Review question

What are the effects of non-medicine therapies in men with longstanding pain and discomfort around their prostate and pelvis, so-called chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)?

Background

CP/CPPS is a common disorder in which men feel pelvic pain or have bothersome symptoms (or both of these) when urinating. Its cause is unknown and there are many different treatments for this condition.

Study characteristics

The evidence was current to August 2017. We found 38 studies that were conducted between 1993 and 2016 with 3187 participants that made 23 comparisons between different treatments in men with CP/CPPS. The evaluated interventions usually implied the use of devices, medical advice or some form of physical therapy. In many cases, these therapies were given to men in an outpatient setting. Most studies did not specify their funding sources; three studies reported funding from device makers.

Key results

Acupuncture: we found that acupuncture (an alternative medicine where thin needles are inserted into the skin at specific points) decrease symptoms in an appreciable number of men and is probably not associated with side effects when compared with pretend acupuncture. It probably decreases symptoms when compared with standard medical therapy.

Circumcision: we found that men who were circumcised (removal of the foreskin of the penis) probably have fewer symptoms (small effect) and may not have more side effects when compared to men who delay circumcision.

Electromagnetic chair: we are uncertain of the effects of the use of an electromagnetic chair (a device that provides magnetic stimulation to the pelvis) on men’s symptoms; however, it may not be associated with a greater incidence of side effects when compared with a simulated procedure (where researchers pretended to but did not actually use the device).

Lifestyle modifications: we are uncertain whether the recommendation of lifestyle modifications reduces symptoms when compared to the continuation of the same lifestyle. We had no information regarding side effects.

Physical activity: we found that a physical activity programme may reduce symptoms (small effect) when compared with a non-specific activity used as a control. We have no information regarding side effects.

Prostatic massage: we are uncertain whether the prostatic massage reduces or increases symptoms when compared with no massage. We found no information regarding side effects.

Extracorporeal shockwave therapy: we found that extracorporeal shockwave therapy (where shock waves are passed through the skin to the prostate) decreases appreciably symptoms compared to a simulated procedure. These results may not be lasting after more continued treatment. This treatment may not be associated with side effects.

Transrectal thermotherapy compared to medical therapy: we found that transrectal thermotherapy (which applies heat to the prostate and pelvic muscle area) alone or in combination with medical therapy may cause a small decrease in symptoms compared to medical therapy alone. One of the included studies reported that participants may experience transient side effects.

There is uncertainty about the effects of other interventions.

Quality of the evidence

The quality of the evidence was low in most cases, meaning that there is much uncertainty surrounding the results. The included studies were not well designed, had a small sample size and had a short follow-up time (usually 12 weeks).