Acute & Chronic Prostatitis. Get a treatment plan that's right.

Antibiotics are the cornerstone of treatment for confirmed bacterial prostatitis (Types I and II) - but they're often inappropriately used for Type III CPPS, where they rarely help and may cause harm through resistance and side effects.

Type I (acute bacterial): urgent treatment, often initially oral, transitioning to IV if resistance to oral antibiotics suspected or clinically unwell. Typical duration 1-2 weeks. Common antibiotics: ciprofloxacin, levofloxacin, trimethoprim-sulfamethoxazole. Most patients respond quickly.

Type II (chronic bacterial): requires prolonged treatment - typically 4-6 weeks, sometimes longer - because the prostate gland is difficult for antibiotics to penetrate. Fluoroquinolones (ciprofloxacin, levofloxacin) are the standard. Trimethoprim-sulfamethoxazole is an alternative.

Diagnosis before treatment: mid-stream urine culture and prostatic massage with post-massage urine culture (4-glass or 2-glass test) establishes diagnosis. Treatment is targeted to the specific bacteria identified.

Effectiveness: studies show 60-80% cure rates with appropriate antibiotic treatment for confirmed bacterial prostatitis (see source 3 below). Failure usually indicates either incorrect diagnosis or resistant bacteria.

When NOT to use antibiotics: no identified bacteria on culture (almost always indicates Type III, not bacterial); previous antibiotic courses have failed to provide sustained benefit; symptoms have been chronic (>3 months) without infectious features.

Repeated antibiotic courses for unidentified "prostatitis" cause antibiotic resistance, gastrointestinal side effects, and tendon problems with fluoroquinolones - without resolving the underlying cause.

Alpha-blockers (the same class used in BPH) provide symptomatic relief in many types of prostatitis by relaxing prostatic and bladder neck muscle. They reduce urinary frequency, urgency, hesitancy, and often pelvic discomfort.

Common medications: tamsulosin, alfuzosin, silodosin. Typically started at standard BPH doses.

How they work: relax smooth muscle in the prostate and bladder neck, reducing functional obstruction and the discomfort associated with it.

Effectiveness: moderate to good for symptomatic relief in Type III CPPS - studies show meaningful improvement in pain and urinary symptoms in 40-60% of patients (see source 4 below).

Time to effect: symptomatic improvement within 1-2 weeks.

Side effects: dizziness (particularly when starting), nasal congestion, retrograde ejaculation. Generally well-tolerated.

Use in CPPS: often combined with pelvic floor therapy and lifestyle measures rather than used alone. Less effective in younger men with predominantly pain (rather than urinary) symptoms.

Low-intensity extracorporeal shock wave therapy (Li-ESWT) delivers focused low-intensity acoustic pulses to the perineum and pelvic floor. It is non-invasive, performed in clinic without anaesthesia, and typical sessions last 15-20 minutes.

Evidence - pain reduction: multiple systematic reviews and meta-analyses demonstrate significant pain reduction with Li-ESWT compared to sham or control. The NIH-CPSI pain domain improves by approximately 3.2-4.4 points at 1-3 months post-treatment; numeric pain rating scale improves by 1.4-2.6 points; pooled pain domain mean difference is -3.93 (95% CI -5.13 to -2.73) at 12 weeks. The Cochrane review rated the evidence as high quality for symptom reduction at 12 weeks.

Evidence - overall symptoms and quality of life: total NIH-CPSI scores improve by approximately 5.5-8.5 points. Quality-of-life domain improves significantly (mean difference -1.71, 95% CI -2.12 to -1.31). Urinary symptoms show modest improvement (mean difference -1.79, 95% CI -2.38 to -1.21). The effect on lower urinary tract symptoms and erectile function is clinically small.

Device modality: a 2026 meta-analysis found focused devices showed the most consistent effects (WMD -6.59; I² = 0.0%), while radial and multifocal devices showed greater heterogeneity in outcomes.

Duration of benefit: the therapeutic effect is most pronounced in the short to medium term, up to 12 weeks. Long-term efficacy beyond 6 months remains uncertain, with some studies showing diminished benefits at 24 weeks. Repeat courses can be considered for patients who respond and later relapse.

Safety: Li-ESWT demonstrates an excellent safety profile, with no major adverse events reported across multiple trials. Minor adverse events have included one first-degree burn and four cases of transient haematuria and haemospermia.

Use at Hisential: Li-ESWT can be used as monotherapy or as add-on therapy to standard medical treatment - alpha-blockers, short-course anti-inflammatories, pelvic floor work, and lifestyle measures. Your personal health concierge coordinates assessment, the treatment course, and structured progress review at 4 and 12 weeks.

For refractory or chronic cases - particularly Type III CPPS - combination therapy is typically more effective than any single approach. The multimodal protocol addresses the multiple mechanisms that contribute to chronic pelvic pain.

NSAIDs (anti-inflammatories): short courses for pain flares. Not for long-term daily use due to gastrointestinal and kidney risks.

Low-dose tricyclic antidepressants (amitriptyline, nortriptyline): at sub-antidepressant doses, these address central pain sensitisation and improve sleep.

Gabapentin or pregabalin: for neuropathic pain components, particularly burning or shooting pain.

Pelvic floor physical therapy: structured pelvic floor relaxation and trigger-point work with a pelvic-floor-trained physiotherapist - one of the most effective single interventions for Type III CPPS.

Dietary adjustments: many men with CPPS report flares with caffeine, alcohol, spicy foods, or acidic foods. Trial elimination identifies individual triggers.

Stress management and CBT: strongly evidence-based for chronic pain syndromes. Stress is both a trigger and amplifier of CPPS.

Pelvic floor relaxation training, including biofeedback where indicated. Quercetin and other phytotherapy have modest evidence for some natural anti-inflammatory benefit.

Treatment timeframe: multimodal protocols typically show meaningful improvement over 3-6 months. Expectations are set up front: CPPS is rarely "cured" but is highly manageable with sustained multimodal approach.

Hisential's role: we coordinate all components - medications, physiotherapy referral, lifestyle support, and psychological support if needed. Your personal health concierge tracks progress across modalities and adjusts the protocol as response emerges.