Prostatitis

When the prostate becomes inflamed, it is called “prostatitis.“ When it is caused by bacteria, it is called “bacterial prostatitis.” The prostate may be inflamed but uninfected – this is called “non- bacterial” prostatitis.

Symptoms of prostatitis include pain which can vary in location. You may have pain in the penis, testicles, groin, or perineum (area under the scrotum, above the anus). You may have pain over the bladder. The urinary stream may be slower or interrupted. You may void more frequently or with greater urgency. Sometimes there is difficulty with erection, possibly pain during or after ejaculation.

Acute bacterial prostatitis – This is usually not hard to diagnose. Along with pain in the penis, testicles, groin, or perineum, men complain of fever, chills, possibly burning pain with urination, and general malaise (feel bad all over). The prostate feels “boggy” (softer than usual) and is quite tender to examination. The urinalysis look infected and bacteria are present.

Non-bacterial prostatitis – The symptoms are similar, but generally no fever or chills. The prostate may or may not feel abnormal. A screening urinalysis may not be helpful. The doctor may do a digital massage of the prostate that could push prostatic secretions to the end of the penis. This discharge can be examined under a microscope for signs of inflammation or infection. If you void after the prostate exam, the urine may contain inflammatory cells that can also help with diagnosis. Non-bacterial prostatitis is divided into toe subtypes, those with inflammatory cells in semen or urine, and those with no signs of inflammatory cells.

Chronic bacterial prostatitis – “Chronic” means that symptoms have lasted longer and need a longer course of antibiotics and possibly anti-inflammatory medication.

• Chronic bacterial and non-bacterial prostatitis, unlike acute prostatitis, may take weeks to fully resolve. Some men who continue to have problems urinating may require additional diagnostic tests such as urodynamics, pelvic imaging, and cystoscopy to search for an abscess or a severe obstruction (urethral stricture, large prostate).

Most cases of acute bacterial prostatitis are treated with antibiotics and rest, and most cases respond within several days. Some men need a temporary urethral catheter if they cannot urinate. Severe cases can lead to a prostatic abscess (pus in the prostate tissue). A pelvic CT scan or transrectal US may be ordered to look for a prostatic abscess. An abscess that does not respond to antibiotics may require surgical drainage.

In theory, non-bacterial prostatitis should not be treated with antibiotics, but some men do benefit from their use, especially those with inflammatory cells in the semen or urine. Prolonged courses of antibiotics are not advised if you do not improve after several weeks.

Most cases of non-bacterial prostatitis are treated with anti-inflammatory medication and alpha blockers (pills that relax the prostate and bladder neck to open the urethra). Some men may have myofascial trigger points in the perineum or pelvis that cause tension in the muscles. Your doctor may advise a visit to a pelvic floor physiotherapist, heat therapy, even yoga.
Phytotherapy (plant extracts) using bee pollen, quercetin, or saw palmetto have been advised, but do not reliably eliminate symptoms. Men with prostatitis and large prostates may improve with Finasteride, a drug that shrinks the prostate. Some men benefit from prostatic massage in the office. In other cases, stress may be causing pelvic tension, so exercises and therapies that reduce stress and anxiety can be helpful.

Surgery is not usually needed for prostatitis unless symptoms persist for months. Refractory cases may require transurethral prostate surgery or transurethral heat treatments to the prostate.

Do not get a PSA (prostate specific antigen) blood test drawn if you have any form of prostatitis. The PSA enzyme is elevated by prostatic inflammation and may create unnecessary worry about prostate cancer. If you want to screen for prostate cancer, wait 6 weeks after the prostatitis has been treated before sending off the PSA blood test. Prostatitis certainly is a nuisance, but it’s very common and improvement is likely. To our knowledge, prostatitis is not associated with prostate cancer.