Efficacy and Safety of Basic Pharmacotherapy of Chronic Abacterial Prostatitis

Abstract

A basic complex has been proposed for the treatment of chronic abacterial prostatitis (CAP), including a nonsteroidal anti-inflammatory drug to limit the effects of prostaglandins; selective alpha adrenergic blocker for modulation of the bladder overactivity and smooth muscle cells of the prostate; Serenoa repens palm fruit extract for prolonged and safe antiinflammatory and anti-sclerotic effects.The objective: evaluation of the efficacy and safety of basic pharmacotherapy of chronic abacterial prostatitis.Materials and methods. The study involved 32 patients with CAP. For the assessment of the patient’s condition, a questionnaires (NIH-CPSI, PHQ-9, GAD-7) and uroflowmetry were used. The ELISA revealed changes in the concentration of testosterone, dihydrotestosterone (DHT), estradiol and prostate-specific antigen (PSA) in the blood, as well as cytokine ejaculate. As a basic treatment, we used a combination of diclofenac sodium (Dicloberl retard, 100 mg/day, orally, 2 weeks), a tamsulozin with modified release (Flosin, 0.4 mg/day, orally, 1 month), an extract of palm fruit Serenoa repens (Prostamol Uno, 320 mg/day, orally, 6 months), regardless of the presence and severity of pain and dysuric manifestations in patients. The reduction of NIH-CPSI by 6 points, PHQ-9 by 6 points, GAD-7 by 5 points were considered as clinically significant.Results. Significant favorable changes in the symptoms of prostatitis, depression and anxiety were observed after 2 weeks and persisted throughout the observation period (6 months). There was a statistically significant increase in testosterone levels, a decrease in blood DHT and PSA, as well as a significant decrease in proinflammatory cytokines in the ejaculate (IL-1β, TNF-α, IL-8), along with an increase in the antiinflammatory cytokine (IL-10). The clinical efficacy of treatment for reducing prostatitis symptoms was 69%, depression symptoms – 75%, anxiety – 84%. Side effects of therapy: ejaculation disorders were observed in 78%, epigastric pain – 10%, orthostatic hypotension – 6%, which did not prevent all patients from completing the treatment.Conclusion. The basic pharmacotherapy was quite effective in reducing the symptoms of prostatitis, associated psychological disorders, was safe and can be recommended for patients with СAP.