What is prostatitis?

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 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 age 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 nonbacterial/prostadynia, is the most common type and causes chronic pelvic pain, or prostadynia. (Prostadynia is also known as chronic pelvic pain syndrome, or 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

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.

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 will perform a physical exam. Diagnosis of prostatitis is usually 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. Other tests include bladder function tests and an analysis of urine and prostate fluid expressed after massaging the prostate gland.

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. Other treatments include alpha-blockers such as Flomax, 5-alpha
reductase inhibitors such as Proscar or Avodart, anti-inflammatory medications
such as ibuprofen, pain killers, warm sitz baths, and repeated prostate massages.

Prevention and Outcomes

There are no guidelines for preventing prostatitis.

Bibliography

Komaroff, Anthony, ed. “Prostate Gland.” In Harvard Medical School Family Health Guide. New York: 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 175 (2006): 619-623.

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

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