Which first-line treatments are advised for managing chronic prostatitis symptoms in a primary care setting?

Recommended first-line treatments for managing symptoms of chronic prostatitis in primary care include:

• A 4–6 week trial of an alpha-blocker (such as doxazosin or tamsulosin) to improve lower urinary tract symptoms (LUTS) and reduce pain and voiding difficulties.
• Analgesia with paracetamol and/or a nonsteroidal anti-inflammatory drug (NSAID) for pain management; opioids are not recommended.
• For men with suspected chronic bacterial prostatitis or early-stage chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), a single course of antibiotics may be considered, typically a quinolone (e.g., ciprofloxacin or ofloxacin) for 4–6 weeks, or second-line options such as trimethoprim or doxycycline if quinolones are unsuitable.
• Use of stool softeners (e.g., lactulose or docusate) if defecation is painful.
• Provision of information and reassurance about the chronic nature of the condition, emphasizing symptom control rather than cure, and addressing psychosocial symptoms with appropriate referral if needed.

Referral to a urologist is advised if symptoms are severe, persist after initial management, or if there is diagnostic uncertainty.

These recommendations are based on UK consensus guidelines, European Association of Urology guidelines, and expert opinion, noting that evidence for treatment efficacy is limited and often based on small studies or expert consensus NICE CKS.