A prospective evaluation of hidden bacterial involvement and antibiotic efficacy in nonbacterial CP/CPPS: addressing an underexplored therapeutic approach

To identify bacteria potentially involved in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) classified as nonbacterial and evaluate the clinical effectiveness of antibiotic therapy against these pathogens. Patients were classified into two groups-CP/CPPS category IIIb and the bacterial prostatitis subgroup of CP/CPPS-based on the presence or absence of pyuria and bacteriuria in urine samples obtained before and after prostatic massage. Treatment efficacy was compared between the two groups. The bacterial prostatitis subgroup was further stratified according to whether uropathogens or non-uropathogens were detected, and treatment responses were analyzed accordingly. A total of 28 patients were classified in the CP/CPPS category IIIb and 17 patients in the bacterial prostatitis subgroup. The bacterial prostatitis subgroup showed a significantly greater reduction in National Institutes of Health-Chronic Prostatitis Symptom Index total scores compared with the IIIb group, particularly in the pain domain, which also showed significant improvement over time. The quality-of-life scores also improved in this subgroup. Within the bacterial prostatitis subgroup, both uropathogen-positive and non-uropathogen-positive patients showed a reduction in pain scores, with significantly greater improvement observed in the non-uropathogen group. These findings suggest that some patients classified as CP/CPPS category IIIb under conventional diagnostic methods may, in fact, have bacterial involvement. Antibiotic therapy may be effective in such cases, including those with non-uropathogenic bacterial detection.