Prostate pain syndrome also called Chronic nonbacterial prostatitis or chronic pelvic pain syndrome, (CPPS) is a common male genitourinary disease. The genital and perineal pain/discomfort and urinary symptoms, erectile dysfunction and premature ejaculation can be periodic or constant and they can have a significant impact on quality of life. Depression is common in these patients.
The complexity of this syndrome, the symptoms not always well defined and the lack of knowledge of the causes can make the diagnosis difficult. Very often these patients receive misdiagnosis or ineffective treatments which lead them to consult many doctors but to no avail. The sense of abandonment (nobody can help me) and depression can be the main component of this disease, especially in the most severe cases.
What are the possible causes of chronic pelvic pain syndrome? Who can be affected and how can be diagnosed and treated?
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The causes remain unknown. The prostate pain might be the result of progression from acute, chronic bacterial and abacterial inflammatory prostatitis. The origin of pain may be related to local factors (nerve damage). The problem may worsen because of abnormal pain perception by the patient (psychologic distress) and painful muscular contracture of the perineum and pelvic floor.
Prostate pain may be periodic or constant. These are:
Anxiety about pain often refers to fears of missed pathology (particularly cancer) as the cause of pain or uncertainties about treatment and prognosis.
The medical history is essential for the evaluation of patients with prostate pain. This pain syndrome is diagnosed according to:
Questionnaires on scoring the prostate pain symptoms help to formulate different sets of multispeciality treatments:
Chronic nonbacterial prostatitis (chronic pelvic pain syndrome) is a benign, not well-known genitourinary disease with a significant impact on the quality of life.
Doctors are unable to diagnose this disease and identify the causes effectively. Not surprisingly, treatment is empiric and guided by a doctor’s clinical experience and instincts rather than the evidence of what works. When they prescribe standard therapies only to have patients experience little relief, many practitioners don’t know what to do next, other than to keep cycling through the same standard treatment options.
Misdiagnosis and poor treatment increase the psychological distress and the abnormal perception of the disease and its symptoms.
European Association of Urology, recently issued specific guidelines based on scientific evidence and strong recommendations in diagnostic and treatment workup (https://uroweb.org/guideline/chronic-pelvic-pain/#1)