A 46-year-old man comes to the office due to dysuria and a dull, aching pain in the penis and perineal region. The symptoms began 6 months ago and prompted the patient to visit an urgent care center twice. Both times, he received a short course of antibiotics, which improved symptoms temporarily, but they returned within days. The patient has also had pain during ejaculation but no urethral discharge, back pain, abdominal pain, weakness, or incomplete voiding. He is married and monogamous with his wife and has 2 children. He does not use tobacco or illicit drugs but occasionally drinks 1 or 2 beers on weekends. He has no medication allergies and no family history of cancer. Temperature is 37.1 C (98.8 F), blood pressure is 126/84 mm Hg, pulse is 72/min, and respirations are 14/min. Physical examination shows no abdominal or costovertebral angle tenderness. Digital rectal examination reveals a mildly tender prostate that is symmetric and not enlarged. The external genitalia are normal in size and appearance and are nontender to palpation. The most likely diagnosis is discussed with the patient, and he asks what can be done to relieve his symptoms. Which of the following is the most appropriate response to this patient?

Question

A 46-year-old man comes to the office due to dysuria and a dull, aching pain in the penis and perineal region.  The symptoms began 6 months ago and prompted the patient to visit an urgent care center twice.  Both times, he received a short course of antibiotics, which improved symptoms temporarily, but they returned within days.  The patient has also had pain during ejaculation but no urethral discharge, back pain, abdominal pain, weakness, or incomplete voiding.  He is married and monogamous with his wife and has 2 children.  He does not use tobacco or illicit drugs but occasionally drinks 1 or 2 beers on weekends.  He has no medication allergies and no family history of cancer.  Temperature is 37.1 C (98.8 F), blood pressure is 126/84 mm Hg, pulse is 72/min, and respirations are 14/min.  Physical examination shows no abdominal or costovertebral angle tenderness.  Digital rectal examination reveals a mildly tender prostate that is symmetric and not enlarged.  The external genitalia are normal in size and appearance and are nontender to palpation. The most likely diagnosis is discussed with the patient, and he asks what can be done to relieve his symptoms.  Which of the following is the most appropriate response to this patient?

Quizplus · Accepted Answer

Explanation: The underlying cause of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) remains unclear. As a result, there is much uncertainty about the ideal approach to treatment. Most patients receive a combination of therapies including medications for prostate enlargement (eg, alpha blockers), antibiotics, anti-inflammatories, and/or psychotherapy. (Choice A) Antispasmodic medications are occasionally prescribed to patients with CP/CPPS who have prominent manifestations of bladder overactivity. However, these medications are not considered first-line for CP/CPPS and are used far more rarely than medications for prostate enlargement. (Choice B) The surgical treatment of CP/CPPS is generally not considered first-line due to inconsistent and limited improvement of symptoms. (Choice D) Patients who develop CP/CPPS often have a history of other pain disorders such as fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome, leading some researchers to speculate that CP/CPPS might have a psychologic component. Although evidence now shows that cognitive behavior therapy may be a potentially useful therapeutic intervention, antipsychotic medications are not currently recommended as part of first-line care. (Choice E) A wide-range of treatment options are available for CP/CPPS and often improve symptoms when used in combination. Educational objective: The underlying cause of chronic prostatitis/chronic pelvic pain syndrome is unknown. Patients are generally treated with a combination of therapies including medications for prostate enlargement (eg, alpha blockers), antibiotics, anti-inflammatories, and/or psychotherapy.

A 46-Year-Old Man Comes to the Office Due to Dysuria