Prostatitis is a common ailment affecting a large number of men. Many patients with this condition having recurring episodes of prostate infections or discomfort requiring multiple visits to either their family physicians or urologists. Because there often is no quick and easy cure for their condition, many patients are unhappy with their treatment. Furthermore, many physicians have a poor understanding of this disease and the impact it has on their patients' lives. There are four basic types of prostatitis - acute bacterial prostatitis, chronic bacterial prostatitis, non-bacterial prostatitis, and prostatodynia (prostate pain).
Acute Bacterial Prostatitis
Clinical Presentation - Patients often have fever with chills, low back and perineal pain, urinary frequency and urgency, and difficulty urinating (sometimes unable to void at all). The prostate gland is extremely tender on palpation. Too vigorous an examination of the prostate gland can send bacteria into the bloodstream and cause septic shock (marked decrease in blood pressure).
Treatment - patients who have high fevers or who are having difficulty urinating are often admitted to the hospital and given antibiotics (ampicillin and gentamicin) until the fever breaks. Patients are then given an oral antiobiotic such as Septra or Floxin for 30 days. It is necessary to treat the infection for one month due to the difficulty in clearing an infection from the prostate. A shorter course of antibiotics may not completely rid the prostate of bacteria and can lead to recurrent prostatitis. Additional measures which may be beneficial include bed rest and stool softeners.
Chronic Bacterial Prostatitis
Clinical Presentation - Patients have irritative voiding symptoms (urinary frequency and urgency) without fever or chills. Often patients complain of low back or perineal pain, and occasionally have pain with ejaculation. Recurrent urinary tract infections with the same organism is the hallmark of chronic bacterial prostatitis. Urinalysis reveals white blood cells (WBC's) and bacteria. Urine cultures show which organism is causing the infection. The prostate may or may not be tender during rectal exam. Transrectal ultrasound of the prostate may show prostate stones present even if they are not felt during rectal exam.
Treatment - antibiotics such as Septra, Cipro, or Floxin are given for 12 weeks. However, even with long treatment courses the cure rates are only 40 - 50%. Patients may have prostate stones which harbor bacteria despite antibiotic therapy. These patients may require transurethral resection of the prostate gland (TURP) to remove the prostate stones (see BPH - surgical therapy for expanation of TURP). Those patients not cured by antibiotics may benefit from continuous low-dose bacterial suppression with Septra or Macrobid. Discontinuation of antibiotics, however, often results in return of symptoms.
Non-bacterial Prostatitis
Clinical Presentation - Patients have symptoms similiar to chronic bacterial prostatitis. Although the urinalysis shows WBC's, urine cultures are negative for bacteria. Some studies have suggested organisms such as Ureaplasma or Chlamydia as possible causative agents, but most studies have left considerable doubt over their contribution to prostatitis. One theory suggests that bacteria deep in the prostate gland is the cause of this disorder. Another blames urine reflux into the prostatic ducts.
Treatment - a trial on doxycycline for 4 weeks is indicated to cover for Ureaplasma or Chlamydia. If doxycycline is not effective, many physicians would discourage further use of antibiotics. However, some physicians believe that prostate massage every 2 days combined with oral antibiotics (Septra or Floxin) may have some benefit in flushing out bacteria from deep within the prostate gland. Frequent ejaculation may also aid in flushing out the prostate. If antibiotics and prostate message fail, allopurinol may be useful. Some believe that uric acid in the urine causes irritation of the prostate when urine refluxes into the prostatic ducts. Allopurinol blocks the formation of uric acid. Other measures which may help alleviate symptoms include ibuprofen (anti-inflammatory), anticholinergics (relieve bladder spasms), and hot sitz baths.
Prostatodynia
Clinical Presentation - very similar to non-bacterial prostatitis except these patients have a negative urinalysis (no WBC's in the urine). Prostatodynia is thought to be caused by tension in the smooth muscle around the prostate causing increased pressure in the prostate leading to reflux of urine into the prostatic ducts. This causes prostate inflammation and pain. Because stress and anxiety can lead to increased smooth muscle tone, many physicians consider prostatodynia to have a psychologic etiology ("stress prostatitis"). There are some physicians who feel that prostatodynia is really deep seated infection of the prostate gland.
Treatment - alpha-blockers such as Cardura, Hytrin, or Flomax relax the smooth muscle around the prostate and may have some benefit in treating prostatodynia. If these medications fail, patients are given a trial on allopurinol to block uric acid formation. As mentioned above, uric acid is thought by some to be the urine chemical causing irritation of the prostate. If all else fails, prostate message every 2 days for several weeks with oral antibiotics may clear any deep seated prostate infection that might be causing the patient's symptoms. Other supportive treatment measures which may be helpful include hot sitz baths or even stress reduction therapy.
Additional Information
There is a fairly comprehensive site on the internet listed below.