No difference between drug and placebo in treating chronic prostatitis

When it comes to treating chronic prostatitis, also called chronic pelvic pain syndrome, many urologists turn to alpha blockers, drugs commonly prescribed to treat high blood pressure and benign prostatic hyperplasia (BPH). Although not approved for the treatment of chronic prostatitis, alpha blockers had been shown to be effective in some small studies.

However, results from a trial by the Chronic Prostatitis Collaborative Research Network Study Group, a consortium funded by the National Institute of Diabetes and Digestive and Kidney Diseases, call into question the use of one alpha blocker, alfuzosin (Uroxatral), to treat the condition. In the trial, 272 men recently diagnosed with chronic prostatitis who had not taken alpha blockers were randomly assigned to take alfuzosin or a placebo for 12 weeks. The conclusion: alfuzosin and the placebo were equally effective at reducing symptoms — pain, urinary difficulties, and sexual dysfunction — with 49% of participants responding to each.

In theory, alpha blockers might ease the symptoms of chronic prostatitis because they relax the smooth muscles of the prostate and bladder neck. They also improve the lower urinary tract symptoms of BPH. So the trial results, which haven’t been published but were announced at the American Urological Association’s annual meeting in May 2008, surprised researchers.

“As sometimes happens, it was a great hypothesis ruined by good science,” said Dr. J. Curtis Nickel, who presented the group’s findings.

The study did not assess the effectiveness of other alpha blockers, namely doxazosin (Cardura), terazosin (Hytrin), and tamsulosin (Flomax).

SOURCES: Nickel JC, Krieger JN, White PC, et al. A Randomized Multicenter Double-Blind Clinical Trial to Evaluate the Efficacy and Safety of Alfuzosin in the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) in Recently Diagnosed and/or Newly Symptomatic Alpha-Blocker Naïve Patients. The Journal of Urology 2008;179(Suppl):31, abstract 87.

Nickel JC. The Role of Alpha1-Blockers in Chronic Prostatitis Syndromes. BJU International 2008;101(Suppl 3):11–16. PMID: 18307680.