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Decades of prostatocentric research and publications have hampered care for men with genital or pelvic pain syndromes who are often misdiagnosed with prostatitis. The prostatitis classification system as well as other misuse of terminology may have direct and indirect influence on physicians and lay persons alike. Taxonomy, medical culture, and gender issues perpetuate the substandard evaluation of men with this condition as well as the continued overuse of antibiotics. Because the vast majority of men with this condition have neither an infection nor a disease of the prostate gland, physicians must alter their approach to these patients. Thankfully, there is growing interest and evidence to show that male pelvic pain can and should be approached more broadly, even as a nonurological condition.

A common urologic diagnosis in men, urologic chronic pelvic pain (UCPP) is often associated with bothersome lower urinary tract symptoms (LUTS), which contribute to the diminished quality of life observed in these patients. The differential diagnosis of LUTS as a separate entity should be considered during evaluation of UCPP patients to exclude other urologic or neurological conditions. However, most patients can be afforded improvement of LUTS as they receive appropriate therapy for UCPP.

Chronic nonbacterial prostatitis, or urological chronic pelvic pain syndrome (UCPPS), remains a common and often challenging disorder to evaluate and treat. Employing a more holistic approach, including urological therapy, physical therapy, and psychosocial perspectives, may be more appropriate for most patients. Growing evidence supports the use of biofeedback, myofascial trigger point release, prescribed exercise regimens, relaxation techniques, and supportive counseling to treat men with UCPPS.

Chronic prostatitis/chronic pelvic pain syndrome continues to pose a treatment challenge for urologists. Most commonly prescribed medications, such as antibiotics, a-blockers, androgen inhibitors, and anti-inflammatory agents, have been shown to help some patients. However, the efficacy and durability of such treatments lack consistency among men suffering from this disorder. The rationale for such treatments is described in this article, along with possible explanations for the apparent shortcomings. Also included is a brief summary of alternative therapies, which are growing in popularity among patients and gaining acceptance in our medical communities.

The most common form of prostatitis is National Institutes of Health category III, also known as chronic abacterial prostatitis/chronic pelvic pain syndrome. The search for effective and durable therapy for this condition remains frustrating for both patients and physicians. A new approach incorporating a neurobahavioral and musculoskeletal perspective is emerging as a means of diagnosing and treating affected patients. Adopting methods from gynecology, colorectal surgery, and physical therapy has had promising effects in men diagnosed with chronic prostatitis.