Rawal Medical Journal

Rawal Medical Journal
An official publication of Pakistan Medical Association Rawalpindi Islamabad branch
Established 1975
Volume 36
Number 4
October - December
2011
Original Article
Role of alpha blockers in the management of chronic prostatitis
Firas Azer Khori, Mohanned M Naser, Awad B Kaabneh
Prince Hussien Urology Center, Prince Rashid Military Hospital, King Hussien Medical City,
Amman, Jordan
ABSTRACT
Objective
To evaluate the role of α-blockers in treatment of chronic prostatitis.
Methods
A total of 124 patients with chronic prostatitis were followed in urology clinic at Prince Rashid
Military Hospital from January 2006 to march 2010. Only 98 patients completed the study and
were divided into two groups; group A managed with α-blockers and group B with placebo.
Results
There was same response rate in both groups, with 48.7% decrease of at least 4 points in their
total NIH-CPSI score from base line to 6 weeks.
Conclusion
We found that α-blockers are not helpful in the management of chronic prostatitis. (Rawal Med J
2011;36:294-296).
Key words
Prostatitis, alpha blockers,
INTRODUCTION
Prostatitis is considered to be one of the common causes of visit to urology clinic. It accounts for
3-8% of out patients visit to urology clinics in North America and Europe.1-3 It is classified into
four subtypes according to National Institution of Health (NIH): Type I: acute bacterial
prostatitis, Type II: chronic bacterial prostatitis, Type III: chronic prostatitis, chronic pelvic pain
syndrome (CP\CPPS), which is the commonest type, and Type IV: asymptomatic inflammatory
prostatitis.4-6 α-Blockers have been used to treat the symptoms of chronic prostatitis as well as
benign prostate hyperplasia by virtue of their effect on the muscles of prostate and bladder neck.6
These are one of three commonest prescribed medicines by urologists for chronic prostatitis i.e
antibiotics, alpha blockers and anti inflammatory drugs.7 The aim of this study was to evaluate
the role of α-blockers in treatment of chronic prostatitis.
PATIENTS AND METHODS
A total of 124 patients of chronic prostatitis were followed in urology clinic at Prince Rashid
Military Hospital between January 2006 and March 2010. Only 98 patients completed the study.
We divided the patients into two groups; group A (49 patients) managed with α-blocker
Doxazosin 4mg once daily and group B (49 patients) used placebo. The period of the study
lasted for 6 weeks.
We used the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI)4 to
measure the improvement of our patients. NIH-CPSI takes into account pain symptoms, urinary
symptoms and impact on quality of life, with a total score of (0-43). We measured the score for
our patients before and after treatment. Patients were classified as responders if there was 4
points or more improvement and non responders if less than 4 points were achieved.
In both groups, patients ages are symmetrical (27-45years),
RESULTS
Of 124 patients, 26 patients did not complete with the study, only 98 patients did. The ages of
patients range from 27 year to 45 years (mean 39 years). All patients were married. 48.7% men
on alpha blocker showed a decrease of at least 4 points in their total NIH-CPSI score at 6 weeks.
There was almost same rate of response in patients on placebo. At global response, we did not
find any significant difference (p=0.7) or changes over time in the secondary outcome between
the two groups, (32.4% vs33.6%).
DISCUSSION
Chronic prostatitis patients experience a difficult and worse quality of life than patients suffering
from benign prostate hyperplasia or even most of patients with prostate cancer.5 α- Blockers are
considered to be an important modality of treatment of chronic prostatitis/chronic pelvic pain
syndrome, as several studies have shown that they improve symptoms of chronic prostatitis and
decrease the risk of urine retention.8-10 Cheah et al did a randomized study on 86 patients with
chronic prostatitis using α- blockers and placebo, and reported significant response with 50%
reduction in the mean symptoms score compared to 37% in placebo.8 A 65% improvement of
symptoms in comparison with only 42% with placebo,9 and 52% response with α- blockers
compared with 33% with placebo have been reported.10
On the contrary, no significant response with α- blockers in chronic prostatitis was obtained by
Alexander et al who did a large multicenter randomized trial of treatment on patients with
CP\CPPS in two groups, one with ciprofloxacin and α-blockers, other group with placebo. They
found no difference among these drugs, either mono or multi therapy treatment of CP\CPPS.11
CONCLUSION
In our study, our findings did not support use of α-blockers, in treating chronic prostatitis.
Correspondence: Awad B Al-kaabneh. Email:[email protected]
Received: April 07, 2011 Accepted: September 26, 2011
REFERENCES
1. Nickel JC, Teichman JMH, Gregoire M, Clark J, Downey J.
Prevalence,diagnosis,charecterization,and treatement of prostatitis,interstisial cystitis,and
epidymitis in outpatient urological practice:The Canadian PIE study. Urology 2005:66:93540.
2. McNaughton-Collins M, Stafford RS, Oleary MP, Barry MJ. How common is prostatitis? A
national survey of physician visits. J Urol 1998;159:1224-8.
3. Rizzo M, Marchetti F, Travaglini F, Trienchieri A, Nickel JC. Prevalence, diagnosis and
treatment of prostatitis in Italy, a prospective urology outpatient practice study. Br J Urol Int
2004:23:61-66.
4. Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis.
