Prostatitis is a very common condition affecting many if not most men at some time in their lives. It can occur a virtually any age. Like sinusitis, it can be acute, chronic, infectious, allergic, inflammatory or psychosomatic. While frequently disquieting and unpleasant it is rarely serious or life threatening. . There appears to be a minimal relationship between prostatitis and prostate cancer. While most patients who have prostate cancer have some prostatitis on biopsy, both diseases are so common that it is difficult prove a causal relationship.
There are three general types of prostatitis, bacterial prostatitis, the most common type, generally associated with a bacterial infection; non-bacterial or inflammatory prostatitis, when no infection is present; and prostatosis , or prostadynia, or chronic pain in the prostate a subset of non-bacterial prostatitis. Many patients with non bacterial prostatitis and prostatosis are said to be suffering from LUTS, (lower urinary tract symptoms), the latest buzzword. A commonly related condition is semino-vesiculitis. The seminal vesicles lie above and behind the prostate and produce the seminal fluid.
The prostate is built like a sponge, with many pockets, called ascini. With all forms of prostatitis, these ascini become blocked and distended causing symptoms. Obviously, when bacteria are present, these blocked ascini become mini abscesses, like acne. It may be difficult to determine when bacteria are present, because they may be trapped in the ascini, and not easily obtained for identification, or may be very difficult to culture in the laboratory, especially if antibiotics have been recently taken. Similarly, some of these pockets may remain infected despite adequate antibiotic treatment causing the condition to recur.
The most serious form is acute febrile prostatitis with fever above 100.5 F. or 38 C. and/or urinary retention. These require urgent physician attention and occasionally require hospitalization. Rarely, life threatening acute infections may occur. Much more common are the chronic and sub-acute forms of the disease, which may be highly to minimally symptomatic, and may linger for days to months to years.
Prostatitis and PSAProstatitis is the most common cause of a falsely elevated PSA, and treatment will frequently cause the PSA to return to normal.
There are many symptoms of prostatitis, not all of which need to be present for the diagnosis to be made. Most commonly there is painful urination, (dysuria), frequency, voiding small amounts, getting up more frequently at night. It sometimes is difficult to separate prostatitis from bladder or lower urinary tract infections, but that is not always necessary as the treatments are similar. Other common symptoms include: pain in the head of the penis or in the testicles; pain in the groins or lower abdomen, pain behind the scrotum; discomfort or pain on erection or orgasm, decrease in sexual desire or function, tiredness or lethargy; chronic low back pain; blood in the urine, (hematuria), or semen, (hematospermia), although the latter is usually caused by seminovesiculitis. Many times the patient does not recognize all the symptoms until they disappear after treatment. If the symptoms of prostatic infection are accompanied by fever greater than 100.5 F. or 38 C. and/or the patient cannot void, urgent physician contact is required.
The most common causes leading to an attack of prostatitis is holding onto urine for a long time, as on a car or plane trip, or lifting or straining with a full bladder. This, high pressure situation forces urine into the tubes and ducts of the prostate, causing severe irritation, and making the prostate more susceptible to infection. Other causes of high pressures in the prostate may be due to obstruction from strictures, (narrowing of the urethra), or a tiny opening at the tip of the penis, (meatal stenosis). Seasonal or dietary allergies may inflame the prostate causing LUTS and enabling it to be more easily infected, or inflamed. Prostatitis is usually not a sexually transmitted disease and usually cannot be caught or passed to a partner although, sexually transmitted diseases such as gonorrhea or chlamydia may infect the prostate,causing prostatitis. Unprotected anal sex can cause bacterial contamination and infection. Prolonged sexual excitement without ejaculation may lead to painful, acute congestive prostatitis, (blue balls in the vernacular), easily relieved by ejaculation, but also resulting in inflammation and the potential for infection. Stress and other psychosomatic causes may lead to non-bacterial prostatitis or prostatosis or LUTS, or worsen the symptoms of bacterial prostatitis.
