Prostatitis syndrome or just prostatitis is the most common condition diagnosed in urological practice in men under the age of 50 years. After 50 years, it becomes the third most common, after benign prostatic hyperplasia (BPH) and prostate cancer.

Due to its growing presence and etiology of multiple factors, there has been a significant change in its classification since the last two decades.

The diagnosis of each type of prostatitis depends on the findings of the physical examination by the urologist, laboratory tests, and imaging studies carried out.

Treatment of both, its acute and chronic forms, is with drugs, a prostatic massage where indicated, surgery where required, and certain home remedies.

By consensus, the National Institutes of Health has classified the prostatitis syndrome in a new fashion, which is in use now and based on the symptoms and the presence of bacteria and infection-fighting cells in the prostate secretions.

The classification is as follows:

  • Acute bacterial prostatitis
  • Chronic bacterial prostatitis
  • Chronic prostatitis or chronic pelvic pain syndrome
  • Asymptomatic inflammatory prostatitis

Firstly, the urologist comes to a diagnosis that it is a prostate problem, then he narrows the diagnosis to prostatitis from other prostate problems. Lastly, he has to pinpoint the diagnosis to the category of prostatitis in order that the right treatment is administered to the patient.

Diagnosis of prostatitis and its type

It’s just not enough to diagnose prostatitis. Confirming the presence of the type of prostatitis is necessary to arrive at the right treatment option for cure.

How is acute bacterial prostatitis diagnosed?

Acute bacterial prostatitis presents as part of urinary tract infection along with systemic symptoms. E. coli is the most predominantly responsible bacteria.

Physical examination

Physical palpation of the abdomen helps to rule out a full bladder due to urinary retention and other causes of abdominal pain. The scrotal examination will rule out epididymo-orchitis.

Palpation by a digital rectal examination (DRE) reveals a prostate that can be described as hot, tender, and swollen.

Lab tests 

Microscopic analysis of the midstream urine sample is followed by microbiological urine culture if the initial test shows infection. The most common pathogen is E. coli followed by enterococci and less commonly Pseudomonas aeruginosa.

Imaging studies

Ultrasound of abdomen and pelvis evaluates the amount of post-void residual urine. In cases not responding to treatment, a transrectal ultrasound (TRUS) of the prostate or a CT scan will help to rule out a prostate abscess.

Diagnosing chronic bacterial prostatitis

Chronic bacterial prostatitis is characterized by recurrent urinary tract infections with the patient being asymptomatic between the infection episodes.

Medical history and physical examination

The urologist first undertakes the following:

  • History of symptoms
  • A focused physical examination of the abdomen
  • DRE
  • followed by a prostate massage for culture

Lab investigations

Bacterial cultures are fundamental to diagnose chronic bacterial prostatitis. A midstream pre-prostate massage urine sample and a first stream urine sample post-prostate massage are sent to the lab.

In chronic bacterial prostatitis, the bacterial count in the post-prostate massage sample should be tenfold that of the pre-prostate massage sample.

Semen cultures of the ejaculate are not of much help because of their low sensitivity.

Diagnosis of chronic pelvic pain syndrome (CPPS)

The pathology of CPPS is poorly understood and therefore, arriving at a confirmed diagnosis is challenging, as there is no standard diagnostic procedure for it.

Diagnosis is based on excluding other urological conditions such as chronic bacterial prostatitis, urethritis, urogenital malignancy, neurological disorders with impaired bladder function, and psychological factors.

Painful or burning urination or pelvic pain is the predominant symptom of CPPS that differentiates it from BPH.

Your doctor will do a digital rectal examination, get your urine sample tested, and possibly your prostate fluid as well.

Asymptomatic prostatitis

Asymptomatic prostatitis produces no symptoms and is accidentally discovered in a patient being evaluated for other urologic problems. It is discovered when subjecting the patient to infertility or elevated PSA levels. Ejaculate will show elevated white blood cells without pus cells.

Prostate biopsy is another possible investigation your doctor may want to undertake.

Treatment of prostatitis

Treatment of acute bacterial prostatitis

This acute form of prostatitis is treated with antibiotics for a period of 4 to 6 weeks. If the fever does not subside with oral antibiotics within 3 to 4 days, then you may be admitted to the hospital to facilitate intravenous administration of antibiotics.

You may at times require the administration of two antibiotics in order to control the infection. Anti-inflammatory painkillers are given for pain and inflammation.

Once the patient becomes afebrile, he may be put back on oral antibiotics.

Improper medication can lead to the formation of a prostate abscess for which the urologist will perform surgery to drain the abscess.

After drainage of the abscess, the doctor will put you on antibiotics for six weeks

 Chronic bacterial prostatitis treatment

For chronic bacterial infection of the prostate, you will have to take antibiotics for a longer period, for 4 to 12 weeks depending on the doctor’s judgment.

If there is a recurrence, you will have to take a long-term antibiotic course again. However, low-dose antibiotics can be used over a long period to prevent recurrences.

Chronic prostatitis/chronic pelvic pain syndrome treatment

The doctor prescribes antibiotics for infection, nonsteroidal anti-inflammatory drugs for pain, inflammation and to relax the smooth muscles.

Since this is a chronic condition, it can be treated but is without a permanent cure, it is necessary to assure the patient that this is not a life-threatening condition, not a venereal disease, and not contagious. The doctor will look for a psychiatrist’s opinion to address the patient’s stressed mental state.

In all forms of prostatitis,

Drugs used:

  • Antibiotics used more commonly are Ampicillin, Gentamycin, Ciprofloxin, and TMZ/SMZ (Trimethoprim and sulphamethoxazole combination).
  • NSAIDs such as Ibuprofen and aspirin may be used along with muscle relaxants.
  • Paracetamol will be used for fever.
  • Alpha-blockers help relax the bladder neck and muscle fibers to ease symptoms, such as painful urination.

Physical examination

  • Prostatic massage may be done to drain the prostate and ease pressure in it.

Home remedies

  • Hot baths, hot water bottles, or heating pads may also help ease the pain.
  • Avoid alcohol, caffeine, and spicy or acidic foods.
  • Avoid prolonged sitting or bicycling because it can aggravate your prostate pain.
  • Drink plenty of fluids to flush bacteria from your urinary bladder.

Surgery

Surgery may be required to treat urinary retention caused by chronic bacterial prostatitis. Surgical excision of scar tissue in the urethra often improves urine flow and reduces urinary retention.

Prognosis

  • With complete treatment, most cases of acute bacterial prostatitis are cured.
  • CP/CPPS is not as easy to treat. Anti-inflammatory drugs, frequent prostate massages, physiotherapy, or alpha-blockers may offer relief from symptoms.

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