Objective:

The review examines evidence linking CP/CPPS with pain processing, immune activity, metabolism, and gut microbiota, and discusses potential diagnostic and treatment approaches.

Approach:

• Review scope: The review examines evidence linking prostate inflammation with nervous-system pain processing, immune activity, metabolism, and gut microbiota.
• Potential diagnostic components: Discussed approaches include candidate inflammatory biomarkers in expressed prostatic secretions, multiparametric MRI, microbiome analysis, and symptom-based assessment tools.
• Potential treatment strategies: The authors discuss neuromodulation, interventions targeting inflammatory or metabolic pathways, microbiota-directed treatments, and integrated psychological support.

Key Findings:

• CP/CPPS causes persistent pelvic pain, urinary difficulties, and sexual dysfunction, but diagnosis is challenging because symptoms vary and reliable laboratory biomarkers are lacking.
• The authors propose that persistent inflammation may sensitize pelvic nerves and alter central pain processing, potentially contributing to symptoms that continue after local inflammation subsides.
• Candidate biomarkers and imaging approaches are not yet able to reliably distinguish CP/CPPS subtypes.

Interpretation:

The authors argue that CP/CPPS should be considered in relation to interconnected biological processes rather than solely as a prostate disorder. They propose that combining diagnostic approaches could help identify mechanisms associated with individual symptoms and guide treatment selection.

Limitations:

• Much of the supporting evidence comes from small observational studies, genetic analyses, or preclinical experiments.
• Prospective studies and clinical trials are needed to validate biomarkers, establish clinically meaningful subgroups, and assess whether mechanism-guided treatment improves outcomes.

Conclusion:

The review presents a broader, mechanism-focused diagnostic framework as a proposal; its candidate tools and treatment strategies require further validation.

Sources:

• Review published in iMetaMed (article context provided)