A Chinese expert consensus on prostate-pelvic syndrome

Acknowledgments

Lead drafting experts

Cheng Yang, First Affiliated Hospital of Anhui Medical University;

Chaozhao Liang, First Affiliated Hospital of Anhui Medical University;

Shujie Xia, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine;

Chunhua Deng, First Affiliated Hospital of Sun Yat-sen University;

Zhiping Wang, Second Hospital, Lanzhou University

Experts in discussion and review

Yutian Dai, The Affiliated Drum Tower Hospital of Medical School of Nanjing University;

Chunhua Deng, The First Affiliated Hospital of Sun Yat-sen University;

Qiang Dong, West China Hospital, Sichuan University;

Bangmin Han, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine;

Zongyao Hao, The First Affiliated Hospital of Anhui Medical University;

Dalin He, The First Affiliated Hospital of Xi’an Jiaotong University;

Houbao Huang, The Second Affiliated Hospital of Wannan Medical College;

Zhigang Ji, Peking Union Medical College Hospital;

Chaozhao Liang, The First Affiliated Hospital of Anhui Medical University;

Hongjun Li, Peking Union Medical College Hospital;

Zheng Li, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine;

Xuejun Shang, General Hospital of Eastern Theater Command;

Benkang Shi, Qilu Hospital of Shandong University;

Shaogang Wang, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology;

Sheng Wang, The First Affiliated Hospital of Bengbu Medical University;

Xinghuan Wang, Zhongnan Hospital of Wuhan University;

Shujie Xia, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine;

Jun Xiao, The First Affiliated Hospital of USTC;

Liping Xie, The First Affiliated Hospital, Zhejiang University School of Medicine;

Junping Xing, The First Affiliated Hospital of Xi’an Jiaotong University;

Nianzeng Xing, Cancer Hospital, Chinese Academy of Medical Sciences;

Wanhai Xu, The Second Affiliated Hospital of Harbin Medical University;

Cheng Yang, The First Affiliated Hospital of Anhui Medical University;

Guosheng Yang, Shanghai East Hospital, Tongji University;

Xiantao Zeng, Zhongnan Hospital of Wuhan University;

Bo Zhang, Tangdu Hospital, Air Force Medical University;

Ligang Zhang, The First Affiliated Hospital of Anhui Medical University;

Zhansong Zhou, The First Affiliated Hospital of Army Medical University;

Dong Zhuo, Yijishan Hospital of Wannan Medical College

Statement of ethics

This consensus is a translation and secondary dissemination of a published consensus, involves no collection of new patient data and thus no additional ethical review has been applied for.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Funding source

None.

Author contributions

This consensus was jointly written by the Andrology and Sexual Medicine Branch of Chinese Medical Doctors Association; Chinese Association of Andrology; Chinese Collaborative Group on Diagnosis and Efficacy Evaluation Standards for Chronic Prostatitis.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

[1] Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999; 282(3):236-237.

[2] Murphy SF, Schaeffer AJ, Thumbikat P. Immune mediators of chronic pelvic pain syndrome. Nat Rev Urol 2014; 11(5):259-269.

[3] Liang C, Fan S. Proposal and thinking of renaming type Ⅲ prostatitis to prostate-pelvic syndrome [in Chinese]. Zhonghua Mi Niao Wai Ke Za Zhi 2020; 41(5):326-329.

[4] Rees J, Abrahams M, Doble A, Cooper A; Prostatitis Expert Reference Group (PERG). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: A consensus guideline. BJU Int 2015; 116(4):509-525.

[5] Zhang Y, Zheng T, Tu X, et al. Erectile dysfunction in chronic prostatitis/chronic pelvic pain syndrome: Outcomes from a multi-center study and risk factor analysis in a single center. PLoS One 2016; 11(4):e0153054.

[6] Krakhotkin DV, Chernylovskyi VA, Bakurov EE, Sperl J. Evaluation of influence of the UPOINT-guided multimodal therapy in men with chronic prostatitis/chronic pelvic pain syndrome on dynamic values NIH-CPSI: A prospective, controlled, comparative study. Ther Adv Urol 2019;11:1756287219857271.

[7] Liang CZ, Zhang XJ, Hao ZY, et al. An epidemiological study of patients with chronic prostatitis. BJU Int 2004; 94(4):568-570.

[8] Zhang R, Sutcliffe S, Giovannucci E, et al. Lifestyle and risk of chronic prostatitis/chronic pelvic pain syndrome in a cohort of United States male health professionals. J Urol 2015; 194(5):1295-1300.

[9] Riegel B, Bruenahl CA, Ahyai S, Bingel U, Fisch M, Löwe B. Assessing psychological factors, social aspects and psychiatric co-morbidity associated with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men -- A systematic review. J Psychosom Res 2014; 77(5):333-350.