JAMA 1999:282:236-7.
5. Nickel JC. Alpha Blockers for the treatment of prostatitis like syndromes. Rev Urol
2006:8(suppl 4):S26-S34.
6. Gul O, Eroglu M, Ozok U. Use of terazosine in patients with chronic pelvic pain syndrome
and evaluation by prostatitis symptom score index. Int Urol Nephrol 2001:32:433-6.
7. Nickel JC. The three A”s of chronic prostatitis therapy,antibiotics,alpha blockers, and anti
inflamatories.what is the evidence|? Br J Urol Int 2004,94:1230-1233.
8. Cheah PY, Liong ML, Yuen KH, Teh CL, Khor T, Yang JR. Terazosin therapy for chronic
prostatitis|chronic pelvic pain syndrome: a randomized placebo controlled trial. J Urol
2003:169:592-6.
9. Mehik A, Alas P, Nickel JC, Sarpola A, Helstrom PJ. Alfuzosin treatement for chronic
prostatitis|chronic pelvic pain syndrome: a prospective, randomized, double blind, placebo
controlled, pilot study. Urology 2003:62:425-9.
10. Nickel JC, Narayan P, Mckay J, Dolye C. Treatement of chronic prostatitis|chronic pelvic
pain syndrome with tamsulosin:a randomized double blind trial. J Urol 2004:171:1594-7.
11. Alexander RB, Propert KI, Schaeffer AJ, Landis JR, Nickel JC, O’Leary MP, et al.
Ciprofloxacin or tamsulosin in men with chronic prostatitis|chronic pelvic pain syndrome: a
randomized, double blind trial. Ann Intern Med 2004:141:581-9.
12. Propert KJ, Alexander RB, Nickel JC, Kusek JW, Litwin MS, Landis JR, et al. Desgin of a
multicenter randomized clinical trial of chronic prostatitis|chronic pelvic pain syndrome.
Urology 2002:59:870-6.
13. Nickel JC, Downey J, Arden D, Clark J, Nickel K. Failure of a monotherapy strategy for
difficult of chronic prostatitis/chronic pelvic pain syndrome. J Urol 2004:172:551-4.
14. Mc Naughton,CM. The impact of chronic prostatitis/chronic pelvic pain syndrome on
patients. World J Urol 20003,21:86-9.
15. Kramer G, Mitteregger M, Marberger M. Is benign prostate hyperplasia(BPH)an immune
inflammatory disease? Eur Urol 2007;51:1202-6.
16. Propert KJ, Litwin M, Wang Y, Alexander RB, Calhoun E, Nickel JC, et al. Responsiveness
of National Institutes of Health- Chronic Prostatitis Symptom Index (NIH-CPSI). Qual life Res
2006,15:299-305.
17. Dimitrakov JD, Kaplan SA, Kroenke K, Jackson JL, Freeman MR. Manegemant of chronic
prostatitis/chronic pelvic pain syndrome: an evidence- based approach. Urology 2006;67:881-8.
Table 1. NIH-Chronic Prostatitis Symptom Index (NIH-CPSI)
Pain or Discomfort
1. In the last week, have you experienced any
pain or
discomfort in the following areas?
Yes No
a. Area between rectum and 1 0
testicles (perineum)
b. Testicles 1 0
c. Tip of the penis (not related to 1 0
urination)
d. Below your waist, in your 1 0
pubic or bladder area
2. In the last week, have you experienced:
Yes No
a. Pain or burning during 1 0
urination?
b. Pain or discomfort during or 1 0
after sexual climax (ejaculation)?
3. How often have you had pain or discomfort in
any of these areas over the last week?
0 Never
1 Rarely
2 Sometimes
3 Often
4 Usually
5 Always
4. Which number best describes your
AVERAGE pain or discomfort on the days that
you had it, over the last week?
0 1 2 3 4 5 6 7 8 9 10
No pain
Pain bad as you can imagine
Urination
5. How often have you had a sensation of not
emptying
your bladder completely after you finished
urinating,
over the last week?
0 Not at all
1 Less than 1 time in 5
2 Less than half the time
3 About half the time
4 More than half the time
5 Almost always
6. How often have you had to urinate again less
than two
hours after you finished urinating, over the last
week?
0 Not at all
1 Less than 1 time in 5
2 Less than half the time
3 About half the time
4 More than half the time
5 Almost always
Impact of Symptoms
7. How much have your symptoms kept you
from doing
the kinds of things you would usually do, over
the
last week?
0 None
1 Only a little
2 Some
3 A lot
8. How much did you think about your
symptoms, over the
last week?
0 None
1 Only a little
2 Some
3 A lot
Quality of Life
9. If you were to spend the rest of your life with
your
symptoms just the way they have been during
the last
week, how would you feel about that?
0 Delighted
1 Pleased
2 Mostly satisfied
3 Mixed (about equally satisfied and
dissatisfied)
4 Mostly dissatisfied
5 Unhappy
6 Terrible
Scoring the NIH-Chronic Prostatitis
Symptom Index Domains
Pain: Total of items 1a, 1b, 1c,1d, 2a, 2b, 3, and
4=
Urinary Symptoms: Total of items 5 and 6 =
Quality of Life Impact: Total of items 7,
8, and 9