This protocol addresses male patients with primary prostate pain syndrome — persistent or recurrent episodic pelvic pain lasting at least 3 months, convincingly reproduced by prostate palpation, with no proven infection or other identifiable local pathology — who have completed a course of first-line phytotherapy without achieving the target reductions in NIH-CPSI total score or chronic pelvic pain severity.
Male sex. Persistent or recurrent episodic prostate pain, duration ≥ 3 months, convincingly reproduced by prostate palpation. Infection excluded. No other obvious local pathology identified.
A completed course of phytotherapy — including options such as pollen extract (Cernilton), Serenoa repens, quercetin, DEPROX 500, or pentosane polysulphate — did not achieve the following targets at 12 weeks:
Non-achievement of these targets escalates management to the next structured protocol.
The evidence-based next step involves procedural physical therapy; extracorporeal shockwave therapy is among the options with established clinical evidence in this setting. The complete regimen, sequencing, and full range of alternatives are detailed in the full protocol.
Treatment goals: Reduction in chronic pelvic pain severity and improvement in lower urinary tract voiding symptoms at 12 weeks.