Prostatitis (Inflammation of the Prostate Gland)

  • Medical Author:
    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

  • Medical Editor: Steven Doerr, MD
    Steven Doerr, MD

    Steven Doerr, MD

    Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

Prostatitis facts

  • Ten to twelve percent of all men experience prostatitis symptoms.
  • Prostititis is most common prostate problem in men under the age of 50.
  • Prostatitis can be an acute illness or a chronic condition.

Prostatitis definition

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.

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 NIH consensus definition and classification of prostatitis:

  1. 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.
  2. Chronic bacterial prostatitis: Characterized 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 successfully treat.
  3. Chronic prostatitis/chronic pelvic pain syndrome: Most cases of prostatitis fall into this category, however it is the least understood. It can be further characterized 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.
  4. Asymptomatic inflammatory prostatitis: This condition is often diagnosed incidentally during the work-up 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
Picture of the male reproductive and urinary anatomy

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What causes prostatitis?

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.

What are the risk factors for prostatitis?

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

What are the signs and symptoms of prostatitis?

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:

When should I see my doctor for 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).

How is the diagnosis of prostatitis made?

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.

What is the treatment for prostatitis?

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.

What are the complications of 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.

What is the prognosis for prostatitis?

  • 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.

Prostatitis conclusion

Prostatitis can be an acute bacterial illness that is often easily treated with antibiotics, or it can be a chronic condition that recurs and requires long-term medical attention.

Medically reviewed by Michael Wolff, MD; American Board of Urology

REFERENCE:

Tintinalli's Emergency Medicine; 7th edition; Judith Tintinalli; McGrawHill 2011.

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Reviewed on 8/17/2016
References
Medically reviewed by Michael Wolff, MD; American Board of Urology

REFERENCE:

Tintinalli's Emergency Medicine; 7th edition; Judith Tintinalli; McGrawHill 2011.

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