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Ask the Doctor


Medical View of Prostatitis

Prostatitis is often described as an infection of the prostate, but it can also be an inflammation with no sign of infection. Just 5 percent to 10 percent of cases are caused by bacterial infection.

Prostatitis can affect men of all ages. An estimated 50 percent of all men experience prostatitis-like symptoms at some point during their lifetime. In fact, chronic prostatitis is the number one reason men under the age of 50 visit a urologist. In some cases, chronic prostatitis follows an attack of acute prostatitis. Chronic prostatitis might also be associated with other urinary tract infections.

The primary symptom of chronic infectious prostatitis is usually repeated bladder infections. Prostatitis is considered chronic if it lasts more than three months.

Types of prostatitis include:

Acute bacterial prostatitis — This is a sudden bacterial infection that is characterized by inflammation of the prostate. It  is the least common form of prostatitis, but the symptoms are usually severe. Patients with this condition have an acute urinary tract infection with increased urinary frequency and urgency, a need to urinate a lot at night, and pain in the pelvis and genital area. They often have fever, chills, nausea, vomiting, and burning when urinating. Acute bacterial prostatitis requires prompt treatment, as the condition can lead to bladder infections, abscesses in the prostate or — in extreme cases — completely blocked urine flow. Left untreated, the condition can cause confusion and low blood pressure, and might be fatal. The condition is usually treated in the hospital with intravenous antibiotics, pain relievers, and fluids.

Chronic bacterial prostatitis — This condition is the result of recurrent urinary tract infections that have entered the prostate gland. The symptoms are similar to acute bacterial prostatitis, but are less severe and can fluctuate in intensity. The diagnosis of this condition is often challenging. It’s often difficult to find the bacteria in the urine. Treatment includes antibiotics for 4 to 12 weeks and other treatment for pain. Sometimes men are given suppressive low-dose, long-duration antibiotic therapy.

Chronic non-bacterial prostatitis/chronic pelvic pain syndrome — This is the most common form of the disease, accounting for 90 percent of the cases. The condition is characterized by urinary and genital pain for at least three of the past six months. Patients have no bacteria in their urine, but might have other signs of inflammation. The condition can be confused with another called interstitial cystitis (a chronic infection of the bladder)

Do I have prostate disease?
Note: You should see your doctor if there are any signs that your urination pattern has changed. Changes in urination pattern may well be associated with some form of prostate disease. Men with prostatitis usually also have other symptoms that are associated with infection, including fever, tiredness and muscle pain. It is important to note that a number of men with BPH or prostate cancer may not have many, or any symptoms. It is therefore important for men over the age of 50 years to have their prostate checked by the doctor every year. Men who have a family history of prostate cancer should have regular prostate checks before the age of 50.

What causes prostatitis?
How the prostate becomes infected is not clearly understood. The bacteria that cause prostatitis might get into the prostate from the urethra by backward flow of infected urine or stool from the rectum.

At one time, prostatitis was believed to be a sexually transmitted disease, but more recent research suggests that only a small number of cases are passed on through sex.

Certain conditions and medical procedures increase the risk of developing prostatitis. You are at higher risk for getting prostatitis if you:

What are the symptoms of prostatitis?
You might experience no symptoms, or symptoms so sudden and severe that you seek emergency medical care.

When present, symptoms include:

Other symptoms might include pain that comes and goes low in the abdomen, around the anus, in the groin, or in the back. In some cases, bacteria can get into the vas deferens (the tube that carries sperm from the testicles to the urethra), causing groin pain or an infection of the epididymis (area near the testicles where sperm mature and are stored). The prostate might swell, causing a less forceful urine stream. Sometimes blood in the urine and painful ejaculation are other symptoms of prostatitis.

Men might also complain of pelvic pain, pain during ejaculation, and pain with sexual intercourse.

What are the main signs of prostate disease?
The close location of the prostate around the urethra means that any enlargement of the gland may block the urethra and interfere with the flow of urine and changes in urination pattern. The first sign that there may be prostate problems may be when: A man has difficulty in passing urine; A man experiences the urge to pass urine more frequently. Some men may experience pain at the base of the scrotum and penis (referred to as perineal pain).

