Diseases

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 you have recurring episodes of urinary tract infections and prostatitis, your health care professional may need to more closely evaluate your genitourinary system for anatomic abnormalities that make you more prone to infection.

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.

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

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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

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.

• 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 physician or a urologist.
• Prostatitis does not increase your risk of developing prostate cancer.

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The 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 supportive care, pain control if needed, and close follow-up with your health care professional. In certain instances, some individuals with prostatitis may require hospitalization. Treatment modalities may include the following:

• 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.
• 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.
• Alternative treatments: 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 individuals suffering from prostatitis.

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).