Chronic prostatitis is often refractory to antibiotics, however biopsy and molecular data indicate persistent symptoms may be due to occult infection. Combining antibiotic therapy with regular prostatic massage has been suggested as an effective therapy for some of these men. From November 1996 to December 1998, 73 men with chronic pelvic pain syndromes were treated with antibiotics and prostatic massage. Antibiotic selection was based on culture and sensitivity of prostatic fluid or empirically if cultures were negative. Prostatic massage was done 1 to 3 times per week and fluid examined for WBCs and cultured for bacteria. The average age of the group was 43.5 y (range 23-72) and average duration of symptoms 6.7 y (median 3 y, range 3 months-30 y). Prostatic cultures were negative in 19, grew uropathogens in 2, and Gram positive bacteria in 52 patients. Overall 29 patients (40%) had complete resolution of symptoms, 14 (19%) had complete resolution followed by a recurrence, 15 (21%) had some improvement and 15 (21%) had no improvement. All positive cultures were sterilized during treatment. Combination prostatic massage and culture specific antibiotics can be an effective treatment in a proportion of men with long standing refractory chronic prostatitis.