Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) Diagnosis and Management

Clinical Presentation and Diagnosis

The American Urological Association suggests that CP/CPPS is characterized by pelvic pain or discomfort for at least 3 months, localized to the perineum, suprapubic region, testicles, or tip of the penis, often exacerbated by urination 1, 2.
The diagnosis of CP/CPPS is made when evaluation excludes other identifiable causes such as infection, cancer, urinary obstruction, or urinary retention, and is supported by the presence of prostatic tenderness on digital rectal examination 1, 2.
Urinary symptoms including frequency, urgency, hesitancy, and sense of incomplete emptying are characteristic of CP/CPPS 1, 2.

The European Association of Urology recommends considering Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) in men with pain perceived to be bladder-related, as clinical characteristics overlap significantly with CP/CPPS 3, 1, 2.
IC/BPS is defined as unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes 3.
Urethritis typically presents with urethral discharge and dysuria, and is diagnosed by >5 polymorphonuclear leukocytes per oil immersion field on urethral smear, and the negative STI screen for gonorrhea and chlamydia makes typical urethritis less likely 5, 2.

The European Urology association recommends performing the Meares and Stamey 2- or 4-glass test in patients with suspected chronic bacterial prostatitis to definitively rule out bacterial infection 4.
Consider transrectal ultrasound in selected cases to rule out prostatic abscess 4.
Assess for pelvic floor tenderness, as this guides treatment selection 1.

Manual physical therapy techniques, including resolving pelvic, abdominal and/or hip muscular trigger points, lengthening muscle contractures, and releasing painful scars, should be offered to patients with pelvic floor tenderness 1.
Patients should be encouraged to implement stress management practices, such as meditation and imagery techniques 1.
For patients with overlapping IC/BPS symptoms, oral medications like amitriptyline, cimetidine, and hydroxyzine may be effective 1.