Most oral drugs for chronic prostatitis or chronic pelvic pain syndrome not beneficial: Lancet

Salient findings include:

· 25 studies (3514 patients) assessed 26 treatments. Low to very low-quality evidence indicated that doxazosin and the doxazosin, ibuprofen, and thiocolchicoside combination were significantly more effective than placebo in the NIH CPSI total score.

· Other NIH CPSI relative outcomes (pain, urinary, and QoL scores) showed a similar pattern.

· Low and very low-quality evidence suggested that combination treatment including doxazosin, ibuprofen, and thiocolchicoside and the tamsulosin and dapoxetine combination caused more adverse events.

· In half of all comparisons regarding NIH CPSI pain scores and quality of life scores, heterogeneity was minimal or low.

· Heterogeneity was high in both NIH CPSI total symptom scores and pain scores for tamsulosin versus placebo.

· There was also high heterogeneity in NIH CPSI urine scores for the combination of tamsulosin and ciprofloxacin versus tamsulosin, tamsulosin, and levofloxacin versus tamsulosin, and tamsulosin versus placebo.

The researchers conclude, "pharmacological treatments have little evidence supporting efficacy for CP/CPPS." Therefore, it is advised to carefully weigh the benefits of medications against their potential harms. 

"Future studies could personalize therapy for individuals according to specific symptoms of CP/CPPS and identify nonpharmacological targets for CP/CPPS," they wrote. 

Reference:

Qin Z, Zhang C, Guo J, Kwong JSW, Li X, Pang R, Doiron RC, Nickel JC, Wu J. Oral pharmacological treatments for chronic prostatitis/chronic pelvic pain syndrome: A systematic review and network meta-analysis of randomised controlled trials. EClinicalMedicine. 2022 May 20;48:101457. doi: 10.1016/j.eclinm.2022.101457. PMID: 35706494; PMCID: PMC9125656.