Chronic Prostatitis (CP) is a condition of unknown cause. Therefore, there are numerous theories that exist. What I like to stress is that every patient is like a snowflake, as they are all different. Everyone requires individual evaluation and treatment. Patients and physicians like the infection theory because it is easy to say that you have an infection, and we will continue to need to treat you with antibiotics. Most people don’t have an infection, and those that do tend to respond to antibiotics in the same manner as patients with no diagnosable infection. One can argue that we have only discovered about 10% of the world's bacteria, and therefore we simply can’t culture the organisms or we can’t culture them because they can hide in the prostate in small numbers protected by something call a biofilm. Conversely, since antibiotics can be antimicrobial, antipyretic (reduce fever), analgesic (reduce pain), and anti-inflammatory, one could argue that one of their other important properties is really at work. We can do our best to determine whether or not there is an infection and offer five day cultures.

CP, also referred to as Chronic Pelvic Pain Syndrome (CPPS), can have a number of etiologies. The syndrome may not even involve the prostate. There may be obstructions within the ducts of the prostate, and the best therapy may be repeated prostate massage. Patients may come with the diagnosis of prostatitis, but on examination may actually have tenderness and malfunction of their pelvic floor musculature. These patients are best treated with pelvic floor physiotherapy. The physical therapist that you use should have experience with this type of therapy, or it may not be beneficial. Also, cysts and obstructions within the prostate are sometimes seen on transrectal ultrasound, and may have a role in the etiology of the patient’s symptoms. Ultrasound is a helpful tool in diagnosis and treatment.

Alternatively, there are physicians who believe that the pain and voiding dysfunction in patients with CP/CPPS may be Interstitial Cystitis (IC). IC is classically perceived as a disease of the bladder in women, and may affect small numbers of men. Some physicians believe that they are the same disease.

Finally, there are those that think that CP/CPPS can be caused by local nerves in the pelvis, and the pudendal nerve for one has been implicated. More centrally-located nerves can be affected as they emanate from the spinal cord. Nerve roots, if compressed, can cause pelvic pain, just as they cause sciatica-like pain.

As pointed out previously, all patients are different and require individual care. While the symptoms may be the same, the cause may be completely different.



The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), a simple questionnaire that can be completed in less than five minutes, is a useful and reliable tool for both patients and medical professionals. It is provided below in PDF format for easy viewing and/or printing.

NIH-Chronic Prostatitis Symptom Index