[10] Zhang LG, Chen J, Meng JL, et al. Effect of alcohol on chronic pelvic pain and prostatic inflammation in a mouse model of experimental autoimmune prostatitis. Prostate 2019; 79(12):1439-1449.

[11] Pontari MA, McNaughton-Collins M, O’leary MP, et al. A case-control study of risk factors in men with chronic pelvic pain syndrome. BJU Int 2005; 96(4):559-565.

[12] Pontari MA, Ruggieri MR. Mechanisms in prostatitis/chronic pelvic pain syndrome. J Urol 2004; 172(3):839-845.

[13] Parsons CL. Prostatitis, interstitial cystitis, chronic pelvic pain, and urethral syndrome share a common pathophysiology: Lower urinary dysfunctional epithelium and potassium recycling. Urology 2003; 62(6):976-982.

[14] Parsons CL, Rosenberg MT, Sassani P, Ebrahimi K, Koziol JA, Zupkas P. Quantifying symptoms in men with interstitial cystitis/prostatitis, and its correlation with potassium-sensitivity testing. BJU Int 2005; 95(1):86-90.

[15] Fan S, Hao ZY, Zhang L, et al. ASIC1a contributes to the symptom of pain in a rat model of chronic prostatitis. Asian J Androl 2018; 20(3):300-305.

[16] Liang CZ, Guo QK, Hao ZY, et al. K channel expression in prostate epithelium and its implications in men with chronic prostatitis. BJU Int 2006; 97(1):190-192.

[17] Zhang Z, Liang CZ, Zhang XS, Hao ZY, Fan S, Liu JH. Impact of BKCa channel in prostate smooth muscle cells on the membrane potential in rats with chronic abacterial prostatitis [in Chinese]. Zhonghua Nan Ke Xue 2013; 19(1):10-14.

[18] Ding H, Liang CZ. Advances in the pathogenesis of pain in chronic pelvic pain syndrome (CPPS) [in Chinese]. Zhongguo Nan Ke Xue Zazhi 2015; 29(3):58-61.

[19] Nickel JC, Tripp DA, Chuai S, et al. Psychosocial variables affect the quality of life of men diagnosed with chronic prostatitis/chronic pelvic pain syndrome. BJU Int 2008; 101(1):59-64.

[20] Clemens JQ, Brown SO, Calhoun EA. Mental health diagnoses in patients with interstitial cystitis/painful bladder syndrome and chronic prostatitis/chronic pelvic pain syndrome: A case/control study. J Urol 2008; 180(4):1378-1382.

[21] Chung SD, Lin HC. Association between chronic prostatitis/chronic pelvic pain syndrome and anxiety disorder: A population-based study. PLoS One 2013; 8(5):e64630.

[22] Zhang Y, Liang C. Progress of research on the influence of psycho-spiritual factors on chronic prostatitis [in Chinese]. Anhui Med J 2013; 34(9):1420-1421.

[23] Shoskes DA, Berger R, Elmi A, et al. Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: The chronic prostatitis cohort study. J Urol 2008; 179(2):556-560.

[24] Hetrick DC, Ciol MA, Rothman I, Turner JA, Frest M, Berger RE. Musculoskeletal dysfunction in men with chronic pelvic pain syndrome type III: A case-control study. J Urol 2003; 170(3):828-831.

[25] Anderson RU, Orenberg EK, Chan CA, Morey A, Flores V. Psychometric profiles and hypothalamic-pituitary-adrenal axis function in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol 2008; 179(3):956-960.

[26] Yang CC, Lee JC, Kromm BG, Ciol MA, Berger R. Pain sensitization in male chronic pelvic pain syndrome: Why are symptoms so difficult to treat? J Urol 2003; 170(3):823-826; discussion 826.

[27] Zhang H, Liu LM, Lu GS, et al. Correlation between activation of L5-S 2 spinal cord astrocytes and effect of substance P in chronic prostatitis pain [in Chinese]. Zhonghua Nan Ke Xue 2009; 15(11):1021-1027.

[28] Zhang H, Liu L, Lu G, et al. Chemical irritation of the prostate sensitizes P(2)X(3) receptor-mediated responses in rat dorsal root ganglion neurons. . Neurourol Urodyn 2011; 30(4):612-618.

[29] Park JS, Jin MH, Hong CH. Neurologic mechanisms underlying voiding dysfunction due to prostatitis in a rat model of nonbacterial prostatic inflammation. Int Neurourol J 2018; 22(2):90-98.

[30] Yang CC. Neuromodulation in male chronic pelvic pain syndrome: Rationale and practice. World J Urol 2013; 31(4):767-772.

