Prostatitis

What is Prostatitis?

Prostatitis is a general term used to describe the inflammation of the prostate gland. The term is very broad referring to the general spectrum of clinical manifestations related to the prostate inflammation. It is a very common disease occurring in men of all ages. It is the most common urological disease in men below the age of 50, and the third most common at the age above 50. Today, it is known that there are different types of prostatitis:

  •         Acute Bacterial Prostatitis
  •         Chronic Bacterial Prostatitis
  •         Chronic Non-bacterial Prostatitis
  •         Asymptomatic Inflammatory Prostatitis

What are the causes and symptoms of Prostatitis?

Causes and symptoms differ according to the type of prostatitis.

  •  Acute Bacterial Prostatitis

Acute Bacterial Prostatitis is prostatic infection caused by bacteria. The most common bacteria involved are E.coli, Klebsiella and Proteus. The microbe can be transmitted sexually, through blood or may arise as a complication from prostate biopsy. The patient presents intense infection symptoms -fever, shivering, weakness, fatigue- with concomitant urinary frequency and dysuria. 

  • Chronic Prostatitis (Bacterial and Non-bacterial)

Chronic bacterial prostatitis is usually due to the same bacteria causing acute bacterial prostatitis. Other microorganisms have also been blamed in more rare cases, such as gonococcus, chlamydia, mycoplasm and fungi.  There is often chronic urinary infection with urine regurgitation towards the prostate that leads to prostatitis. The etiology of chronic non-bacterial prostatitis is unclear. Symptoms are similar in both types and include: 

·         Feeling of tension or heaviness in the perineum (area between testes and anus)

·         Urinary frequency and urge to defecate

·         Feeling of incomplete bladder emptying

·         Dysuria (difficulty to urinate)

·         Burning sensation during micturition

·         Pain in the region of testes and groin

·         Hypoactive (low) sexual desire

·         Erectile disorders

·         Dyspareunia (painful sexual intercourse)

·         Premature or even painful ejaculation

·         Nocturia

·         Psychological burdening 

  • Asymptomatic Inflammatory Prostatitis

​It is called asymptomatic because there are no symptoms at all. It is usually diagnosed accidentally when prostate biopsy is done for another irrelevant reason. Its etiology is not yet fully clarified. 

How is Prostatitis diagnosed?

The diagnosis is based on the patient's history and thorough clinical examination. Urine culture is useful for identifying any bacterium and determining the type of prostatitis. The physician will decide whether more specialized screening tests are needed, such as UltraSound (bladder-prostate-testes U/S) and CTscan.

Acute Bacterial Prostatitis

Based on the patient's history and clinical examination, the physician will identify whether it is a case of acute prostatitis. The general blood test will confirm the diagnosis, while urine culture will identify the bacterial strain that is responsible.

Chronic Bacterial Prostatitis

The diagnosis is set based on the patient's history and clinical examination. Urine culture may not identify the bacterium causing this specific type of prostatitis. Urine sample collected after performing prostate massage may help to identify the microorganism involved.

Chronic Non-bacterial Prostatitis - Chronic Pelvic Pain

After ruling out other diseases and types of prostatitis and if symptoms persist for a period over 3 months, the diagnosis is set. It is a chronic condition significantly affecting the patient's quality of life. It takes a lot of experience from the Urologist, for there are many difficulties in the patient's management. The main difficulty lies in the fact that this type of prostatitis cannot be evidence-based with laboratory tests -as blood and ultrasound appear to be normal. 

How is Prostatitis treated?

The therapy recommended by the physician depends on the type of prostatitis:

  •  in Acute Bacterial Prostatitis

Antibiotics (oral or injectable), antipyretics and antiinflammatory agents are given. Excessive fluid intake is recommended and very often hospitalization is required to provide intravenous administration of fluids and antibiotics.  

  •  in Chronic Bacterial Prostatitis

Antibiotic treatment is indicated for this type of prostatitis, as well. The treatment lasts long -3 to 8 weeks- so as to minimize the risk of relapse. At the same time, the causes involved in the etiology of urinary tract infections have to be investigated. Such conditions are urolithiasis, benign prostatic hyperplasia  with residual urine and various diseases affecting bladder nerves. Your physician will advise you whether and how  you should treat some of these.  

  • in Chronic Non-bacterial Prostatitis - Chronic Pelvic Pain

As long as causes are not known, there is not one single therapy for all cases. There is a great variety of symptoms which differ in every patient. There are often exacerbations and remissions, while triggering factors are different for every patient. The therapy is usually long and combined with lifestyle changes in the patient's life. All the above have a negative effect on quality of life,  may influence the patient's psychological state and it is not rarely that may induce anxiety and depression.

This complex entity requires experience from the physician, who should individualize and adjust therapies according to the case. Therapies are usually combined for eliminating symptoms and improving quality of life. Other options are antibiotics, antiinflammatory drugs, muscle relaxants, drugs improving urine flow and urinary frequency (α-adrenergic blockers, anticholinergics), drugs improving erectile function, natural/plant extracts, as well as neuroleptics in patients with chonic pain. Food, drinks or habits aggravating symptoms should be avoided. 

In some cases, trained Physiotherapists can help both alleviate chronic pelvic pain and 'educate'  the patient how to relax his pelvic floor. When psychological symptoms are severe, there may be also need for cooperation with a Psychiatrist of Psychologist. 

What is the prognosis of Prostatitis?

Acute bacterial prostatitis is fully curable with antibiotics taken for a small period of time (usually 3 weeks). Although there are often relapses, chronic bacterial prostatitis does respond well to antibiotics and the patient is asymptomatic after the antibiotic treatment. Chronic bacterial prostatitis is a challenge both for the patient and the physician. Symptoms do not usually fully resolve; there are exacerbations and remissions. The aim is to improve the patient's quality of life without having his sociability being affected. Asymptomatic inflammatory prostatitis is not clinically important and does not need to be treated.