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THREM for refractory CP/CPPS: what the 20-patient study shows — and its limits

A plain-language review of the published THREM retrospective study: design, outcomes, and what the evidence cannot claim.

Evidence boundary: supported, not supported, still unknown

Evidence supports

  • In 20 men with refractory CP/CPPS, pain, urinary and quality-of-life scores were lower at 6 months than before 7 days of THREM (DOI: 10.21037/tau-23-386).
  • 17 of 20 follow-up completers self-rated at least 60% relief of their main symptoms. That figure belongs to this cohort only.

Evidence does not support

  • It cannot prove THREM caused the change, because there was no control group.
  • 17/20 is not a general response rate, a cure rate, or a result for men over 60 or men with BPH or prostate cancer.
  • It cannot separate the enema from the massage, or show that THREM is better than other care.

Still unknown

  • Long-term recurrence is unknown; follow-up stopped at 6 months.
  • Systematic safety is unknown; the paper did not fully collect adverse events.
  • Routine-practice case counts are unaudited, so this site does not publish them.
Published: Last reviewed: Author: Feel Better editorial teamMedical review: Dr. Zhiyong Wu
Research literature and evidence review setting

Many people with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) remain symptomatic after oral medicines, physiotherapy, or other routine care. Before exploring a new combination approach, it helps to ask two questions: is there verifiable published evidence, and how far does that evidence actually go?

The main peer-reviewed source the team cites is a single-center retrospective study in Translational Andrology and Urology (2024; DOI: 10.21037/tau-23-386). This article is educational only and is not personal medical advice.

Who was studied?

The paper reports 20 men described as having refractory CP/CPPS, with a mean age of about 38. The study excluded men older than 60, those with benign prostatic hyperplasia or prostate cancer, people unable to tolerate the intervention, uncontrolled hypertension or diabetes, psychiatric illness, and other serious comorbidities.

Results therefore cannot be applied directly to older men, significant BPH, or complex medical backgrounds. Our results page states this limitation separately.

Intervention and measurements

  • The intervention was THREM — herbal retention enema combined with perineal massage — once daily for 7 consecutive days.
  • Outcomes included Visual Analog Scale (VAS) pain scores, International Prostate Symptom Score (IPSS), and NIH-CPSI quality-of-life items.
  • Comparisons were made between baseline and follow-up at about 6 months.
  • The design was pre–post only, with no randomized control group and no way to separate the enema and massage components.

What the paper reported

Authors reported that among 20 men who completed follow-up, VAS, IPSS, and NIH-CPSI QoL scores were lower at 6 months than at baseline, with statistically significant differences. The paper also notes that 17 of 20 follow-up completers self-rated at least 60% relief of their main symptoms.

This remains preliminary evidence from a small, uncontrolled, single-center series. It shows score changes in that cohort — not proof that THREM caused improvement, outperformed other care, or will work for any individual patient.

How to read “preliminary evidence”

  • Do not turn 17/20 into a cure rate or a guaranteed response proportion.
  • Do not call the paper “authoritative proof of efficacy” or “proof of safety” — systematic adverse-event collection was not reported.
  • Do not extrapolate 20 patients into “thousands of identical outcomes” or all CP/CPPS populations.
  • If you are considering care, decisions should rest on in-person assessment, full informed consent, and local medical standards.
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