Prostatitis

• ANATOMY OR SYSTEM AFFECTED: Genitourinary tract, glands, reproductive system
• ALSO KNOWN AS: Prostadynia

Definition

Prostatitis is inflammation of the prostate gland. The prostate is a walnut-sized gland in males that surrounds the urethra. The prostate produces a fluid that is a part of semen.

There are four types of prostatitis: categories 1 through 4. Category 1, or acute bacterial, is the least common of the four types but is the most common in men aged thirty-five years and younger. Category 2, or chronic bacterial, is not common but affects mostly men between the ages of forty and seventy years. Category 3, or chronic prostatitis/chronic pelvic pain syndrome, or CP/CPPS, is the most common type and causes chronic pelvic pain. CPPS a condition that has similar symptoms to those of chronic nonbacterial prostatitis. However, CPPS has no evidence of prostatic inflammation.) The final type of prostatitis is category 4, or asymptomatic inflammatory prostatitis.

Causes

Acute and some chronic bacterial prostatitis are caused by bacteria that infect the prostate gland. The bacteria usually come from the urinary tract or rectum. The causes of nonbacterial prostatitis can be difficult to identify, but some believe it may be caused by pathogens such as Mycoplasma, Chlamydia, a virus, or a fungus.

The causes of prostadynia can be even more difficult to identify. However, the condition can be associated with stress or disorders (or both) of pelvic floor muscle tension or conditions such as interstitial cystitis. Asymptomatic inflammatory prostatitis is found during a prostate biopsy. The cause is not clearly understood.

Risk Factors

Two million men seek out medical intervention for prostatitis each year, and it is the most common urinary tract issue for men under the age of fifty years. Risk factors include medical procedures that involve inserting a catheter or other tubing into the urethra or rectum; anal intercourse; a recent bladder infection; abnormalities in the anatomy of the urinary tract; diabetes; a suppressed immune system; and obstruction of the bladder, such as by a tumor, a kidney stone, or an enlarged prostate gland. Psychological factors, such as stress and anxiety, may exacerbate symptoms of CP/CPPS.

Symptoms

Symptoms of prostatitis can appear slowly or suddenly, and they can be mild or quite severe. In nonbacterial prostatitis, symptoms often come and go. Symptoms may include needing to urinate frequently or urgently, or both, especially at night; pain or burning while urinating; difficulty urinating; blood in the urine; psychological stress; lower abdominal pain or pressure; rectal or perineal discomfort; lower back pain; fever or chills; painful ejaculation; and impotence, because of inflammation around the gland.

Screening and Diagnosis

A doctor will ask about symptoms and medical history and perform a physical exam. Diagnosis of prostatitis can be based on the symptoms and on massaging the prostate gland. In this test, the doctor places a lubricated, gloved finger into the rectum to feel the back wall of the prostate. In prostatitis, the prostate is usually tender and soft. These tests are not performed for acute bacterial prostatitis. Other tests include bladder function tests and an analysis of urine and prostate fluid expressed after massaging the prostate gland. Blood tests and imaging tests may also be used.

Treatment and Therapy

Treatment depends on the type of prostatitis. Acute bacterial prostatitis is treated with oral antibiotics for one to two weeks. The commonly used drugs include quinolones (norfloxacin, ciprofloxacin, and levofloxacin) or trimethoprim, and in severe cases, treatment with intravenous antibiotics may be necessary. Chronic bacterial prostatitis is also treated with oral antibiotics but for four to twelve weeks. Other medications include stool softeners, anti-inflammatory medications, other analgesics or pain medications, alpha-blockers such as Flomax, and 5-alpha reductase inhibitors such as Proscar or Avodart.

For noninfectious prostatitis, patients are often initially given a course of antibiotics in case an infectious cause was missed during diagnosis. This recommendation, however, was declining in popularity due to antibiotic resistance concerns. Other treatments include alpha-blockers such as Flomax, 5-alpha reductase inhibitors such as Proscar or Avodart, anti-inflammatory medications such as ibuprofen, painkillers, and warm sitz baths.

Prevention and Outcomes

There are no guidelines for preventing prostatitis.

Bibliography

Gatta, Frances. “Prostatitis (Prostate Infection): Causes, Symptoms, Treatments.” WebMD, 15 July 2024, www.webmd.com/men/prostatitis. Accessed 18 Nov. 2024.

Komaroff, Anthony, ed. “Prostate Gland.” In Harvard Medical School Family Health Guide. Free Press, 2005.

Propert, K. J., et al. “A Prospective Study of Symptoms and Quality of Life in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome: The National Institutes of Health Chronic Prostatitis Cohort Study.” Journal of Urology, vol. 175, 2006, pp. 619-23. doi:10.1016/S0022-5347(05)00233-8. Accessed 20 Nov. 2024.

“Prostate Disorders.” In The Merck Manual Home Health Handbook, edited by Robert S. Porter et al. Merck Research Laboratories, 2009.

“Prostatitis: Causes, Symptoms, Diagnosis & Treatment.” Cleveland Clinic, 14 Nov. 2023, my.clevelandclinic.org/health/diseases/15319-prostatitis. Accessed 18 Nov. 2024.

“Prostatitis - Symptoms and Causes.” Mayo Clinic, 19 Feb. 2022, www.mayoclinic.org/diseases-conditions/prostatitis/symptoms-causes/syc-20355766. Accessed 18 Nov. 2024.

Walsh, Patrick C., et al., eds. Campbell-Walsh Urology. 4 vols. 9th ed. Saunders/Elsevier, 2007.