How do you approach a man with chronic prostatitis and chronic pelvic pain syndrome whose symptoms persist after an alpha-blocker and a course of antibiotics?

For persistent chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), I would reassess the diagnosis, rule out infection or other causes, and use a multimodal treatment approach. I would avoid repeated antibiotics without evidence of infection and consider pelvic floor physical therapy, NSAIDs,...

• Diet modification
• Pelvic physical therapy
• Intrarectal diazepam