Prostatitis
What is prostatitis?
Prostatitis is inflammation of the prostate (a gland beneath the bladder that produces components of semen). This inflammation can be acute (acute prostatitis) when it is commonly due to infection, or persistent or relapsing (chronic prostatitis).
Acute prostatitis
Caused by bacterial infection usually associated with spread from the bladder or urethra.
What are the symptoms?
How is the diagnosis made?
What is the treatment?
Chronic prostatitis
These symptoms have been blamed on chronic inflammation of the prostate gland that in the past was presumed to be due to infection.
However, an infection will be found in less than 5 per cent of such patients, so the term chronic pelvic pain syndrome (CPPS) is now often used instead of chronic prostatitis.
A recent study suggests that in the majority of patients the condition is a consequence of modern living. Psychological tests have demonstrated higher than average scores for anxiety, depression and hypochondriasis in men with CPPS.
Other studies have found physical abnormalities that could be the cause of the inflammatory or infective process: excessive pressure on the external urethral sphincter (responsible for voluntary control of urination) and sometimes reflux of urine into the prostate gland from the urethra (urine tube in the penis).
Attacks may be provoked by several triggering events, such as:
Infection should be excluded by examination of the urine. A blood test may reveal a slightly raised PSA (prostate specific antigen) level but examination and tests are frequently normal.
Some urologists used to attempt prostatic massage to produce a sample for examination, but this is now rarely carried out.
What is the treatment?
If the patient expects a simple solution to the problem, he is often reluctant to accept its relapsing nature. A full explanation of the nature of the disorder often helps.
Various self-help measures may be beneficial:
Drugs that reach adequate levels in the prostate must be used and for sufficient periods, at least one month. Tetracycline antibiotics, especially doxycycline, erythromycin
or ofloxacin are the drugs of choice.
Drugs, such as alpha-blockers
or alfuzosin), which act by relaxing the urethral sphincter and easing spasm can be helpful, as can finasteride, a drug known to 'shrink' the prostate. The latter is more likely to work in patients with an enlarged or tender prostate.
The range of other treatments used is listed below and probably reflects the lack of a single effective therapy:
Burning on passing urine with severe pain felt deep between the legs. There may be a penile discharge if an STD is present.
The infection may be cultured from the urine, a swab from the urethra or, occasionally, the doctor may obtain a specimen of prostate secretions by massaging the prostate using a finger placed in the rectum.
Treatment is with the appropriate antibiotic, such as trimethoprim, doxycycline
or ciprofloxacin.
Family doctors are seeing increasing numbers of men, usually aged 35 to 45 years, who have genital or pelvic pain that persists for weeks or months.
What are the symptoms?
The common symptoms are:
How does the doctor make the diagnosis?
Rectal examination of the prostate might produce discomfort or pain and the gland can feel 'spongy' to the doctor.
Unfortunately, no single intervention has been shown to work. As the patient may be excessively anxious about this and other aspects of his health this makes the problem more difficult to treat.
Antibiotics are frequently useful and are usually tried first even if infection is not found, although they might be working by an anti-inflammatory rather than an antibacterial effect.
In recent years, there has been a resurgence of interest in this condition, with most physicians preferring a more holistic approach to the problem that takes into account all aspects of the patient's situation.
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