Background:

Patients who present with symptoms of prostatitis without a positive result after urine culture or expressed prostate secretion (EPS) culture is referred to as onbacterial prostatitis.

Medical Care:

2-week trial of an antibiotic such as trimethoprim-sulfamethoxazole (160 mg/800 mg), levofloxacin (250 mg qd), or ciprofloxacin (500 mg) twice daily for 2 weeks may help lead to the diagnosis. If the patient improves, continue therapy with a full 4- to 6-week course of treatment.

Flomax (0.4-0.8 mg), a more selective alpha-blocker with fewer adverse effects, may also be tried. Alpha-blocker therapy should be continued for a minimum of 6 months or symptoms may recur. Bladder neck dysfunction may be treated with alpha-blockers such as terazosin (2-15 mg) or doxazosin (2-8 mg) given in a dose titration.

Saw palmetto, an herbal supplement for BPH, has been used with some success.

Cernilton, a pollen extract product, is thought to have anti-inflammatory activity.

Finasteride, a 5-alpha-reductase inhibitor, has been shown to be effective in reducing symptoms.

Quercetin, a flavonoid found in green tea, oranges, and onions has also been shown to reduce symptoms.

Patient Education:

• In addition, patients should be told that certain foods (see Diet) may cause more irritation; and, with a little experimenting, they can determine which foods to avoid or limit.

• Some urologists, the author included, also recommend frequent ejaculation to prevent a buildup or stasis of secretions within the prostate, thus avoiding inflammation and prostatitis symptoms.

• Patients should be instructed to try to limit stress in their lives, which may exacerbate symptoms.