The Effect of α‐Adrenergic Antagonists in Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Meta‐Analysis of Randomized Controlled Trials

Abstract

The effectiveness of a-adrenergic antagonists on patients with chronic prostatitis/chronic pelvic pain syndrome (CP/ CPPS) has not been supported by well-evaluated study. The metaanalysis was performed to supply the best evidence about use of this class of drugs in CP/CPPS. A fully recursive literature search to June 2005 was conducted in PubMed, EMBASE, the Cochrane Controlled Trials Register, and the Chinese Biomedicine Database to identify potentially relevant randomized controlled trials. RevMan4.2 was used for statistical analysis. Nine studies with 734 patients were included. Combined analysis showed a significant reduction of total NIH-CPSI or I-PSS in patients with treatment duration of more than 3 months. There were also valuable results in urinary symptom alleviation. Alpha-adrenergic antagonists did not show benefit in pain. The meta-analysis revealed that the use of a-adrenergic antagonists was warranted in CP/CPPS, and the treatment duration should be long enough (more than 3 months).

Management of Chronic Prostatitis/ Chronic Pelvic Pain Syndrome

“…Search terms and strategies for each database are described in the eAppendix (available at http://www.jama.com). Reference lists of included trials and the previous systematic reviews 6,16 were explored.…”

“…[27][28][29] An advantage of network meta-analysis is the ability to "borrow" information on the treatment groups from other studies, thereby increasing the total sample sizes. For example, direct comparisons in a previous meta-analysis 16 included 466, 236, and 123 patients in pooling for total symptom, pain, and voiding scores, respectively, comparing ␣-blockers vs placebo. In the current analysis, the corresponding numbers of patients were 1549, 1556, and 1546.…”

“…To date, only 1 systematic review 6 and 1 meta-analysis 16 of ␣-blockers vs placebo of which we are aware have been performed for treatment of CP/CPPS. We therefore performed a systematic review and network meta-analysis mapping all treatment regimens, with 2 aims.…”

Phenotypic approach to the Management of chronic prostatitis/chronic pelvic pain syndrome

“…Four smaller and less restrictive RCTs were, in fact, positive in terms of showing the effectiveness of terazosin [18], alfuzosin [19], doxazosin [20], and tamsulosin [21] over placebo. Although the evidence clearly shows that, overall, α-blockers cannot be considered an effective cure, there is likely a subgroup of CP/CPPS men who may respond to this approach [22,23].…”

Efficacy of acupuncture for chronic prostatitis/chronic pelvic pain syndromes: study protocol for a randomized, sham acupuncture-controlled trial

“…According to the consensus guidelines, there is still no standard treatment for CP/CPPS; as a result, individualized therapy and symptom-based treatment approaches are recommended [5]. The interventions for CP/CPPS include medication (alpha-adrenergic antagonists, antibiotics, pain pharmacotherapies, 5-alpha-reductase inhibitors, and phytotherapy), physiotherapy (biofeedback, acupuncture) and surgical intervention [7–10]. Drugs such as alpha-adrenergic antagonists and antibiotics have been considered the initial treatment options for CP/CPPS, but in most cases, the administration of a single drug does not relieve multiple symptoms [5].…”