• In patients with CP/CPPS, we suggest initial treatment with combination alpha-blocker and antibiotic therapy (Grade 2B). We use tamsulosin 0.4 mg daily and ciprofloxacin 500 mg twice daily. After initial treatment, we suggest NOT repeating a course of antibiotics unless there is a subsequent positive urine culture (Grade 2C). (See 'Medical treatment' above.)
• Anti-inflammatory medications, finasteride, and phytotherapies also appear to have modest, but lesser, effects on symptoms. Physical therapy aimed at myofascial release may have benefit in patients with pelvic floor muscle spasm. A cognitive behavioral treatment program may be beneficial in some patients with concomitant psychosocial problems. (See 'Management' above.)
• Patients whose symptoms persist despite these initial treatments, or who are found to have abnormalities such as hematuria or an elevated PSA, should be referred to a urologist. (See 'Referral' above.)
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