What are the recommended diagnostic criteria for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in primary care?

Recommended Diagnostic Criteria for Chronic Prostatitis and Chronic Pelvic Pain Syndrome (CP/CPPS) in Primary Care

Diagnosis of chronic prostatitis and CP/CPPS in primary care is primarily clinical, based on a history of pelvic pain lasting for at least 3 months without evidence of urinary tract infection or other identifiable causes. The condition is multifactorial and often chronic, with symptoms including pelvic pain, lower urinary tract symptoms, and sometimes sexual dysfunction.

Key diagnostic steps include:

• Taking a detailed medical history focusing on duration (≥3 months) and nature of pelvic pain and urinary symptoms.
• Performing a physical examination including abdominal, external genitalia, and digital rectal examination to exclude other causes such as prostate cancer or benign prostatic enlargement.
• Using symptom assessment tools such as the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) or the UPOINT classification system to phenotype symptoms and guide management.
• Excluding urinary tract infection by urine dipstick testing and, if indicated, urine culture.
• Considering referral for urological assessment if there is diagnostic uncertainty, severe symptoms, persistence after initial management, or suspicion of chronic bacterial prostatitis (e.g., history of recurrent urinary tract infections or acute prostatitis within the last 12 months).

Routine imaging, flow rate measurement, or post-void residual volume measurement are not recommended at initial assessment unless clinically indicated.

Reassure patients that chronic prostatitis/CPPS is not cancer and rarely caused by sexually transmitted infections. The diagnosis is often one of exclusion and symptom control is the main treatment goal.

Summary: Diagnosis is clinical, based on chronic pelvic pain ≥3 months, exclusion of infection and other causes, symptom scoring (NIH-CPSI, UPOINT), physical examination including digital rectal exam, and urine testing. Referral to urology is advised if diagnosis is uncertain or symptoms are severe or persistent.

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