[31] Trevisani M, Campi B, Gatti R, et al. The influence of alpha1-adrenoreceptors on neuropeptide release from primary sensory neurons of the lower urinary tract. Eur Urol 2007; 52(3):901-908.

[32] Ye C, Xiao G, Xu J, et al. Differential expression of immune factor between patients with chronic prostatitis/chronic pelvic pain syndrome and the healthy volunteers. Int Urol Nephrol 2018; 50(3):395-399.

[33] Penna G, Mondaini N, Amuchastegui S, et al. Seminal plasma cytokines and chemokines in prostate inflammation: Interleukin 8 as a predictive biomarker in chronic prostatitis/chronic pelvic pain syndrome and benign prostatic hyperplasia. Eur Urol 2007; 51(2):524-33; discussion 533.

[34] Stancik I, Plas E, Juza J, Pflüger H. Effect of antibiotic therapy on interleukin-6 in fresh semen and postmasturbation urine samples of patients with chronic prostatitis/chronic pelvic pain syndrome. Urology 2008; 72(2):336-339.

[35] He L, Wang Y, Long Z, Jiang C. Clinical significance of IL-2, IL-10, and TNF-alpha in prostatic secretion of patients with chronic prostatitis. Urology 2010; 75(3):654-657.

[36] Desireddi NV, Campbell PL, Stern JA, et al. Monocyte chemoattractant protein-1 and macrophage inflammatory protein-1alpha as possible biomarkers for the chronic pelvic pain syndrome. J Urol 2008; 179(5):1857-1861; discussion 1861.

[37] Gao M, Ding H, Zhong G, et al. The effects of transrectal radiofrequency hyperthermia on patients with chronic prostatitis and the changes of MDA, NO, SOD, and Zn levels in pretreatment and posttreatment. Urology 2012; 79(2):391-396.

[38] Ihsan AU, Khan FU, Khongorzul P, et al. Role of oxidative stress in pathology of chronic prostatitis/chronic pelvic pain syndrome and male infertility and antioxidants function in ameliorating oxidative stress. Biomed Pharmacother 2018;106:714-723.

[39] Pavone C, Caldarera E, Liberti P, et al. Correlation between chronic prostatitis syndrome and pelvic venous disease: A survey of 2,554 urologic outpatients. Eur Urol 2000; 37(4):400-403.

[40] Song S, Zhang C, Zhang B, et al. Targeting the brain-gut-prostate axis in chronic prostatitis: Mechanisms and therapeutics. Front Endocrinol (Lausanne) 2025;16:1628094.

[41] Shoskes DA, Wang H, Polackwich AS, Tucky B, Altemus J, Eng C. Analysis of gut microbiome reveals significant differences between men with chronic prostatitis/chronic pelvic pain syndrome and controls. J Urol 2016; 196(2):435-441.

[42] Du HX, Yue SY, Niu D, et al. Gut microflora modulates Th17/Treg cell differentiation in experimental autoimmune prostatitis via the short-chain fatty acid propionate. Front Immunol 2022;13:915218.

[43] Shoskes DA, Altemus J, Polackwich AS, Tucky B, Wang H, Eng C. The urinary microbiome differs significantly between patients with chronic prostatitis/chronic pelvic pain syndrome and controls as well as between patients with different clinical phenotypes. Urology 2016;92:26-32.

[44] Wang S, Zang M, Yang X, et al. Gut microbiome in men with chronic prostatitis/chronic pelvic pain syndrome: Profiling and its predictive significance. World J Urol 2023; 41(11):3019-3026.

[45] Zhang T, Hu C, Chen J, et al. Analysis of the clinical value of the first and second editions of the Prostate Imaging Reporting and Data System in identifying peripheral zone prostatitis from prostate cancer [in Chinese]. Zhonghua Yi Xue Za Zhi 2019; 99(31):2455-2458.

[46] Li P, Huang Y, Li Y, et al. Multi-parametric magnetic resonance imaging for the diagnosis and differential diagnosis of early prostate cancer and prostatitis in the peripheral zone [in Chinese]. Zhonghua Yi Xue Za Zhi 2016; 96(37):2973-2977.

[47] Magistro G, Wagenlehner FM, Grabe M, Weidner W, Stief CG, Nickel JC. Contemporary management of chronic prostatitis/chronic pelvic pain syndrome. Eur Urol 2016; 69(2):286-297.

[48] Yokoyama T, Hara R, Fukumoto K, et al. Effects of three types of alpha-1 adrenoceptor blocker on lower urinary tract symptoms and sexual function in males with benign prostatic hyperplasia. Int J Urol 2011; 18(3):225-230.