Some urologists rely on the three glass test, a test involving intermittent urine specimens separated by a prostatic massage, or a semen culture to try to separate bacterial from non-bacterial prostatitis, and prostatitis from lower urinary tract infections. However, although a positive test will diagnose a bacterial condition, a negative test may miss an infection due to bacteria being trapped in pockets in the prostate, and therefore not found in the prostatic fluid; "fastidious" or difficult to culture bacteria being present in the samples; or recent antibiotic treatment blocking the laboratory's ability to culture the bacteria. Separating prostatitis from lower urinary tract infection, which may have similar symptoms, is not vital, as both require antibiotic treatment.
Patients with recurrent prostatitis may require a urinary tract evaluation with a cystoscopy, an internal visual examination, of the urethra, bladder and prostate to rule out urinary tract blockage or other conditions that may be causing the recurrences. Urinary tract x-ray examinations may also be needed in difficult cases.of prostatitis is usually effective, though sometimes may require several or prolonged treatments. Not all antibiotics can get into the prostatic fluid, so choice of treatment is important. Treatment should start with a simple effective, inexpensive drug such as a tetracycline, sulfa or nitrofurantoin, for two to four weeks, and only after failure of the primary treatment, should treatment progress to the more expensive quinolones. Frequently several different drugs must be tried before success is obtained. Treatment is usually effective, though sometimes may require several or prolonged treatments. Indeed some patients require chronic prophylactic antibiotic treatment for years, similar to acne. Frequently several different drugs must be tried before success is obtained. (Patient Instructions). Sometimes drugs called alpha blockers such as flomax or uroxatral are used to help lower voiding, pressure.
Prostatic irritants, such as caffeine, alcohol and highly spiced, especially peppery, foods should be completely avoided during treatment, and only slowly reintroduced after resolution of the condition. If the patient is aware of other foods that induce symptoms, those too should be eliminated completely.
Prostatic drainage, usually by ejaculation, should be achieved two to three times a week. Two to three times a night is overuse, and harmful. Infrequently, a patient may require a prostatic massage by a urologist, to help drain the prostate, though this is an uncomfortable procedure not needed by the vast majority of patients.
Sitting in a hot bathtub or hot tub once or twice a day may relieve symptoms and help treat the problem. Other stress reduction techniques may help relieve symptoms, especially in those patients with non-bacterial prostatitis or prostatosis , LUTS or a psychosomatic component to the condition.
Never, never hold urine for extended periods of time, and do not do lifting or straining with a full bladder, even if this requires breaking a workout to urinate. Withholding of ejaculation for prolongation of sex is also inadvisable.
Surgery is rarely helpful in treating prostatitis or LUTS unless there is also significant obstruction from BPH
Some patients, especially those not responsive to antibiotics, or with non-bacterial prostatitis, or prostatosis may require anti-inflammatory drugs, (NSAIDS), or drugs to decrease intraprostatic pressures. Others, especially those with chronic unremitting prostatic pain symptoms may require mild antidepressant drugs, usually tricyclics such as amyltryptolene, that have proven to be very effective in chronic pain syndromes. (Patient Instructions)
While many patients with prostatitis hve been shown to have low prostatic zinc levels. No study has ever shown that these levels can be increased by taking zinc by mouth or injection. Similarly there are many over the counter medications for prostate disease, especially saw palmetto, which may relieve some symptoms due to BPH or prostatism, but rarely have an effect on prostatitis, and may have unwanted side effects. or be chronic. The recurrence may be only days or may be years later, but will probably occur. Most men may get a day or two's symptoms on occasion, especially after violating the no-hold rule, or a dietary indiscretion. It is important to remember that virtually everyone gets occasional, short lived urinary symptoms, that are not of consequence. If the symptoms disappear in hours or a day or three, treatment is not necessary. However when the symptoms continue for longer they should be treated. The longer untreated symptoms continue, in terms of weeks or months, the more difficult it may be to treat the condition.
An annual prostate exam, (DRE + PSA), is recommended for all men over 50 and after age 40 for African-American males and all men who have a strong family history of prostate cancer.
MidAtlantic Urology Associates LLC
Formerly Werner-Francis Urology Associates LLC
Greenbelt - Bowie - Laurel Maryland
(301) 477-2000 Fax (301) 474-2389
7500 Greenway Center Drive Eigth Floor Greenbelt, MD 20770
A Patient Care Center of Mid Atlantic Urology Associates, LLC