Main view thoughts on causes

If NIH-I&II are excluded the answer is quite honestly simply: nobody knows for sure! But the following ideas and hypotheses on etiology and pathogenesis have been put forth (see Karlovsky (1), Pontari and Ruggieri (2), for a fuller review):

Popular ideas

1. Undiscovered micro-organism causing "hidden" chronic infection (i.e. unhealed). The most popular vectors are bacteria. This has been pursued with pig-headed insistence despite no proof. But, remember Helicobacter pylori...
2. Neuro-muscular or musculoskeletal disorders, e.g. myofascial pain.
3. Persistent inflammation triggered by an inappropriate immunological response to a previous, and supposedly healed, infection.

Less popular ideas

1. Auto-immune condition.
2. Persistent neuropathy (damage to nerves controlling pain regulation/signaling) possibly caused by any of the above causes (or neurogenic inflammation and/or "idiopathic" mast cell activation). Pudendal neuropathy is popular, but oft unproven.

Other ideas

1. Estrogen-similar substances, e.g. soy flavonoids.
2. Endocrinological (hormonal) disorders.
3. Psychological (when you do not know cause nor what to do blame the patient...).

Do notice that causes can be multiple. For example bacteria may trigger an inflammatory/neurological reaction that triggers a muscular reaction etc etc. Diet and life-style may in their turn exacerbate or skew symptoms, thus "confounding" the issue. Many of the above causes may also include some hitherto undiscovered genetic mechanism predisposing for the disease. Or some undiscovered pollutant.

Andra bloggar om CPPS, kroniskt bäckenbottensmärtsyndrom, kronisk abakteriell prostatit, NIHIIIb
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(1) Karlovsky ME, Pontari MA. Theories of prostatitis etiology. Curr Urol Rep 3(4):307-312, 2002.
(2) Pontari MA, Ruggeri MR Mechanisms in prostatitis/chronic pelvic pain syndrome. J Urol 172(3):839-845 2004