Prostatitis - infection - symptoms, treatment and chronic prostatis

INFLAMMATION, INFECTION, or PAIN of the PROSTATE GLAND. Prostatitis may be acute (come on suddenly) or chronic (persist or recur over time). Urologists classify five types of prostatitis:

• Acute bacterial prostatitis occurs as a result of infection with BACTERIA, usually URINARY TRACT INFECTION (UTI), that infiltrates the prostate gland. SEXUALLY TRANSMITTED DISEASES (STDS), notably GONORRHEA and CHLAMYDIA, may also cause acute bacterial prostatitis. Treatment with appropriate ANTIBIOTIC MEDICATIONS usually cures the infection.
• Chronic bacterial prostatitis occurs as a result of an underlying chronic health condition that allows continued or repeated bacterial access to the prostate gland. Treatment requires longterm, and sometimes repeated, antibiotic therapy as well as efforts to resolve the underlying condition.
• Chronic inflammatory prostatitis causes pain and exists when there is inflammation but no infection. Treatment is with NONSTEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS) to reduce inflammation and relieve pain.
• Asymptomatic inflammatory prostatitis does not cause any symptoms and is sometimes a factor in male INFERTILITY that shows up during FERTILITY testing. NSAIDs may improve the inflammation.
• Prostadynia, also called chronic noninflammatory prostatitis, involves neither inflammation nor infection though pain is persistent and sometimes debilitating. Doctors do not know what causes prostadynia. Medications such as alpha blockers, used to treat BENIGN PROSTATIC HYPERPLASIA (BPH), and NSAIDs sometimes provide relief. BIOFEEDBACK, ACUPUNCTURE, and prostatic massage are other methods to relieve pain.

Symptoms of Prostatitis and Diagnostic Path

The primary symptom of all but asymptomatic inflammatory prostatitis is pain in the lower pelvis. Men who have acute bacterial infection often have FEVER and feel quite ill. Men who have chronic bacterial prostatitis may feel intermittently fatigued. The diagnostic path for prostatitis may include DIGITAL RECTAL EXAMINATION (DRE) to palpate the prostate gland, measurement of BLOOD PROSTATE-SPECIFIC ANTIGEN (PSA) levels, urinalysis including urine culture, and SEMEN analysis to look for the presence of red blood cells (evidence of bleeding), white blood cells (evidence of inflammation), and bacteria (evidence of infection). When symptoms are chronic, additional diagnostic procedures may include transrectal ULTRASOUND (TRUS), COMPUTED TOMOGRAPHY (CT) SCAN, prostate biopsy, or CYSTOSCOPY.

Prostatitis Treatment Options and Outlook

Treatment and outlook depend on the identified underlying cause for the symptoms. Because the structure of the glandular tissue within the prostate gland is such that it prevents blood components from entering the prostate gland (a protective mechanism to prevent ANTIBODY formation and to keep the semen PSA concentration high), the course of antibiotic therapy for bacterial prostatitis is lengthy, typically four to eight weeks. A complication of untreated or undertreated bacterial prostatitis is prostatic ABSCESS (the formation of a contained pocket of pus), which may require a cystoscopic procedure under ANESTHESIA to drain the abscess.

Risk Factors and Preventive Measures

Prompt diagnosis and treatment of UTIs and STDs significantly reduce the risk for bacterial prostatitis. There are no clear preventive measures for other forms of prostatitis.

See also CHRONIC PAIN; CYSTITIS; MALDYNIA; SEXUALLY TRANSMITTED DISEASE (STD) PREVENTION; URETHRITIS.

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