Prostatitis: Prostate Inflammation

Prostatitis is the inflammation of the prostate either as a result of bacterial infection or decreased immune or muscle related function. Prostatitis is an umbrella term that describes a group of disorders that have related symptoms. According to the Professional Guide to Diseases, 9th ed., as many as 35 percent of men older than 50 have chronic prostatitis and about 50 percent of males will be diagnosed with prostatitis at some point during their lives.

Causes

Causes of Bacterial Prostatitis

Prostatitis develops when bacteria invade the prostate resulting in inflammation of the prostate and other symptoms. Bacteria can find their way up the urethra on their own, they may hitch a ride on a urinary catheter or any other instrument inserted into the urethra, or they can originate in the bladder and make their way to the prostate via the urine. Regardless of their travel method, once bacteria settle into the prostate, they should be treated immediately before they cause bladder infections, abscesses in the prostate, or they completely block the flow of urine. If the bacteria move into the bloodstream, they can rush throughout the body and cause a significant drop in blood pressure, confusion, and possibly even death. Fortunately, in most cases, the right treatment for bacterial prostatitis can usually eliminate the bacteria. Any bacteria that is capable of invading the urinary tract and causing an infection are capable of triggering acute bacterial prostatitis.

The main bacteria is Escherichia coli (E. coli) although there are others that can directly or indirectly trigger the disease.

Causes of Nonbacterial Prostatitis

Experts do not know why men get this nonbacterial form of the disease. Some propose that it is caused by germs that go undetected, while others suggest it is associated with nerve or muscle function in the area of the prostate, a renegade immune system, substances such as uric acid that move from the blood into the prostate and irritate the gland, pressure exerted on the prostate from nearby diseased tissue, and psychological stress. Over time, chronic nonbacterial prostatitis can cause semen abnormalities, infertility, and a poor life quality.

Symptoms and Severity

Three of the four different types of prostatitis.

  1. Acute bacterial prostatitis
  2. Chronic bacterial prostatitis
  3. Chronic nonbacterial prostatitis/chronic pelvic pain,
  4. Asymptomatic inflammatory prostatitis

All four types of prostatitis have similar symptoms, yet there are a few notable differences among
them Generally, symptoms include:

  • A strong urge to urinate immediately
  • Difficulty starting the urinary stream
  • A weak urinary stream once it starts
  • Dribbling after you think you’re finished
  • Frequent nighttime urination
  • Pain and/or burning when you urinate
  • Pain in the genital and pelvic area
  • Pain when you ejaculate
  • Blood in the urine or seman
  • Chills and Fever
  • Malaise (generally feeling run-down)
  • Nausea and Vomiting

Getting Help

In order to detect and diagnose prostatitis Dr. Alarcon may first ask you questions about your urinary function and may also give you a form to fill out, called the National Institutes of Health Chronic Prostatitis Symptom Index to help determine a diagnosis before performing other tests for prostatitis.

Other Tests to help diagnose prostatitis, include:

PSA Test. An elevated PSA can be caused by many factors including prostate cancer so a PSA test must be used along with several other tests before a diagnosis of prostatitis can be made.

Digital Rectal Examination (DRE). The DRE is used to check for abnormalities in the size, shape and structure of the prostate and is considered the “gold standard” for determining prostate disorders including prostatitis.

Urinalysis. Dr. Alarcon may undertake an analysis of the urine to determine bacteria and presence of infection in the prostate.

In some cases, more tests are necessary to identify the cause. These tests may include:

  • MRI and ultrasound
  • Cystoscopy
  • Uroflowmetry

Meares-Stanley Four Glass Test. An excellent but often overlooked test (because it is expensive and time-consuming) is the Meares-Stanley Four Glass Test, which can determine the type and extent of infection and inflammation in the lower urinary tract of men who are experiencing symptoms of chronic prostatitis.

You will be asked to produce urine samples in four “glasses”: a sample from the beginning of a urination, one from the middle (midstream), a sample of prostatic secretions (the “milking” test above), and a urine sample following the milked sample. Dr. Alarcon will have the four specimens examined and cultured for bacteria or white blood cells, pus cells, or other signs of inflammation.

The idea behind this test is that it is possible for these signs to escape detection in a single test, but they will have a real hard time avoiding all four tests.

Treatment

Treatment Bacterial Prostatitis

With the bacterial forms of prostatitis the treatment goal is to eradicate the bacteria with antibiotics. This will usually involve taking an oral antibiotic prescription at home, but if the infection is severe, Dr. Alarcon may order IV infusions in the hospital.

The antibiotics used to treat acute bacterial prostatitis include:

  • Avelox (moxifloxacin)
  • Geocillin (carbenicillin)
  • Levaquin (levofloxacin)
  • Rocephin (ceftriaxone)

If pain is an issue, you may also be given pain medication.

Treatment for Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome

  • Nonbacterial prostatitis the most difficult prostatitis to treat. Dr. Alarcon will often prescribe antibiotics just to make sure they catch any bacteria that may be present, but if you really have nonbacterial prostatitis, they naturally won’t do anything to help. That’s when Dr. Alarcon may turn to other medications, which include alpha-blockers and 5-alpha reductase inhibitors that are also used to treat benign prostatic hypertrophy (BPH).
  • Alpha blockers (see Medications for BPH) work by relaxing the muscles in the prostate and the neck of the bladder so that urine flows more easily. Use of 5-alpha reductase inhibitors can slow the growth of the prostate and may even cause it to shrink by altering the actions of certain male hormones.
  • Alternative and Natural Treatments for Prostatitis. Numerous studies have been done on the effectiveness of alternative therapies for prostatitis, including acupuncture, biofeedback, exercise, high frequency stimulation, heat therapy (hyperthermia), homeopathy, prostatic massage, and reflexology. Dr. Alarcon may also recommend a number of other steps you can take to help reduce your risk of getting prostatitis as part of your daily lifestyle.