Chronic prostatitis/chronic pelvic pain syndrome: the role of an antifungal regimen

INTRODUCTION: The role of fungal infection as a causative factor for prostatitis is currently underestimated. The aim of our work was to evaluate the response to an antifungal regimen in the setting of patients presenting with symptoms of chronic pelvic pain syndrome that have been refractory to treatment with antibiotics and alpha–blockers. MATERIAL AND METHODS: We included 1,000 consecutive patients. The inclusion criteria included failure of response to four consecutive weeks of antibiotic and alpha–blockers. The antifungal regimen was continued for two weeks. It included a low carbohydrate diet, the alkalinization of urine, and administration of fluconazole. RESULTS: The mean age of the patients was 34 years. Mean serum total PSA and PSA density (PSAd) were 0.6 ng/ml and 0.03 ng/ml/gram, respectively. The mean age, PSA, prostate volume, and PSAd for patients that showed good response were 33, 0.5, 17, and 0.031, respectively. Values for patients that did not show good response were 36, 0.8, 23, and 0.037, respectively (p <0.0001 for all of the variables). Improvement was observed in 80% of cases treated with the antifungal regimen. CONCLUSIONS: Antifungal regimen should be considered for the majority of young adult men, presenting with chronic prostatitis/ chronic pelvic pain syndrome and incomplete response to antibiotics.