MODERN APPROACHES TO THE DIAGNOSIS AND TREATMENT OF CHRONIC PROSTATITIS: A CLINICAL AND LABORATORY ANALYSIS

Аннотация

Chronic prostatitis, particularly chronic pelvic pain syndrome (CP/CPPS), remains a significant diagnostic and therapeutic challenge in clinical urology. It is a multifactorial syndrome with overlapping inflammatory, infectious, neurogenic, autoimmune, and psychosocial components. The purpose of this study is to provide a comprehensive clinical and laboratory evaluation of chronic prostatitis, focusing on modern diagnostic protocols and treatment approaches. The study included clinical data from 80 patients with symptoms lasting longer than three months, and combined both traditional and innovative diagnostics, such as PCR-based pathogen identification, EPS analysis, and transrectal ultrasound. The results show that a personalized, phenotype-based approach, especially using the UPOINT classification, enhances therapeutic outcomes. Antibiotics remain effective in selected cases, but alpha- blockers, physiotherapy, and anti-inflammatory agents also play vital roles. The study highlights the importance of interdisciplinary collaboration and long-term patient monitoring. Keywords: Chronic prostatitis, CP/CPPS, diagnosis, EPS, alpha-blockers, antibiotics, UPOINT classification, pelvic pain, TRUS, microbiology Introduction: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is one of the most prevalent and frustrating urological conditions encountered in men under 50. Although not life-threatening, it significantly impairs quality of life and presents a broad spectrum of clinical symptoms ranging from pelvic pain, urinary frequency, urgency, and painful ejaculation to psychological distress, including anxiety and depression. The pathophysiology of CP/CPPS is complex and incompletely understood. The condition is classified as type III prostatitis by the NIH, and further subclassified into IIIA (inflammatory) and IIIB (non-inflammatory) types. While type II chronic bacterial prostatitis has a clear infectious etiology, most CP/CPPS cases lack identifiable pathogens. Therefore, treatment is often empirical, multifactorial, and prolonged. Modern medicine has introduced a variety of tools and methodologies to improve diagnosis and patient stratification. Among them are advanced imaging, molecular diagnostics (e.g., PCR), and validated symptom questionnaires like NIH-CPSI. Similarly, treatment options have expanded from empiric antibiotic therapy to include alpha-blockers, anti-inflammatory agents, phytotherapy, behavioral therapy, and pelvic floor physiotherapy. This study aims to assess current approaches to the diagnosis and management of chronic prostatitis using clinical and laboratory data, and to explore the effectiveness of multimodal treatment strategies.