What is Prostatitis?

Prostatitis is an inflammation or infection of the prostate gland. It is a very common disorder. In fact, it is the most commonly diagnosed urologic disease in men. About 50% of adult men in the United States will be treated for prostates during their lifetime.

What is the Prostate and How Does it Work?

The prostate is a walnut-sized gland that is part of the male reproductive system. It is located just below the bladder and surrounds the uppermost portion of the urethra (the tube that carries urine from the bladder, through the penis, and out of the body [figure 1]). The main function of the prostate gland is to produce fluid for semen. During orgasm, prostatic fluid combines with sperm (produced in the testicles) and other fluids, is forced into the urethra, and ejaculated as semen.

In most men, the prostate begins a gradual process of enlargement at about 40 years of age. The reasons for this enlargement, known as benign (noncancerous) prostatic (affecting the prostate) hyperplasia (having more cells than is normal), or BPH, are not entirely known. However, this enlargement is most likely related to hormonal changes that accompany the aging process or to chemical reactions that occur within the body. BPH does not always cause problems, although as the prostate grows in size, it can put pressure on the urethra (which it surrounds). This pressure can slow down or cut off urine flow, resulting in urinary retention (urine trapped in the bladder).

What causes Prostatitis?

Infections by bacteria or other organisms cause prostatic inflammation in 50%-70% of men. These bacteria usually come from a bladder infection. However, they also may come from sexual contact with a partner who is infected with a sexually transmitted disease. Using condoms during sexual intercourse may prevent exposure to infection.
Another cause of prostatitis is inflammation caused by a chemical reaction caused by BPH; some urine may remain in the urethra after urination and back up into the prostate gland. This condition is known as urinary reflux. A chemical in the urine known as urate can then irritate tissues of the prostate gland and cause inflammation.

In addition to urinary reflux, there are several other ways an infection organism or irritating chemical can reach the prostate gland. These include descending from the kidney or bladder or ascending from seminal testicles (tubelike structures in the testicles that carry sperm to the part of the urethra surrounded by the prostate.

Men at increased risk for bacterial prostates generally have:

• Had a recent or recurrent bladder infection
• BPH
• Recently had a medical instrument inserted into the urinary tract
• Engaged in anal intercourse
• Abnormalities in the urinary tract

Types of Prostatitis:
There are three major types:

• Bacterial prostatitis
• Nonbacterial prostatitis
• Postatodynia

Bacterial Prostatitis can appear as either acute or chronic. The acute form occurs in about 1 in 10 men with prostatitis and develops suddenly. Some bacteria that can cause acute bacterial prostatitis are E coli, Klebsiella, and Pseudomonas.

Symptoms of acute bacterial prostatitis are often severe, and therefore are usually quickly diagnosed. These symptoms include:

• Fever
  
• Pain in lower back
  
• Chills
  
• Fatigue
  
• Aching Muscles
  
• Frequent or painful urination

Chronic bacterial prostatitis also occurs in about 1 in 10 men with an infected prostate. Since chronic means recurrent, this form of bacterial prostatitis keeps returning after the initial infection has been treated and symptoms disappear.

Nonbacterial prostatitis occurs in about 6 in 10 men with this infection. Although the causes are unknown, the inflammation may be related to organisms other than bacteria. For example, men with a history of allergies and asthma sometimes develop nonbacterial prostatitis. However, doctors cannot be sure exactly how these conditions are related. Doctors do know that nonbacterial prostatitis is not found in men with recurrent bladder infections.
Symptoms Include:

• Occasional vague discomfort in the testicles, urethra, lower abdomen, and back
• Discharge from the urethra, especially during first bowel movement of the day
• Blood or urine in ejaculate
• Low sperm count
• Sexual difficulties
• Frequent urination

Prostatodynia (pain in the area of the prostate gland) occurs in about 3 in 10 men with prostate irritation. Unfortunately, tests used to diagnose infection and other problems affection the prostate gland are not useful in detecting the cause of this pain. In some instances, the pain may be caused by a muscle spasm (an involuntary sudden movement or contraction) at the neck of the bladder or the urethra. However, usually the cause of prostatodynia is unknown. Symptoms include pain and discomfort in the prostate gland, testicles, penis, and urethra, and difficulty urinating.

How is prostatitis diagnosed?

Digital Rectal Exam (DRE)
The DRE is a useful and important tool in the diagnosis of prostatitis. During this exam, your doctor will examine your prostate by inserting a gloved finger into the rectum. This quick, simple procedure will reveal the size, shape, and texture of your prostate. It will also identify if the prostate is soft or hard, bumpy of smooth, warm, or tender. In addition, based on the DRE, your doctor will decide if more tests are necessary.

Prostate Massage
During the DRE, your doctor will massage the prostate gland to expel fluid from the prostate into the urethra. The fluid will them be examined for signs of infection.

Sequential Urine Test
This test can help determine the location of an infection. You will be asked to provide three urine samples: a measured sample of urine, a second sample of any discharge that results from a prostate massage, and a final sample of urine remaining in the bladder following the prostate massage. The first sample washes bacteria from the urethra, the second contains prostatic fluid, and the third includes bacteria in the prostate.

