What is the efficacy of alpha blockers in the treatment of chronic bacterial prostatitis (CBP)?

Updated: Jan 15, 2019
  • Author: Samantha D Kraemer, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Alpha-adrenergic antagonist medications include tamsulosin, alfuzosin, doxazosin, terazosin, and silodosin. The uroselective alpha blockers (tamsulosin, alfuzosin, and silodosin) have better adverse-effect profiles and should be first-line choices. The alpha blockers can help to decrease recurrences by diminishing urinary outflow obstruction due to prostate enlargement or congestion secondary to inflammation and improve urinary flow or diminish intraprostatic ductal reflux. 

These agents have provided significant symptom reduction and improvement in quality of life in patients with CBP, as well as those with CPPS. Ten randomized controlled studies evaluating alpha blockers in patients with prostatitis symptoms, mostly in men with CPPS, have been published, with eight of them reporting positive results, using the NIH-CPSI or other validated symptom-scoring tools.

Experts advise that alpha blockers should be considered as part of initial treatment of patients presenting with lower urinary tract symptoms (LUTS), although there is insufficient evidence to inform best practice with these medications. [26] Alpha blockers should be used as part of a multimodal approach to treatment in a newly diagnosed patient, but are not recommended as monotherapy, especially if the patient has previously been treated with alpha blockers. [1] If no relief of symptoms is achieved in 4-6 weeks then the treatment should be discontinued.


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