This protocol addresses male patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) who also present with urinary voiding symptoms attributable to benign prostatic hyperplasia (BPH) or an enlarged prostate, as confirmed by imaging or PSA level.

Comorbidity: Benign Prostatic Hyperplasia

When CP/CPPS is accompanied by voiding symptoms from BPH or prostatic enlargement — established by imaging or PSA — the treatment approach accounts for both the pelvic pain syndrome and the underlying obstructive process.

Treatment Approach (Partial)

The structured regimen involves a 5-alpha reductase inhibitor directed at both the prostatitis pain complex and the prostatic obstruction driving voiding dysfunction. The full protocol — including agent selection, clinical sequencing, and the complete algorithm — is available in the evidence-based regimen.

Clinical Goals

Treatment aims for a reduction of at least 6 points in the NIH-CPSI total score and meaningful improvement in urinary voiding symptoms.

References

Clinicians may prescribe 5-alpha reductase inhibitors to patients with CP/CPPS who also have voiding symptoms from BPH or enlarged prostate as determined by imaging or PSA level.
Dutasteride 0.5 mg was studied in the REDUCE trial, a 4-year, randomized, double-blind, placebo-controlled study of prostate cancer risk reduction.
After 48 months, among patients with prostatitis-like pain, the dutasteride group noted a significant decrease of 6 points or greater in NIH-CPSI total scores compared with placebo (49% versus 37%; p=0.0033).

DOI: 10.1097/JU.0000000000004564

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Treatment of Chronic Pelvic Pain Syndrome in Males with Benign Prostatic Hyperplasia and Voiding Symptoms

References