Evaluation of prostatic massage in treatment of chronic prostatitis

Objectives. To evaluate the efficacy of regular prostatic massage in combination with culture-specific antibiotic therapy for men with chronic prostatitis. Methods. This study included 81 consecutive patients who attended our outpatient clinic with a history or symptoms suggestive of chronic prostatitis (National Institutes of Health category II and IIIA). In addition to prostatic culture and sensitivity, all patients were asked to complete the National Institutes of Health Chronic Prostatitis Symptom Index. According to their chronic prostatitis category, all patients were divided into four groups: group 1, chronic bacterial prostatitis treated with antibiotics and prostatic massage, n = 17; group 2, chronic bacterial prostatitis treated with antibiotics alone, n = 20; group 3, chronic nonbacterial prostatitis treated with antibiotics and prostatic massage, n = 25; and group 4, chronic nonbacterial prostatitis treated with antibiotics alone, n = 19. Results. Of the 37 patients with initially positive cultures, 30 (81.1%) had sterile final cultures. Overall, 30 patients (37%) of 81 had complete resolution of symptoms, 18 (22.2%) had initial resolution but had recurrence after therapy, 22 (27.1%) had partial improvement, and 11 (13.5%) had no improvement. No significant difference was found in the response between patients treated with antibiotics alone and those treated with antibiotics and prostatic massage in all four groups. Only 29% of class IIIa patients had complete improvement in contrast to 52% complete improvement in the class II patients. Conclusions. Prostatic massage did not significantly improve the response of patients with chronic pelvic pain syndrome to antibiotics. Patients with National Institutes of Health class II prostatitis should be primarily treated with culture-sensitive antibiotics. Treatment of nonbacterial prostatitis is challenging and requires additional extensive research.