Prostatitis benefit seen with alpha-blocker, antibiotic combinations

Treatment that combines alpha-blockers and antibiotics appears to provide the greatest improvement in symptom relief in patients with chronic prostatits/chronic pelvic pain syndrome (CP/CPPS), according to findings from a recent meta-analysis.

However, the benefits of alpha-blockers may be overestimated because of publication bias, say the study’s authors, writing in JAMA (2011; 305:78-86).

Researchers from Mahidol Hospital, Bangkok, Thailand and colleagues from New South Wales, Australia, and Kingston, Ontario, searched MEDLINE from 1949 and EMBASE from 1974 to November 2010 for randomized controlled trials comparing drug treatments in CP/CPPS patients. Two reviewers independently extracted mean symptom scores, quality of life measures, and response to treatment between treatment groups.

Twenty-three of 262 studies identified were eligible. Compared with placebo, alpha-blockers were associated with significant improvement in symptoms with standardized mean differences in total symptom, pain, voiding, and quality of life scores of –1.7 (95% CI, –2.8 to −0.6), –1.1 (95% CI, –1.8 to –0.3), –1.4 (95% CI, –2.3 to –0.5), and –1.0 (95% CI, –1.8 to –0.2), respectively.

Patients receiving alpha-blockers or anti-inflammatory medications had a higher chance of favorable response compared with placebo, with pooled relative risks of 1.6 (95% CI, 1.1 to 2.3) and 1.8 (95% CI, 1.2 to 2.6), respectively. Data analysis suggested the presence of publication bias for smaller studies of alpha-blocker therapies, according to the authors, led by Ammarin Thakkinstian, PhD, of Mahidol Hospital.

Combining alpha-blockers and antibiotics yielded the greatest benefits compared with placebo, with corresponding decreases of –13.8 (95% CI, –17.5 to –10.2) for total symptom scores, –5.7 (95% CI, –7.8 to –3.6) for pain scores, –3.7 (95% CI, –5.2 to –2.1) for voiding, and –2.8 (95% CI, –4.7 to –0.9) for quality of life scores.