Primary prostate pain syndrome

Primary prostate pain syndrome (PPPS; also known as chronic prostatitis/chronic pelvic pain syndrome, chronic pelvic pain syndrome in men, or chronic non-bacterial prostatitis) typically presents as persistent pelvic pain of at least 3 months’ duration centred around the prostate. Patients may report pain occurring in pelvic areas outside the prostate, such as the rectum, perineum, penis, testicles, abdomen, lower back, and the inguinal region.

The diagnosis is clinical so taking a detailed history and ruling out other pathologies are fundamental to the diagnosis. Investigations may also be helpful for phenotypical description.

Assess the severity of pain and associated symptoms, their progression, and response to treatment using reliable and validated symptom-scoring tools.

Combinations of pharmacological and non-pharmacological interventions administered through a multimodal, multidisciplinary approach have a higher chance of improving the patient's condition, especially if tailored to the individual. Treatment options include physical therapy, psychological therapy, analgesia, antibiotics, and alpha-blockers.

Patient education promotes self-management and improves treatment adherence and engagement.

PPPS is defined as a history of persistent pelvic pain for a minimum of 3 months in the region of the prostate and absence of other lower urinary tract pathology.[1]Loeser JD, Arendt-Nielsen L, Baron R, et al; International Association for the Study of Pain. Classification of chronic pain, second edition (revised).​ 2012 [internet publication]. https://www.iasp-pain.org/publications/free-ebooks/classification-of-chronic-pain-second-edition-revised [2]Krieger JN, Riley DE, Cheah PY, et al. Epidemiology of prostatitis: new evidence for a world-wide problem. World J Urol. 2003 Jun;21(2):70-4. http://www.ncbi.nlm.nih.gov/pubmed/12712363?tool=bestpractice.com [3]Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999 Jul 21;282(3):236-7. http://www.ncbi.nlm.nih.gov/pubmed/10422990?tool=bestpractice.com [4]Engeler D, Baranowski AP, Borovicka J, et al; European Association of Urology. EAU guidelines on chronic pelvic pain. March 2022 [internet publication]. https://uroweb.org/guidelines/chronic-pelvic-pain The diagnostic approach of PPPS is fundamentally based on history-taking as pain syndromes are symptomatic diagnoses. Pelvic pain associated with a specific disease, such as bacterial infection, cancer, neurogenic disease, or primary anatomical or functional disease, must be ruled out.[4]Engeler D, Baranowski AP, Borovicka J, et al; European Association of Urology. EAU guidelines on chronic pelvic pain. March 2022 [internet publication]. https://uroweb.org/guidelines/chronic-pelvic-pain PPPS is often associated with negative cognitive, behavioural, sexual, or emotional consequences, as well as with symptoms suggestive of lower urinary tract, sexual, or bowel dysfunction.[1]Loeser JD, Arendt-Nielsen L, Baron R, et al; International Association for the Study of Pain. Classification of chronic pain, second edition (revised).​ 2012 [internet publication]. https://www.iasp-pain.org/publications/free-ebooks/classification-of-chronic-pain-second-edition-revised

The term chronic pelvic pain syndrome is often used when pain is localised to more than one organ site in the pelvis (typically including perineal, suprapubic, testicular, or penile pain).[1]Loeser JD, Arendt-Nielsen L, Baron R, et al; International Association for the Study of Pain. Classification of chronic pain, second edition (revised).​ 2012 [internet publication]. https://www.iasp-pain.org/publications/free-ebooks/classification-of-chronic-pain-second-edition-revised Some specialists may also prefer not to subdivide pain syndromes by anatomy and instead refer to all patients with pain perceived within the pelvis, with no specific underlying disease process identified, as having chronic pelvic pain syndrome. This topic covers chronic pelvic pain centred around the prostate, of non-bacterial origin. However, take into consideration that chronic pelvic pain syndromes are closely linked and are difficult to separate in clinical practice.