Is terazosin helpful in chronic prostatitis?
The Journal of Family Practice. 2003 March;52(3):431-454
March 1, 2003|Family Medicine
Author and Disclosure Information
- BACKGROUND: Lifetime prevalence of chronic prostatitis in men aged 40 to 79 years is 5%, resulting in significant morbidity, unnecessary antibiotic use, and both patient and physician frustration.1 The vast majority of cases of chronic prostatitis are nonbacterial, recently termed chronic prostatitis/chronic pelvic pain syndrome by the National Institutes of Health (NIH) consensus classification of prostatitis syndromes.
- POPULATION STUDIED: One hundred men aged 20 to 50 years were recruited from hospitals in Northern Malaysia (mostly of Chinese and Malay ethnicity) during a national prostatitis awareness campaign. Eligible men met NIH criteria for chronic prostatitis, with recent pain and decreased quality of life.
- STUDY DESIGN AND VALIDITY: Subjects were randomly assigned in double-blind fashion to receive terazosin or identical placebo. It was not possible from the text to determine if allocation assignment was concealed. Terazosin was initiated at 1 mg/d and titrated as tolerated to 5 mg/d over 2 weeks, and continued for a total of 14 weeks. Outcomes were assessed at 2, 4, and 14 weeks using intention-to-treat analysis.
- OUTCOMES MEASURED: The primary outcome measured was the quality-of-life item on the NIH-CPSI. Patients answered the questions 0 to 6 (0=delighted, 1=pleased, 2=mostly satisfied, 3=mixed, 4=mostly dissatisfied, 5=unhappy, 6=terrible). Patients with scores of 0, 1, or 2 at week 14 were considered responders. The secondary outcome measured was a 50% or greater reduction in the NIH-CPSI pain domain score.
- RESULTS: At week 14, 56% of patients receiving terazosin versus 33% receiving placebo responded to treatment (P=.03; number needed to treat [NNT]=4). More patients in the terazosin group reported a 50% decrease in pain domain scores (60% versus 37%; P=.03; NNT=4).
PRACTICE RECOMMENDATIONS
Terazosin, an alpha-1-adrenergic blocker, is well tolerated, relieves pain symptoms, and improves quality of life in healthy men aged 20 to 50 years who have chronic prostatitis/chronic pelvic pain syndrome.
Terazosin should be strongly considered as a first-line treatment in such patients. However, men with infectious prostatitis were excluded from this study. Also, the benefits of terazosin beyond 14 weeks are unknown.