What are the symptoms?
A number of men with prostate disease may not have many or any symptoms. Those men who do have symptoms usually find that there are noticeable changes to urination because prostate disease affects the part of the prostate around the urethra. If symptoms develop, they are usually described as either obstructive or irritative, but other symptoms may also happen.

Obstructive symptoms Hesitancy (a longer than usual wait for the stream of urine to begin); Weak and poorly directed stream of urine; Straining to urinate; Dribbling after urination has finished or an irregular stream; Urinary retention (not all the urine is passed from the bladder making the need to urinate more often); Overflow or paradoxical incontinence (urine overflows from a full bladder uncontrollably even though normal urination cannot be started).

Irritative symptoms Urgency (an urgent feeling of needing to urinate); Frequency (a short time between needing to urinate); Nocturia (a need to pass urine more than twice at night).

Other symptoms Perineal pain (pain at the base of the scrotum and penis); Dysuria (painful urination); Haematuria (blood in the urine).

What is LUTS? LUTS, or lower urinary tract symptoms, is a common term used to describe the range of urinary symptoms that may be linked with prostate disease. LUTS can be described as mild, moderate or severe, depending on how much the symptoms are bothersome to the man’s general lifestyle and activities. Other issues not directly related to the man’s urinary symptoms may make the symptoms more bothersome, for example reduced physical movement may make it more difficult for a man to get to the toilet in time. Prostate disease is not the only cause of LUTS. LUTS can happen after changes in the workings of the bladder, urethra and/or prostate. Some other causes of LUTS include neurological disease (such as stroke, Parkinson’s Disease), some medicines, infections and an irritable bladder.

What should be done if urination problems exist? Any symptoms involving changes to urination should be discussed with a local doctor, particularly if they are affecting a man’s quality of life or interfering in his normal daily activities. Many people think that urinary symptoms in men are a sign of prostate cancer. This is not true. Sometimes, but less commonly, prostate cancer is present, but urinary symptoms are most often caused by prostate enlargment. It is important to have any urinary problems checked by a doctor, the possibility of prostate cancer is discussed, and a diagnosis of the problem is made.

How is prostatitis diagnosed?
If your doctor suspects that you have prostatitis or another prostate problem, he or she might refer you to a urologist (a doctor who specializes in diseases of the urinary tract and the male reproductive system) to confirm the diagnosis.

Patients typically undergo a comprehensive examination, including a digital rectal exam. Then, if the doctor is still not sure what you have, more tests, such as a biopsy, voiding studies, or MRI might be conducted. Voiding studies involve the collection and analysis of urine to determine which part of the urinary system is infected.

What is the treatment for prostatitis?
Treatments vary among urologists and are tailored to the type of prostatitis you have. Correct diagnosis is crucial because each type of prostatitis is treated differently, and it’s important to make sure your symptoms are not caused by urethritis (inflammation of the urethra) or another condition that might lead to permanent bladder or kidney damage.

Treatments generally include the following:

Other treatments for chronic non-infectious prostatitis include the use of the drugs Proscar, Hytrin, and Cardura. These drugs relax the muscles of the prostate and bladder to improve urine flow and decrease symptoms.

Many cases of abacterial (non-bacterial) prostatitis (also considered chronic pelvic pain syndrome) respond to multidisciplinary approaches incorporating exercise, myofascial trigger point release, progressive relaxation, and counseling.

Prostatitis is a treatable disease. Even if the problem cannot be cured, you can usually get relief from your symptoms by following the recommended treatment. It is important to follow the full course of the prescription, even if you no longer have any symptoms. With infectious prostatitis, for example, the symptoms might disappear before the infection has completely cleared.

What are the long-term effects of chronic prostatitis?
Chronic prostatitis affects men differently, with varying degrees of discomfort or pain.

Prostatitis is a contagious disease. You can live your life normally and continue sexual relations without passing it on.

Having prostatitis does not increase your risk of developing prostate cancer or any other prostate or kidney disease. But even if your prostatitis is cured, you should continue to have regular examinations to detect prostate cancer.


