Rethinking Prostatitis: Why the Traditional Model Falls Short
Prostatitis and Chronic Pelvic Pain Syndrome (CP/CPPS) are among the most complex and misunderstood conditions in men’s health. In his article published in Trends in Urology & Men’s Health, Karl Monahan advocates for moving beyond outdated treatments and adopting a biopsychosocial framework. Read the full article here.
Monahan highlights that prostatitis accounts for 25% of urology consultations, yet treatment typically involves repeated prescriptions with minimal long-term benefit. “The prostatitis patient represents one of the biggest clinical conundrums in urology today,” he writes, urging for more holistic strategies.
The Biopsychosocial Model: Rethinking Prostatitis and seeing the Whole Patient
The biopsychosocial model, first proposed by George Engel (1977), emphasizes treating the whole person rather than just the biological symptoms. Monahan echoes this view:
“Beneath the clinical presentation… there is an individual.”
He stresses the urgent need for empathetic, patient-centred care, especially given the emotional toll CP/CPPS takes on men. Psychological distress is well documented, and “suicidal thoughts are not uncommon,” he notes.
Smarter Diagnostics: Beyond “Prostatitis”
The article also challenges the utility of the term prostatitis, calling it “archaic” and often misleading. Monahan advocates for using better diagnostic tools, including the pre- and post-prostate massage test (PPMT) and the UPOINT system, which classifies patients into six domains: urinary, psychosocial, organ-specific, infection, neurologic/systemic, and tenderness.
As Monahan notes, “A model that only focuses on one of these variables is arguably incomplete.” By tailoring treatment based on UPOINT classification, clinicians can better support the diverse needs of pelvic pain patients.
From “Prostatitis” to UPOINT: A Smarter Classification
Monahan critiques the term “prostatitis” as outdated and misleading. Instead, he champions the UPOINT system—a six-domain clinical phenotyping model created by Dr. Daniel Shoskes—which allows practitioners to classify and tailor treatment for CP/CPPS more effectively.
UPOINT stands for:
- Urinary
- Psychosocial
- Organ-specific
- Infection
- Neurologic/systemic
- Tenderness of skeletal muscle
Initial studies show that multimodal treatment guided by UPOINT results in improved outcomes and better quality of life.
A Way Forward for Men with Pelvic Pain
Prostatitis and CP/CPPS are not life sentences. As Karl Monahan highlights, when we listen to the patient’s story, use smarter diagnostics, and treat the whole person—not just the symptoms—recovery becomes a reality, not just a hope. By embracing the biopsychosocial model and the UPOINT framework, we pave the way for more effective, compassionate care. The future of male pelvic pain management is changing—and with the right approach, there truly is light at the end of the tunnel.
Learn More
For tailored pelvic pain support, visit The Pelvic Pain Clinic.
To explore Karl Monahan’s full article, visit Wiley Online Library.
Reference:
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136. DOI:10.1126/science.847460
Monahan, K. (2017). The inflammatory journey of a prostatitis patient. Trends in Urology & Men’s Health. Read the full article
Shoskes, D. A., Nickel, J. C., Rackley, R. R., & Pontari, M. A. (2009). Clinical phenotyping in chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis: A management strategy for urologic chronic pelvic pain syndromes. Prostate Cancer and Prostatic Diseases, 12(2), 177–183. DOI:10.1038/pcan.2008.60