Prostatitis

Every year, about 2 million doctor visits result in a diagnosis of prostatitis, a term that means "inflammation of the prostate". Behind that simple definition lies a complicated, mysterious malady. In up to 95 percent of cases, there's no known cause for the inflammation.

Prostatitis is a bewildering condition, but that's starting to change. Researchers are pressing to understand its characteristics and develop effective new treatments. Despite all the lingering questions, many patients are able to find relief.

What are the different types of prostatitis?

A small percentage of men with prostatitis have clear signs of a bacterial infection of the prostate. Doctors call this condition bacterial prostatitis. Symptoms may come on suddenly (acute bacterial prostatitis) or develop gradually (chronic bacterial prostatitis). Either way, these patients are the exception to the rule. Their doctors can point to a specific cause of the trouble and plan a specific course of action.

In roughly 90 to 95 percent of cases of prostatitis, however, there's no clear sign of infection. Doctors call this chronic nonbacterial prostatitis or chronic pelvic pain syndrome. Nobody knows what causes this condition. Some researchers blame "hidden" infections that don't show up in normal tests. Others believe it could be an autoimmune disorder, a condition in which immune system cells attack healthy tissues. Still others trace the symptoms to overly tense pelvic muscles. Most experts agree that there's probably more than one cause.

For patients without acute infections, prostatitis is not a major health threat. It doesn't raise the risk of cancer or any other serious disease. With very few exceptions, prostatitis also poses no risk to sexual partners. (Rarely, men with prostatitis have acute infections of bacteria such as Chlamydia that can be sexually transmitted.)

What are the symptoms of prostatitis?

Common symptoms of prostatitis include the following:

  • Pain in the groin, genitals, or lower back
  • Pain during urination
  • Frequent urination
  • Pain during ejaculation
  • Loss of interest in sex
  • Trouble achieving or maintaining erections
  • Fever, especially in cases of acute bacterial prostatitis

How is prostatitis diagnosed?

Prostatitis is a tricky disease to diagnose. A doctor can feel the prostate during a digital rectal exam, but in most cases the gland will seem normal. A doctor can also conduct a urine culture to check for bacteria, but once again, the test isn't likely to reveal anything (unless the patient has an acute bacterial infection).

Doctors often diagnose prostatitis when they can't find any other explanation for symptoms (such as an enlarged prostate or a urinary tract infection). With a little extra detective work, however, it's possible to get a more definitive diagnosis.

In addition to a regular urine sample, a doctor can collect a sample after massaging the prostate. This sample will contain secretions from the prostate -- and, perhaps, a few clues to the condition. Among patients with chronic bacterial prostatitis, cultures from the post-massage urine sample may be positive for bacteria. If a patient has chronic nonbacterial prostatitis, the sample will usually have large levels of white blood cells, which is a sign of inflammation.

How is prostatitis treated?

Cases of bacterial prostatitis call for antibiotics. Common treatments include tetracyclines, fluoroquinolones (ciprofloxacin, levofloxacin), and the combination of trimethoprim and sulfamethoxazole (marketed under the brands Bactrim or Septra and available as a generic).

Treatment of nonbacterial cases of prostatitis is fraught with more uncertainty. Many doctors prescribe antibiotics on the theory that the patient may have a hidden infection, but such treatment is not supported by scientific evidence. Other common treatments are aimed at the symptoms, not the underlying condition. In recent years there was a belief that a class of drugs known as alpha-blockers, including tamsulosin (Flomax) and alfuzosin (Uroxatral) may help some men with urinary symptoms, but recent studies have not been hopeful. A 2004 study did not find tamsulosin to be effective, and a 2008 study found that alfuzosin was not more effective than a placebo. Hot baths and nonsteroidal anti-inflammatory drugs (such as ibuprofen) may help ease pain.

Researchers are currently working to shed some light on this disease. One study is testing whether etanercept (Enbrel), a drug used to treat rheumatoid arthritis (an auto-immune disorder), can be of help.

For now, patients should work closely with their doctors and be willing to try different treatments.

References

Nickel, JC, et al. Alfuzosin and symptoms of chronic prostatitis/chronic pelvic pain syndrome. New England Journal of Medicine. December 18, 2008; 359(25): 2663-73.

McNaughton-Collins M, et al. Prostatitis. In: Litwin MS, Saigal CS, eds. Urologic Diseases in America. National Institutes of Health. February 2007.

Taylor, BC, et al. Excessive antibiotic use in men with prostatitis. The American Journal of Medicine. May 2008; 121(5): 444-449.

Stevermer, J.J. and S.K. Easley. Treatment of prostatitis. American Family Physician. May 15, 2000.

Journal of the American Medical Association. News: Prostate disease begs understanding. July 25, 2001. 286(4): 406-408.

Epperly, T.D. and K.E. Moore. Health issues in men. American Family Physician. June 15, 2000.

American Academy of Family Physicians. Information from your family doctor: Prostatitis. 2000.

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