What is prostatitis?
Prostatitis is an inflammation of the prostate gland. Prostatitis can cause many symptoms, including the following: Difficult or painful urination Frequent urination Fever Low-back pain Pain in the groin Inability to get an erection Decreased interest in sex Prostatitis may be easily confused with other infections in the urinary tract. If you think you have prostatitis, see your doctor.

What is the prostate gland?
The prostate is a gland that lies just below a man's urinary bladder. It surrounds the urethra and is in front of the rectum. The urethra is the tube that carries urine out of the bladder, through the penis and out of the body.

What is the function of the prostate gland?
The prostate produces a thick fluid that becomes part of the semen. Semen is the white fluid that contains sperm.

How frequent are prostate problems?
Prostate problems are common in men. Most of these problems can be treated successfully. A urologist is a specialist in the diseases of the urinary system, including the diagnosis and treatment of conditions involving the prostate gland.

Do symptoms always happen? Not all men get symptoms from prostate disease. For some men, the symptoms are quite mild or non-existent and treatment is not needed. It is also true that early stage prostate cancer does not usually produce urinary symptoms. For these reasons, men over the age of 50 years, particularly those who have a family history of prostate cancer amongst brothers, fathers and uncles, may need to think about having a prostate examination each year. During a prostate check, the doctor assesses the size, shape and feel of the prostate gland. There is much debate about the benefits of early detection and treatment of prostate cancer. Information about risks and benefits should be discussed with a doctor before a decision is made about testing. Any concerns should be talked about with the doctor.

Should I see a doctor? Note: The ability to control urination (continence) and the ability to have erections (potency) can be affected after operations on the prostate. BPH and prostate cancer happen more commonly in men over the age of 50. Men who are concerned about prostate disease should see their doctor, who can perform an examination of their prostate gland. This is done by having a digital rectal examination (DRE), where the doctor places a finger in the back passage (rectum) to check the size, shape and feel of the prostate gland. Any symptoms involving changes to urination should be mentioned to the doctor, particularly if they are causing any change to a man's quality of life or interference in his normal daily activities. A local doctor may refer a man to see a specialist (urologist).

How common is prostatitis?
Prostatitis is a very common health concern for men. This complaint accounts for up to 25% of all medical office visits by young and middle-age men for issues relating to the genital and urinary systems. The most common types of prostatitis are inflammatory and noninflammatory chronic pelvic pain syndrome, which account for about 90% of prostatitis cases.

What causes prostatitis?
There are 2 kinds of prostatitis: acute prostatitis and chronic bacterial prostatitis. Both are caused by an infection of the prostate. Some kinds of prostatitis may be a result of the muscles of the pelvis or the bladder not working correctly.

What Happens in Prostatitis?
Prostatitis, especially if it continues for a long time, can cause stress, anxiety, and depression.

Acute prostatitis Men with acute prostatitis have severe pain and fever and may need hospitalization. Most men recover fully when treated with antibiotics. Delaying treatment increases the risk of developing complications, such as sepsis or an abscess in the prostate.

Chronic bacterial prostatitis Chronic bacterial prostatitis can be difficult to treat, because some medications have a hard time reaching the prostate. Men with chronic bacterial prostatitis commonly have repeated urinary tract infections. The infection may spread to the epididymis. The presence of infected prostate stones (prostatic calculi) can make treatment of chronic bacterial prostatitis more difficult.

Chronic prostatitis/pelvic pain syndrome, inflammatory and noninflammatory Chronic prostatitis/pelvic pain syndrome, inflammatory and noninflammatory, often get better over time without serious complications. However, the symptoms sometimes return unexpectedly.

Is there more than one type of prostatitis?
Yes. The term "prostatitis" encompasses the following four disorders of the prostate:

Acute bacterial prostatitis is the least common of the four types. It is also the easiest to diagnose and treat effectively. The man with this disease often experiences chills, fever, pain in the lower back and genital area, body aches, burning or painful urination, and the frequent and urgent need to urinate, often at night. The urinary tract is infected, as is evidenced by white blood cells and bacteria in the urine. The treatment of acute bacterial prostatitis is with an antibiotic appropriate for the particular bacteria. Sometimes nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are given to relieve pain.

