Prostatitis: diagnosis, treatment and prevention
One of the most common reasons why young and middle-aged men consult an urologist, prostatitis affects five to 10 per cent of men of all ages, with those between the ages of 30 and 50 years considered at most risk.
This inflammation of the prostate – the walnut-sized gland underneath the bladder – may be either acute or chronic. While the acute symptoms usually result in prompt diagnosis and treatment, chronic prostatitis often goes unnoticed or ignored for a long time and is only identified when complications occur.
Acute prostatitis is caused by a bacterial infection, which typically mimics a severe urinary tract infection (UTI) with fever, chills, discomfort in the lower abdomen and perineal area, frequent and burning urination and painful ejaculation. The pathogen usually contaminates the prostate from the urethra (the tube from the bladder that allows urine to pass out of the body) or from the bowel. In rare cases, a sexually transmitted microorganism such as Chlamydia, mycoplasma and Neisseria gonorrhoeae the bacterium responsible for gonorrhoea, may be the cause.
Symptoms of chronic prostatitis, a far more frequent condition, are similar to the acute phase but are milder and occur progressively without fever. It can be induced by an infection (chronic bacterial prostatitis) or by other non-infectious causes (nonbacterial prostatitis) such as past prostate damage, a nervous disease or an immune system disorder. However, in many cases, the exact cause cannot be identified. Risk factors for prostatitis include past injury within the prostate area, previous prostate biopsy, conditions requiring the use of urinary catheter, dehydration, past UTI, Sexually Transmitted Infections and Aids.
A frequent type of chronic prostatitis, without persistent infection, is referred to as chronic pelvic pain syndrome. The patient may experience various signs of prostatitis (painful urination or ejaculation, discomfort in the genital area) fluctuating over time from minor to significant intensity.
Left untreated or poorly managed, prostatitis can lead to acute and long-term complications that include the progression of the infection to other organs (testes) or to the blood (septicaemia), an abscess within the prostate and infertility. Despite the absence of clear evidence, some scientists believe that chronic inflammation of the prostate may increase the risk for benign prostate hypertrophy, lower urinary tract symptoms and prostate cancer.
Individuals presenting prostatitis symptoms can be treated by a general practitioner or referred to an urologist. During the clinical exam, the doctor performs a digital rectal examination, which allows for the identification of a swollen and tender prostate gland. The specialist may carry out a prostate massage to extract the prostatic fluid to search for the causal bacterium. A urinary analysis and culture, a PSA test (which assesses blood markers from either normal or malignant prostatic cells) and a lower abdomen ultrasound are often requested to rule out other diagnoses, especially prostate cancer. The PSA test should be interpreted with caution because it may be falsely elevated in prostatitis.
Treatment depends on the cause. Most acute bacterial prostatitis is treated with oral antibiotics. First line agents are ciprofloxacin or ofloxacin, which diffuse well into the prostate tissue. The therapy is given for a minimum of two weeks that can be prolonged up to 12 weeks in chronic bacterial prostatitis. Other medications can be prescribed such as alpha-blockers (to relax the muscle around the prostate and bladder and facilitate bladder emptying), anti-inflammatory and painkiller pills. Over two thirds of the cases respond well to treatment. Some patients may not however be easily cured and may experience frequent recurrences of the symptoms even after repeated and prolonged antibiotic courses.
As a home remedy, hot sitz baths are useful in relieving discomfort. From the lifestyle point of view, caffeinated drinks, spicy food, and some high-risk sports such as bicycling and horse riding are best avoided. The prevention of prostatitis relies on proper genital hygiene, good hydration through drinking two litres of water per day to produce significant urination and awareness and early treatment of any possible urinary tract infection.
Dr Gerard Lalande is managing director of CEO-HEALTH, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected].