[49] Nickel JC, O’Leary MP, Lepor H, et al. Silodosin for men with chronic prostatitis/chronic pelvic pain syndrome: Results of a phase II multicenter, double-blind, placebo controlled study. J Urol 2011; 186(1):125-131.

[50] Zhao WP, Zhang ZG, Li XD, et al. Celecoxib reduces symptoms in men with difficult chronic pelvic pain syndrome (category IIIA). Braz J Med Biol Res 2009; 42(10):963-967.

[51] Wagenlehner FM, Schneider H, Ludwig M, Schnitker J, Brähler E, Weidner W. A pollen extract (Cernilton) in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome: A multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study. Eur Urol 2009; 56(3):544-551.

[52] Song B, Yang Y, Liao L, et al. Diagnostic and Therapeutic Guidelines for Overactive Bladder Disease - China Urology Disease Diagnostic and Therapeutic Guidelines. People’s Medical Publishing House; 2006: 1-13.

[53] Shulyak A, Gorpynchenko I, Drannik G, Poroshina T, Savchenko V, Nurimanov K. The effectiveness of the combination of rectal electrostimulation and an antidepressant in the treatment of chronic abacterial prostatitis. Cent European J Urol 2019; 72(1):66-70.

[54] Xia D, Wang P, Chen J, Wang S, Jiang H. Fluoxetine ameliorates symptoms of refractory chronic prostatitis/chronic pelvic pain syndrome. Chin Med J (Engl) 2011; 124(14):2158-2161.

[55] Franco JV, Turk T, Jung JH, et al. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev 2018; 1(1):CD012551.

[56] Chen SD, Li J, Li SQ, Qian LH, He Y, Liu BP. Biofeedback therapy for chronic prostatitis: Application and consideration [in Chinese]. Zhonghua Nan Ke Xue 2016; 22(1):57-62.

[57] Qin Z, Wu J, Tian J, Zhou J, Liu Y, Liu Z. Network meta-analysis of the efficacy of acupuncture, alpha-blockers and antibiotics on chronic prostatitis/chronic pelvic pain syndrome. Sci Rep 2016;6:35737.

[58] Kabay S, Kabay SC, Yucel M, Ozden H. Efficiency of posterior tibial nerve stimulation in category IIIB chronic prostatitis/chronic pelvic pain: A sham-controlled comparative study. Urol Int 2009; 83(1):33-38.

[59] Chiang PH, Chiang CP. Therapeutic effect of transurethral needle ablation in non-bacterial prostatitis: Chronic pelvic pain syndrome type IIIa. Int J Urol 2004; 11(2):97-102.

[60] Liatsikos EN, Dinlenc CZ, Kapoor R, Smith AD. Transurethral microwave thermotherapy for the treatment of prostatitis. J Endourol 2000; 14(8):689-692.

[61] Hu M, Wazir J, Ullah R, et al. Phytotherapy and physical therapy in the management of chronic prostatitis-chronic pelvic pain syndrome. Int Urol Nephrol 2019; 51(7):1081-1088.

[62] Kong X, Hu W, Dong Z, et al. The efficacy and safety of low-intensity extracorporeal shock wave treatment combined with or without medications in chronic prostatitis/chronic pelvic pain syndrome: A systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2023; 26(3):483-494.

[63] Guo Y, Xin Z, Li H, et al. Embracing the third revolution in life sciences emphasizing the development of microenergetic medicine [in Chinese]. Beijing Da Xue Xue Bao 2015; 47(04):559-565.

[64] Jin C, Bian Z, Song Z, et al. Effect of low-intensity extracorporeal shock wave on the treatment of chronic prostatitis in rats [in Chinese]. Zhonghua Mi Niao Wai Ke Za Zhi 2020; 41(10):779-783.

[65] Zimmermann R, Cumpanas A, Miclea F, Janetschek G. Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: A randomised, double-blind, placebo-controlled study. Eur Urol 2009; 56(3):418-424.

[66] Wang J, Liang K, Sun H, Li L, Wang H, Cao J. Psychotherapy combined with drug therapy in patients with category III chronic prostatitis/chronic pelvic pain syndrome: A randomized controlled trial. Int J Urol 2018; 25(8):710-715.

[67] Ren F, Dong L, Dong R, et al. Value of tertiary prevention for the chronic prostatitis [in Chinese]. Zhong Guo Xing Ke Xue 2015; 24(12):59-61.

[68] Wang Y, Su B, Alcalde-Herraiz M, et al. Modifiable lifestyle factors and the risk of post-COVID-19 multisystem sequelae, hospitalization, and death. Nat Commun 2024; 15(1):6363.

[69] Keltikangas-Järvinen L, Mueller K, Lehtonen T. Illness behavior and personality changes in patients with chronic prostatitis during a two-year follow-up period. Eur Urol 1989; 16(3):181-184.