Efficacy of a Simplified Diagnostic–Therapeutic Strategy Based on the Prostate–Pelvic Syndrome Theory Versus NIH Conventional Classification‑Based Protocol for Type III Prostatitis: A Randomized Controlled Trial

Background To evaluate and compare the efficacy of a simplified diagnostic and individualized comprehensive treatment strategy based on the “prostate–pelvic syndrome (PPS)” theory versus the traditional National Institutes of Health (NIH) conventional classification‐based protocol for type III prostatitis in men under 40 years. Methods In this prospective randomized controlled trial, 222 patients (18–39 years) with type III prostatitis were randomly assigned to individualized comprehensive therapy guided by simplified PPS‐based diagnosis ( n = 112) or traditional NIH conventional classification‐based therapy ( n = 110) for 6 weeks. Randomization was performed using a computer‐generated sequence with allocation concealment via sealed opaque envelopes. The primary endpoint was the change in the NIH‐chronic prostatitis symptom Index (NIH‐CPSI) total score and the response rate (≥ 6‐point decrease). Secondary endpoints included changes in prostate volume (PV), NIH‐CPSI subdomain scores, and the proportion of patients with sexual dysfunction (SD). Univariate and multivariate analyses identified factors influencing treatment response. Results A total of 212 patients completed follow‐up (108 PPS and 104 NIH). Baseline characteristics were comparable between groups ( p > 0.05). After treatment, the median decrease in NIH‐CPSI total score was significantly greater in the PPS group than in the NIH group ( p = 0.003), and the response rate was higher (79.6% versus 61.5%, p = 0.004). The intergroup difference was primarily driven by the quality‐of‐life domain ( p = 0.003), while pain and voiding domain changes did not differ significantly between groups. Multivariate analysis identified PPS‐based treatment [odds ratio (OR) = 2.227, 95% onfidence intervals (CI): 1.143–4.337] and baseline factors, including SD (OR = 0.334, 95% CI: 0.165–0.673), sedentariness (OR = 3.554, 95% CI: 1.652–7.642), and PV ≥ 20 mL (OR = 4.850, 95% CI: 1.870–12.575), as independent predictors of response. Conclusion In men under 40 years with type III prostatitis, individualized comprehensive therapy guided by simplified PPS‐based diagnosis was associated with greater symptom improvement—particularly in quality of life—compared with the traditional NIH conventional classification‐based protocol. The findings suggest that a comprehensive, symptom‐directed treatment strategy may outperform a more restricted classification‐based regimen, though the contribution of the simplified diagnostic pathway—eliminating lower urinary tract pathogen localization and invasive expressed prostatic secretion testing—per se requires further study. Trial Registration: MR‐34‐24‐035332; https://www.medicalresearch.org.cn .