Anti-inflammatory agents and 
immune modulators


Various non-steroidal anti-inflammatories, corticosteroids, and immunosuppressants have been looked at as potential therapies for CP/CPPS. Short-term cyclooxygenase type 2 therapy has shown a modest dose dependent response for reducing pain symptoms and improving quality of life.26,27 Specifically, nimuliside and rofecoxib have been shown to result in symptom improvement. Long-term cyclooxygenase type 2 therapy is not recommended. Short-term nonsteroidal anti-inflammatory drugs are worth considering in the early stage of the condition. Meta-analyses show that although the benefits overall are very modest, some patients do achieve clinically acceptable results, even with monotherapy.25

Other medical therapies


Given the lack of a gold standard treatment for CP/CPPS, it is not surprising that a number of agents have been examined as possible alternative treatments for this condition. Skeletal muscle relaxants have been advocated as adjuncts for CPPS as pelvic floor neuromuscular dysregulation has been hypothesized as a possible cause for some of the symptoms. Baclofen, for instance, has shown some benefit in one small trial in patients with chronic abacterial prostatitis.28 Other suggested skeletal muscle relaxants include diazepam and cyclobenzaprine. The 5-alpha reductase inhibitors, finasteride and dutasteride, may be helpful in older patients with concurrent BPH, although they cannot be recommended as monotherapy.29 A number of phytotherapeutic agents, such as Cernilton, a pollen extract, Quercetin, a natural bioflavonoid, and an extract 
of Serenoa repens (saw palmetto), provide modest benefit in some patients.30-32 Neuromodulatory intervention (using, for example, tricyclic antidepressants and gabapentinoids) show some 
promise for refractory patients who develop a chronic pelvic neuropathic type of pain.33


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Physical therapy


Prostatic massage was the mainstay of therapy for prostatitis in the first half of the 20th century. Evidence supporting repetitive prostate massage therapy is conflicting, and a consensus panel concluded that prostatic massage could be used as an adjunct form of therapy only in selected patients. Frequent ejaculation may achieve the same.34 Heat therapy, physiotherapy massage, ischemic compression, stretching, anesthetic injections, acupuncture, electroneural modulation, and mind-body interactions such as progressive relaxation exercises, yoga, and hypnosis have all been tried, although more scientific scrutiny is necessary to understand the role of these interventions in the treatment of CP/CPPS.35