Pain in the prostate: can medicines help?

In this blog for men with chronic prostatitis thinking of starting a course of drug treatment, Robert Walton, a Senior Fellow in General Practice, reviews new Cochrane evidence on what medicines have to offer in terms of reduction in symptoms.         

Worried by that pain in the pelvis – coming and going over the last few months? It’s sometimes quite severe but then it goes away and you can almost forget about it.  Well almost.  Maybe it’s taking longer to pass urine than you think it should and you’re up through the night more – could be just age, but at the back of your mind there’s always the worry about cancer.

Well the good news is that chronic prostatitis is not known to be linked to prostate cancer although if you are concerned about this it’s very easy to call in to your GP for a check-up (you can read the NHS pages on prostate cancer here).

But say you’ve done that and it’s all clear – then what?

What drug treatments can help with chronic prostatitis?

Well the news is fairly good here too.  A new Cochrane review pulled together the evidence from studies on different medicines for chronic prostatitis and several of these offered the prospect of providing some relief.  Although finding lots of different treatments for a medical condition is a tell-tale sign that there isn’t a magic bullet that cures everyone.

The review brought together the evidence from 99 studies which included 9,119 men with this condition – you are not alone!  Most of the studies looked at alpha blockers which are probably the medication you are most likely to be offered by your GP.  These drugs relax the neck of the bladder and so might be expected to help with symptoms.  Unfortunately, the evidence in the review was very low certainty.  This means that we can’t really draw any conclusions because the studies were not of high enough quality.  It’s a potential problem too with these drugs that the side effects of dizziness and low blood pressure are common, especially at higher doses.

Although side effects from alpha blockers tend to get better over time, or maybe with a reduction in dose, 5 alpha reductase inhibitors may also be an option.  These drugs reduce the action of testosterone on the prostate and make it slightly smaller which sometimes improves symptoms.  The review found moderate quality evidence of improvement in symptoms although this came from only one small study and the evidence about frequency of side effects was low quality.

Anti inflammatories such as ibuprofen are probably the mainstay for relief of symptoms and the review confirmed that they may be of benefit, as may antibiotics if the condition has been present for less than six months or started after a urine infection (here’s a scenario from NICE).  NICE also suggests that stool softeners may help if constipation is a problem.

I’m not really very keen on taking drugs – are there any other options?

There were some alternative therapies covered in the review which may reduce symptoms and one of these is phytotherapy.  This treatment uses treatments derived from plants that are thought to have anti-inflammatory properties – examples include bioflavonoids and pollen extracts.  There may also be some benefit from traditional Chinese medicine.  There was no evidence of increased frequency of side effects with these alternative medicines although the evidence was low quality.

One small study showed quite a large benefit from injection of botulinum toxin into the prostate although there were only 60 men who took part and this treatment is not readily available in the UK.

So what’s the answer?

Well we don’t know what causes chronic prostatitis and it is possible that the underlying reasons for the persistent and unpleasant symptoms are different in different people.  In addition some people have side effects from particular treatments and some do not.  There’s no way of telling in advance who will suffer from the unwanted effects of these medicines.  So from my perspective as a GP trying several different treatments in sequence over a period of time does not seem at all unreasonable, bearing in mind that it may take weeks or even months to get the full benefits from some of the drugs. There is also a range of therapies not involving drugs and you’ll find the details in another Cochrane review, here.

Take-home points

  • There is no evidence of a link between chronic prostatitis and prostate cancer
  • Since we don’t know what causes chronic prostatitis there may be different reasons for the symptoms in different people
  • Several types of drug treatment may give some benefit from symptoms and it may be worth trying another if one does not work

Join in the conversation on Twitter with @rtwalton123 @CochraneUK or leave a comment on the blog.

References may be found here.

Declaration of interest:

Dr. Walton reports grants from NIHR Health Technology Asessment, grants from NIHR Programme Grants for Applied Research, personal fees and other from TTS Pharma,  outside the submitted work;  In addition, Dr. Walton has a patent WALTON R, MCKINNEY E, MARSHALL S, MURPHY M, WELSH K, others. GENETIC INDICATORS OF TOBACCO CONSUMPTION. Patent number: 2001038567. Filed date: 24 Nov 2000. Publication date: 01 Jun 2001  with royalties paid to gNostics, and a patent Tucker MR, Walton R, Matthews H, Miskin A. Method and Kit for Assessing a Patient’s Genetic Information, Lifestyle and Environment Conditions, and Providing a Tailored Therapeutic Regime. Patent number: US20110251243 A1. Application number: US 12/944,372. Filed date: 11 Nov 2010. Publication date: 13 Oct 2011  issued to None.


Robert Walton

About Robert Walton

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Robert Walton is a Cochrane UK Senior Fellow in General Practice. Robert qualified in medicine in London in 1983, having taken an intercalated degree in human pharmacology and immunology. He trained at St Georges Hospital, London and became a member of the Royal College of Physicians in 1986. His work applying computerised decision support to prescribing drugs in the Department of Public Health and Primary care in Oxford led to a doctoral thesis in 1998. Robert was elected a Fellow of the Royal College of General Practitioners in 1999 and the RoyalCollege of Physicians in 2001. He became a Senior Investigator in the National Institute for Health Research (NIHR) in 2016. Robert is Clinical Professor of Primary Medical Care at Queen Mary and joint lead of the NIHR Research Design Service east London team, his research interests are in primary care, genetics, clinical trials and personalised medicine. Robert leads a five-year NIHR funded programme developing a novel training intervention to promote smoking cessation in pharmacies in east London which involves a substantive systematic review and meta analysis on behaviour change interventions in community pharmacies and will lead to a large scale cluster-randomised clinical trial. His research team is also developing a smartphone game to promote smoking cessation and researching a personalised/stratified medicine approach to tobacco dependence using computerised decision support. He sits on the NIHR Programme Grants for Applied Research sub panel A and works as an evaluator for the European Union Horizon 2020 programme (Global Alliance for Chronic Diseases, New Therapies for Rare Diseases). He contributes to UK national guidance, serving on the National Institute for Health and Care Excellence (NICE) Outcome Indicator and Technology Appraisals Committees. He worked as a general practitioner in Oxford from 1988 to 2019.

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