: Why can chronic prostatitis not be cured simply with antibiotics? Acute bacterial prostatitis can be cured with antibiotics while chronic prostatitis cannot be cured by antibiotics. Why is this the case?

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If you have chronic prostatitis, treatment is highly individual and will depend on the type of symptoms that you have. Fortunately, there are many options, and with some trial and error, you may find one that works for you.

An antibiotic might be combined with an alpha blocker to get better relief from discomfort and voiding difficulties. But if a first course of antibiotics does not improve symptoms, then a second one is unlikely to work, so it's wise to explore other options.

Some studies suggest that men with chronic prostatitis may find relief from a herbal diuretic and anti-inflammatory pill. It can not only eliminate the symptoms but also cure the condition from its root causes. Choosing the suitable treatment for chronic prostatitis.

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There are multiple types of prostatitis:

Source: Krieger JN, Nyberg, Jr L, Nickel JC. NIH Consensus Definition and Classification of Prostatitis. JAMA. 1999;282(3):236–237. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-3-jac90006
Also: J. Curtis Nickel (1999). Textbook of prostatitis. Taylor & Francis. pp. 28. ISBN 978-1-901865-04-2.

Prostatitis Type III and IV are non-bacterial, and as antibiotics are successful at killing bacteria, usage of it has been debated.

Pathogenic organisms can be cultured only in acute and chronic bacterial prostatitis. These conditions should be treated with antibiotics, usually fluoroquinolones, for an adequate period of time. 90% of patients with prostatitis syndrome, however, suffer not from bacterial prostatitis but from chronic (abacterial) prostatitis / chronic pelvic pain syndrome (CP/CPPS). It remains unclear whether CP/CPPS is of infectious origin, and therefore the utility of a trial of antimicrobial treatment is debatable. Treatment with alpha receptor blockers is recommended if functional subvesical obstruction is documented or suspected. Symptomatic therapy for pelvic pain should be given as well.

[...]

Recommended therapies
- Alpha-receptor blocker therapy for newly diagnosed patients not previously treated with alpha-blockers
- Antimicrobial therapy for newly diagnosed patients not previously
treated with antibiotics
- Multimodal symptomatic therapy

Not recommended therapies
- Alpha-receptor blockers for patients with prior
multiple therapies
- Anti-inflammatory monotherapy
- Antimicrobial therapy for patients with prior multiple therapies
- 5-alpha-reductase inhibitor
monotherapy
- Minimally invasive therapies, such as TUNA, laser
therapies, etc.
- Invasive surgical therapies, such as TURP and radical
prostatectomy

Source: Florian ME Wagenlehner et al., Dtsch Arztebl Int. Prostatitis and Male Pelvic Pain Syndrome: Diagnosis and Treatment, 2009 Mar; 106(11): 175–183

Other studies are less critical:

Our review suggests that ?-blockers, antibiotics, or combinations of both are most appropriate for therapy of CP/CPPS, particularly for patients with voiding symptoms. However, the magnitude of apparent benefit with ?-blockers may be distorted by publication bias. Anti-inflammatory medications remain an option for patients presenting with pain. While finasteride and phytotherapy may provide benefit to some patients, these therapies require more evaluation, perhaps in selected subgroups of CP/CPPS patients.

Source: Anothaisintawee, T; Attia, J; Nickel, JC; Thammakraisorn, S; Numthavaj, P; McEvoy, M; Thakkinstian, A (Jan 5, 2011). "Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis". JAMA: the Journal of the American Medical Association. 305 (1): 78–86. doi:10.1001/jama.2010.1913. PMID 21205969.