Prostatitis (Inflammation of the Prostate Gland)

Prostatitis is an inflammation of the prostate gland. Treatments depend on the causes.

• Prostatitis is inflammation of the prostate gland. The inflammation can be due to an infection as well as other various causes.
• Prostatitis accounts for nearly 2 million visits per year to outpatient urology practices in the United States.
• Ten to twelve percent of all men experience prostatitis symptoms.
• Prostatitis is the most common prostate problem in men under the age of 50.
• Prostatitis can be an acute illness or a chronic condition, The NIH consensus definition and classification of prostatitis is:
  • Acute bacterial prostatitis: Caused by a bacterial infection, and it typically starts suddenly and may include flu-like symptoms. It is the least common of the four types of prostatitis.
  • Chronic bacterial prostatitis: Described by recurrent bacterial infections of the prostate gland. Between attacks, the symptoms might be minor or the patient may even be symptom free; however, it can be difficult to treat successfully.
  • Chronic prostatitis/chronic pelvic pain syndrome: Most cases of prostatitis fall into this category; however, it is the least understood. Chronic prostatitis/chronic pelvic pain syndrome can be described as inflammatory or noninflammatory, depending upon the presence or absence of infection-fighting cells in the urine, semen, and prostatic fluid. Often no specific cause can be identified. The symptoms can come and go or remain chronically.
  • Asymptomatic inflammatory prostatitis: This condition is often diagnosed incidentally during the workup for infertility or prostate cancer. Individuals with this form of prostatitis will not complain of symptoms or discomfort, but they will have the presence of infection-fighting cells present in semen/prostatic fluid.

Picture of the male reproductive and urinary anatomy

The prostate gland is part of the male reproductive system, and it is a walnut-sized gland found in men that is located below the bladder and in front of the rectum. It surrounds the urethra, the tube through which urine and semen exit the body. Its main function is to produce seminal fluid in order to transport sperm through the urethra.

The symptoms associated with prostatitis can vary depending on the underlying cause of prostatitis. The symptoms may appear slowly or come on quickly, and they may improve rapidly (depending on the cause and treatment available) or they may last for several months and they can keep recurring (chronic prostatitis). The rapidity and severity of onset is usually most pronounced with acute bacterial prostatitis. The following are signs and symptoms that may be present with prostatitis:

• Painful, difficult and/or frequent urinating
• Blood in the urine
• Groin pain, rectal pain, abdominal pain and/or low back pain
• Fever and chills
• Malaise and body aches
• Urethral discharge
• Painful ejaculation or sexual dysfunction

If you have any of the signs or symptoms consistent with prostatitis, you should see your health care professional for further evaluation. Depending on the symptoms and your response to therapy, your doctor may need to refer you to a urologist (a physician specializing in the genitourinary system).

Prostatitis can be caused by bacteria that leak into the prostate gland from the urinary tract (the most common bacterial cause) and from direct extension or lymphatic spread from the rectum. It can also result from various sexually transmitted organisms such as Neisseria gonorrhoeae, Chlamydia trachomatis, or HIV. Other organisms responsible for infection are the same found most frequently in urinary tract infections, such as Escherichia coli. In many instances (especially in the chronic form of prostatitis), no specific cause of prostatitis can be found.

Men of all ages can be affected by prostatitis, but it is more common in young and middle-aged men. Other risk factors for the development of prostatitis include the following:

• A prior history of prostatitis
• Having a recent urinary tract infection
• Recent use of a urinary catheter or a recent urologic procedure
• Enlarged prostate gland
• Engaging in rectal intercourse
• Having a structural or functional urinary tract abnormality
• Dehydration (not enough fluids)
• Local pelvic trauma or injury such as from bicycle riding or horseback riding

Prostatitis is usually diagnosed by analyzing a urine sample and undergoing an examination of your prostate gland by your health care practitioner. This examination involves a digital rectal examination to palpate the prostate gland and feel for abnormalities of the gland. Occasionally, the physician may also collect and test a sample of the prostatic fluid.

Sometimes a prostate massage is performed to compare samples of the prostatic fluid both before and after this intervention has been performed. To perform this procedure, the doctor will stroke/massage the prostate gland during the digital rectal examination. Because there is the concern that this procedure can release bacteria into the bloodstream, this test is contraindicated in cases of acute bacterial prostatitis.

Additional tests that may be obtained include a complete blood count (CBC), an electrolyte panel, blood cultures, a swab of urethral discharge if present, and sometimes a prostate-specific antigen (PSA) level. The PSA test, which is used as a screening test for prostate cancer, may also be elevated with prostatitis.

Other tests that may also be obtained include urodynamic tests (to check how well you empty your bladder and establish if prostatitis is affecting your ability to urinate), ultrasound imaging, computed tomography (CT) imaging, cystoscopy, and a prostate biopsy.

If recurring episodes of urinary tract infections and prostatitis occur, see your doctor for a more detailed evaluation of your genitourinary system for anatomic abnormalities, which may make you more prone to infections.

Treatment for prostatitis depends on the underlying cause and type of prostatitis. Antibiotics are prescribed if the cause is a bacterial infection. All forms of prostatitis require pain control if needed, treatment, relief of complications and side effects, and need to be closely monitored by your doctor. In certain instances, some people with prostatitis may need to be hospitalized for treatment.

• Antibiotics: Your doctor will decide the specific antibiotic and the duration of treatment.
• Anti-inflammatory medications: These can help manage your pain.
• Alpha-blockers: By relaxing the muscle fibers around the bladder and prostate gland, alpha-blockers may decrease your urinary symptoms and help you empty your bladder.

In addition to medical treatment, natural home remedies for prostatitis include:

• Warm sitz baths
• Avoid alcohol, caffeine, and spicy foods.
• Prostate massage: In a few studies, prostate massage has been shown to decrease symptoms in some patients with chronic nonbacterial prostatitis.
• Lifestyle changes: If you cycle or ride horses, it is recommended to suspend this activity until you improve.
• Although there are many herbal preparations available, there is no current evidence that herbal remedies are definitely helpful with prostatitis.
• Acupuncture has shown a decrease in symptoms for some people who suffer from prostatitis.

There are several potential complications of prostatitis, which may include the following:

• acute prostatitis becoming chronic prostatitis,
• bladder outlet obstruction or urinary retention,
• infertility,
• abscess of the prostate gland,
• spreading of the infection to the blood stream (bacteremia/sepsis), and rarely
• death.

Prostatitis can elevate the PSA level. There is no evidence that prostatitis leads to prostate cancer. If the acute inflammation/episode of prostatitis has resolved, the PSA level will usually return to baseline levels.

Prostatitis caused by bacterial illness often can be treated with antibiotics, or the condition can be chronic that recurs and requires long-term medical attention.

• Acute bacterial prostatitis can often be treated very successfully and has a very good prognosis.
• Chronic prostatitis, and especially chronic nonbacterial prostatitis, can often lead to long-term symptoms and discomfort if treatment is unsuccessful. It is important to have close follow-up and continued care by either your primary care doctor or a urologist.
• Prostatitis does not increase your risk of developing prostate cancer.