Alpha-blockers for chronic abacterial prostatitis

Evidence Summaries

Evidence Summaries

Evidence Summaries

Level of Evidence = B
Alpha-blockers alone or combined with antibiotics appear to be effective in improving symptoms in men with chronic abacterial prostatitis.

In a meta-analysis of 23 studies 1 , α-blockers compared with placebo were associated with significant improvement in symptoms with standardized mean differences of total symptom -1.7 (95% CI, -2.8 to -0.6), pain -1.1 (95% CI -1.8 to -0.3), voiding -1.4 (95% CI -2.3 to -0.5) and quality-of-life scores -1.0 (95% CI -1.8 to -0.2). Patients receiving α-blockers or anti-inflammatory medications had a higher chance of favorable response compared with placebo, with pooled RRs of 1.6 (95% CI 1.1-2.3) and 1.8 (95% CI 1.2-2.6), respectively. Contour-enhanced funnel plots suggested the presence of publication bias for smaller studies of α-blocker therapies.

The network meta-analysis suggested benefits of antibiotics in decreasing total symptom scores (-9.8; 95% CI -15.1 to -4.6), pain scores (-4.4; 95% CI -7.0 to -1.9), voiding scores (-2.8; 95% CI -4.1 to -1.6), and quality-of-life scores (-1.9; 95% CI -3.6 to -0.2) compared with placebo. Combining α-blockers and antibiotics yielded the greatest benefits compared with placebo, with corresponding decreases of -13.8 (95% CI -17.5 to -10.2) for total symptom scores, -5.7 (95% CI -7.8 to -3.6) for pain scores, -3.7 (95% CI -5.2 to -2.1) for voiding, and -2.8 (95% Cl -4.7 to -0.9) for quality-of-life scores.

Comment: The level of evidence is downgraded by potential reporting bias.

References

References

References

1. Anothaisintawee T, Attia J, Nickel JC, Thammakraisorn S, Numthavaj P, McEvoy M, Thakkinstian A. Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis. JAMA 2011 Jan 5;305(1):78-86.  [PMID:21205969].
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