Chronic non-bacterial prostatitis (CNBP) is a common yet challenging condition in urological practice, affecting approximately 10–15% of elderly males. It is characterized by persistent pelvic pain and lower urinary tract symptoms (LUTS), often grouped under chronic pelvic pain syndrome (CPPS). Conventional urological treatments, including alpha-blockers and anti-inflammatory agents, have shown limited efficacy in this population. Emerging evidence suggests a strong association between CNBP and psychosocial dysfunction, such as anxiety and stress, which may exacerbate symptoms. Given alprazolam's anxiolytic properties, its potential role in CNBP symptom relief warrants further investigation.

A total of 101 male patients diagnosed with CNBP based on National Institutes of Health (NIH) criteria were randomized into two groups: Alprazolam group: Received alprazolam (0.5 mg daily) plus tamsulosin (0.2 mg twice daily). Control group: Received tamsulosin (0.2 mg twice daily) alone. Patients were assessed at baseline, 4 weeks, and 12 weeks using the NIH Chronic Prostatitis Symptom Index (NIH-CPSI), which evaluates pain, urinary symptoms, and quality of life.

Preliminary findings indicate that patients receiving alprazolam exhibited a greater reduction in NIH-CPSI scores compared to the control group at both the 4-week and 12-week follow-ups. Notably, improvements were observed in pain relief and overall symptom reduction, suggesting that anxiolytic therapy may have a beneficial role in CNBP management.

CNBP/CPPS extends beyond a purely urological disorder and is increasingly recognized as a condition influenced by psychosocial factors. Anxiety and chronic stress may contribute to heightened pain perception and pelvic muscle dysfunction, exacerbating symptoms. Alprazolam, a widely used benzodiazepine for generalized anxiety and panic disorders, may help alleviate CNBP symptoms by modulating stress-related pathways and reducing muscle tension. In this study, patients receiving alprazolam demonstrated statistically significant symptom improvement compared to the control group, particularly in pain-related and quality-of-life domains. These findings suggest that combination therapy with alprazolam and alpha-blockers may provide superior symptom relief compared to monotherapy in elderly patients with CNBP/CPPS. Given the potential role of anxiety in CNBP pathophysiology, targeting psychosocial factors alongside conventional urological management could enhance treatment outcomes. However, long-term safety and dependency risks associated with benzodiazepines should be carefully considered. Future large-scale studies are needed to further validate these findings and establish optimized treatment protocols.