, placebo or sham control studies to show verified treatment.

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Pregabalin for the Treatment of Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Randomized Controlled Trial

Pontari¹,

Krieger²,

Litwin³

et al. 2010

Archives of Internal Medicine

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Background Evidence suggests that the urogenital pain of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) may be neuropathic. Methods This randomized, double-blind, placebo-controlled trial was conducted across 10 tertiary care centers in North America to determine whether pregabalin, which has been proved effective in other chronic pain syndromes, is effective in reducing CP/CPPS symptoms. In 2006–2007, 324 men with pelvic pain for at least 3 of the previous 6 months were enrolled in this study. Men were randomly assigned to receive pregabalin or placebo in a 2:1 ratio and were treated for 6 weeks. Pregabalin dosage was increased from 150 to 600 mg/d during the first 4 weeks. The primary outcome was a 6-point decrease in the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score. Multiple secondary outcomes were assessed. Results Of 218 men assigned to receive pregabalin, 103 (47.2%) reported at least a 6-point decrease in the NIHCPSI total score at 6 weeks compared with 35.8% (38 of 106 men) assigned to receive placebo (P = .07, exact Mantel-Haenszel test, adjusting for clinical sites). Compared with the placebo group, men assigned to receive pregabalin experienced reductions in the NIH-CPSI total score and sub-scores (P < .05), a higher Global Response Assessment response rate (31.2% and 18.9%; P = .02), and improvement in total McGill Pain Questionnaire score (P = .01). Results for the other outcomes did not differ between groups. Conclusion Pregabalin therapy for 6 weeks was not superior to placebo use in the rate of a 6-point decrease (improvement) in the NIH-CPSI total score in men with CP/CPPS. Trial Registration clinicaltrials.gov Identifier: NCT00371033

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Alfuzosin and Symptoms of Chronic Prostatitis–Chronic Pelvic Pain Syndrome

Abstract: Background-In men with chronic prostatitis-chronic pelvic pain syndrome, treatment with alphaadrenergic receptor blockers early in the course of the disorder has been reported to be effective in some, but not all, relatively small randomized trials.

Cited by 157 publications

References 34 publications

Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline

Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline

Recent trend of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) management

Pregabalin for the Treatment of Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Randomized Controlled Trial

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