Needle Biopsy
A relatively painless procedure, needle biopsy can be done in your doctor's office. A long thin needle is inserted into the prostate gland to collect small samples of tissue from the prostate. These samples are then examined by your doctor for infection and abnormal cells. A needle biopsy usually is performed to diagnose prostate cancer.

Prostate-Specific Antigen (PSA)
A simple blood test is used to measure the PSA (a substance produced by the prostate) levels. When the prostate gland is inflamed, it may produce high levels of PSA, indicating the possibility of prostatitis. A PSA reading can help your doctor decide what other tests may be needed.

Imaging Tests
The technologies used to produce images of the prostate include:

• Ultrasound - an image created by sound waves
• X-rays - taken after a dye is injected into the blood
• Magnetic resonance imaging (MRI) - produces images of the soft tissues of the body
• Computerized axial tomography (CAT) scans - also produce images of the soft tissues of the body

Your doctor will discuss these with you in detail if you both agree that more testing is needed.

Notes and Questions to Discuss with Your Urologist:

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Treatment Options

Acute Bacterial Prostatitis
Your doctor may prescribe an antibiotic that can generate the prostate gland tissues and kill the bacteria causing the infection. It is important to finish the . entire antibiotic to treat the infection.

Chronic Bacterial Prostatitis
Antibiotics are also used to treat this infection, but you should be aware that a chronic infection is difficult to cure. Longer treatment with antibiotics or different types of medication may be required to cure the infection.

Nonbacterial Prostatitis
Depending on the cause of the irritation, different treatments may be used. If there is an infection caused by a nonbacterial organism (for example, a fungal infection), then drugs to kill the fungus may be prescribed. Ibuprofen may help some patients. If your symptoms are caused by urinary reflux into the prostate gland, your doctor may prescribe a medicine that helps reduce the amount of irritating chemicals in the urine.

Thermotherapy
(heating the prostate gland with an instrument inserted through the urethra or the rectum) relieves symptoms in some patients with non bacterial prostatitis.

Urostatodynia
Your doctor may prescribe medicines that combat urinary problems (such as drugs to prevent muscle spasms in the bladder and urethra), since these conditions may cause difficult or painful urination. Thermotherapy may also relieve symptoms.

Are there any other treatments for Prostatitis?

Medical literature describes many alternative (nondrug) approaches to relieving the symptoms of prostatitis. Several well?documented therapies are listed below. It is recommended that you speak with your doctor before starting any alternative therapy.

Heat
Heat therapy comprises warm sitz baths (sitting in a tub of warm water) and hot compresses (not recommended for patients with acute bacterial prostatitis).

Alternate Hot and Cold Therapy
This form of therapy involves the application of alternating hot and cold compresses to the prostate area. A hot compress is left in place for 10 minutes and then a cold compress is applied for 10 minutes.

Zinc Supplement
Zinc is an important part of the prostate gland's defense against infection. A lack of zinc has been associated with BPH. In addition, some studies show that zinc helps reduce the swelling resulting from chronic prostatitis.

Anxiety Treatment
Antianxiety medication and nondrug stress relief (such as meditation, biofeedback, and yoga) may help some people. Regular moderate exercise is also a good way to reduce stress.

Questions and Answers

What kind of doctor should I see if I am having urinary problems or pain in my pelvic area?
You should see your family physician or internist first. He or she can examine the prostate and test your blood and urine for infection. You may then be referred to a urologist. A urologist is a doctor who specializes in the diagnosis and treatment of urinary tract problems, including diseases of the prostate.

Will the prostate exam be painful of embarrassing?
While no one enjoys a prostate exam, it is a relatively simple and painless procedure. It is important to get a prostate exam if you are a male 40 years of age or older.

I have an enlarged prostate or prostatitis; does that mean I have cancer?
An enlarged prostate is a common condition in men. It is noncancerous, and it does not lead to cancer. Prostatitis is an infection of the prostate that can be used by bacteria or unknown factors. While prostatitis and cancer can exist at the same time, often prostatitis can be treated with medication.

Can I infect a sexual partner if I have prostatitis?
It is possible to infect a sexual partner. Prostatitis is not a contagious infectious disease; however, bacteria contained in semen could be transmitted to your partner during sexual intercourse.

Important Terms and Resources

Acute: sudden and/or severe onset of a condition.

Benign prostatic hyperplasia (BPH): noncancerous enlargement of the prostate gland.

Chronic recurrent or ongoing condition

DRE: digital rectal exam; used to feel the size, shape, and texture of the prostate.

PSA: prostate-specific antigen; a blood test is used too help find or follow prostate cancer by measuring PSA levels.

Prostatitis: an inflammation or infection of the prostate gland

Prostatodynia: pain that appears to originate in the area of the prostate gland.

Urethra: the channel for both urine and semen, leading from the bladder though the prostate and penis.

Resources

Books
Fox A, Fox B. The Healthy Prostate: A Doctors Comprehensive Program for Preventing and Treating Common Problems. NY: John Wiley & Sons, Inc; 1996.
Rous S. The Prostate Book: Sound Advice on Symptoms and Treatment. NY: WW Norton & Co; 1994.
Walsh, P. The Prostate: A guide for Men and Women Who Love Them. Baltimore, MD: Johns Hopkins University Press; 1995.

Organizations
American Foundation for Urologic Disease, Inc.
1128 North Charles Street
Baltimore, Maryland 21201
1-800-242-2383
www.afud.org