Non-Surgical Management of Male Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A UPOINT-Guided Narrative Review.

Background: Primary prostate pain syndrome (PPPS), formerly referred to as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent and heterogeneous chronic pain condition characterized by persistent pelvic pain, lower urinary tract symptoms, sexual dysfunction, and substantial psychosocial burden. Objective: This narrative review summarizes current evidence on the pathophysiology, phenotype-based assessment, and non-surgical management of male CP/CPPS, with emphasis on UPOINT-guided multimodal care. Methods: Evidence was synthesized from guidelines, systematic reviews, meta-analyses, randomized trials, observational studies, and relevant mechanistic literature addressing CP/CPPS, chronic pelvic pain, UPOINT phenotyping, pharmacological treatment, physical therapy, neuromodulation, and psychological interventions. Results: CP/CPPS is best understood as a multidimensional syndrome involving inflammation and immune dysregulation, peripheral and central sensitization, microbiome disturbance, autonomic imbalance, and psychosocial amplification. The UPOINT framework translates this heterogeneity into actionable domains and supports targeted combinations of urinary, organ-specific, infection-directed, neurologic/systemic, tenderness-focused, and psychosocial interventions. Conclusion: Non-surgical management of male CP/CPPS should move toward individualized, phenotype-guided multimodal therapy. In particular, pelvic floor physical therapy (for T phenotype) and neuromodulators/central analgesics (for N phenotype) should be prioritized over empiric monotherapy or prolonged antibiotic use. Future trials should use phenotype-stratified enrollment, standardized outcome measures, and longer follow-up to define optimal combinations and durability of benefit.