Prostatitis

Prostatitis is an inflammation of the prostate. In the United States, more than 2 million patients see doctors each year as a result of prostatitis. It is the most common urologic problem in men younger than 50 years old. Between 6 and 8 percent of men will develop prostatitis in their lifetimes. If a man has an episode of prostatitis, he has a 50 percent chance of having a recurrence in his lifetime.

What is the prostate?
The prostate is a gland of the male reproductive system. It is located in front of the rectum and just below the bladder, the organ that stores urine. The prostate is very small and nearly the size and shape of a walnut. The prostate wraps around a tube called the urethra, which carries urine from the bladder out through the tip of the penis. The gland consists mostly of muscle and glandular tissue. Its main function is to produce fluid for semen, which transports sperm. During the male orgasm, muscular contractions squeeze the prostate’s fluid into the urethra. Sperm, which are produced in the testicles, also are propelled into the urethra during orgasm. The sperm-containing semen leaves the penis during ejaculation.

Types of prostatitis
Category I, or acute bacterial, prostatitis is caused by bacteria and is treated with antibiotics. Acute bacterial prostatitis comes on suddenly, and its symptoms – including chills and fever – are severe. Therefore, a visit to your doctor or emergency room is essential, and usually hospitalization is required.

Category II, or chronic bacterial, prostatitis is also caused by bacteria and requires antibiotics. Unlike acute prostate infection, the only symptoms of chronic bacterial prostatitis may be recurring bacterial cystitis (bladder infection).

Category IIIa, or nonbacterial prostatitis, is not caused by a bacteria or a virus; its cause is unknown. In fact, we’re not even sure that this type is a disease of the prostate. However, the prostate is probably inflamed and prostate massage specimens, semen and urine may have increased numbers of white blood cells (pus cells) when studied under the microscope. Although no bacteria are found, antibiotics may be effective for this type of prostatitis. This category causes the most problems for urologists because its cause is unknown and treatment is difficult. Normally, when pus cells are found, we hope to find a bacteria or virus that causes them, but to date, no one has consistently found any cause. Many doctors suspect that the inflammation is caused by a bacteria or a virus not usually associated with disease, of which there are many. On the other hand, many diseases exist in which inflammation is not associated with a bacteria or virus – such as arthritis.

Category IIIb prostatitis, or prostatodynia, has all the symptoms of prostatitis. However, no bacteria are found on cultures or prostate massage specimens, and semen has no white cells. We have no idea why prostatodynia exists, nor do we have an effective cure. Antibiotics are not effective for this. Many doctors feel that this is some form of nerve-muscle problem with the pelvic region.

Category IV prostatitis patients have no infection and no symptoms, but have pus cells in their prostate massage specimen. These patients don’t know they have the disease.

Why is correct diagnosis so important?
Because the treatment is different for the three types, the correct diagnosis is very important. Nonbacterial prostatitis usually will not clear up without antibiotics, and bacterial prostatitis will not go away without treatment. In addition, it’s important to make sure that your symptoms are not caused by some other condition that could lead to permanent bladder or kidney damage.

How is prostatitis treated?
It depends on the type you have.

Category I. If you have acute bacterial prostatitis, you usually will need to take antibiotics for seven to 14 days. In some cases, IV antibiotics are required in the early stages of treatment. Almost all acute infections can be cured with this treatment. Pain medicines to relieve pain or discomfort are given, and sometimes, hospitalization may be required.

Category II. If you have chronic bacterial prostatitis, you will require antibiotics for a longer time, usually four to 12 weeks. About 60 percent of cases clear up with this treatment. For cases that don’t, long-term, low-dose antibiotic therapy may be recommended to relieve the symptoms. In some cases, surgical removal of the infected portions of the prostate may be advised.

Category III. These types are the hardest to treat. Since we don’t know why the disease exists, the treatments are aimed at lessening symptoms rather than curing the disease. Treatments include antibiotics, hot baths, alpha blockers, anti-spasmodic drugs, anti-inflammatory medications, changes in fluids and diets, and other therapies as recommended by your doctor.

How will prostatitis affect my life?
Prostatitis is not contagious. You can live your life normally and continue sexual relations. It is a treatable disease. Even if it can’t be cured, you usually can get relief from your symptoms by following recommended treatment. Remember – correct diagnosis is important in managing the disease and treatment should be followed, even if you have no symptoms.

Will I get prostate cancer from having prostatitis?
No association has been found between prostatitis and prostate cancer. However, the screening tests that we now use for prostate cancer include the prostate specific antigen (PSA) test, digital rectal exams and prostatic ultrasound. All three can be skewed by the presence of prostatitis.

The PSA levels can be falsely elevated by prostatitis. If a patient has an elevated PSA, along with findings of prostatitis, we encourage treatment and a repeat of the blood tests. Many patients with chronic prostatitis will undergo prostate biopsies because their PSA levels are too high. The biopsy is needed, as we cannot tell prostatitis from prostate cancer in many cases.

Having prostatitis doesn’t increase your risk of getting any other prostate disease. But remember, even if your prostatitis is cured, there are other prostate conditions, such as prostate cancer, that require checkups at least once a year after age 40.

For patient appointments, call (314) 362-8200 (Center for Advanced Medicine and Barnes-Jewish West County Hospital).