Chronic bacterial prostatitis is also relatively uncommon. This condition is basically longstanding prostatitis associated with an underlying defect in the prostate, which then becomes a focal point for the persistence of bacterial infection in the urinary tract. The symptoms include low back pain, discomfort in the perineum (the area between the anus and the genitalia), testicular pain and, if the infection spreads to the bladder, mild pain or burning on urination (dysuria) and frequent and urgent need to urinate (frequency and urgency). The effective treatment of chronic bacterial prostatitis usually requires the identification and removal of the defect in the prostate and then treatment with antibiotics. Antibiotics alone often do not cure the infection. Sometimes nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are given to relieve pain.

Nonbacterial prostatitis is the most common and least understood form of prostatitis. It is believed to occur eight times more often than bacterial prostatitis. Nonbacterial prostatitis is frequently a chronic, painful condition that is found in men of any age. Symptoms go away and then come back without warning. The urine and fluids from the prostate show no evidence of a known infecting organism, but the semen and other fluids from the prostate contain cells that the body usually produces to fight infection. Doctors often treat nonbacterial prostatitis with antibiotics and drugs that relax the muscles of the prostate gland, but these treatments have not been proven to work and, in fact, often fail. This form of prostatitis can be associated with other diseases, such as reactive arthritis (formerly called Reiter's disease). Sometimes nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are given to relieve pain.

Prostatodynia is similar to nonbacterial prostatitis with regard to symptoms, age of patients, and ineffectiveness of treatment. However, there are no objective findings, such as the presence of infection-fighting white blood cells, in the urine of men who suffer from prostatodynia. Sometimes nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are given to relieve pain.

How is prostatitis diagnosed?
If your health professional suspects that you have prostatitis, he or she will begin with a complete medical history and physical exam. The type of prostatitis you have cannot be determined solely from your history and symptoms. Your doctor will do tests to determine the cause of your prostatitis.

Acute prostatitis is the least common type but the easiest to diagnose. If acute prostatitis is suspected, a urine culture will be done to test for the presence and type of bacteria.

If your history and physical exam show that you do not have acute prostatitis, a pre- and post-massage test (PPMT) or expressed prostatic secretions test may be done to determine which type of prostatitis you have. An expressed prostatic secretions test is not done if acute prostatitis is suspected, because when the prostate is inflamed or infected, massaging it to obtain a sample for tests is very painful and possibly dangerous. Some health professionals believe that massaging an infected prostate increases the risk of developing a bacterial infection of the blood (septicemia).

More tests may be necessary if: Your symptoms do not improve with treatment. You continue to have prostate infections. The symptoms could be caused by bladder or prostate cancer. Your health professional suspects you have a complication related to prostatitis, such as an abscess.

Tests that may be done include: Complete blood count (CBC). Digital rectal exam, to check for growths in the prostate gland or to see if it is larger than normal. Blood culture, to check for bacteria in your blood if you have acute prostatitis. Computed tomography (CT) scan or magnetic resonance imaging (MRI) of your pelvic area. Transrectal ultrasound of your pelvic area. Prostate specific antigen (PSA) to rule out prostate cancer.

How is prostatitis diagnosed? Prostatitis is not diagnosed easily because the symptoms can often be the sign of a different infection, or the symptoms are varied. The following tests can be done to check for prostatitis:

A digital rectal examination (DRE) where the doctor places a gloved finger into the rectum, is often used to feel if the prostate gland is swollen or tender.

A three-part urinalysis can also be used. Two urine samples are collected and analysed, the prostate is then massaged and a third urine sample taken that contains fluid from the prostate. Urine is tested to see if white blood cells (leukocytes) are present in the urine. Leukocytes help the body to fight infection, so if there are more leukocytes in the urine than normal, this suggests a bacterial infection. Nonbacterial prostatitis is diagnosed when no bacteria is found in the urine or prostate fluid as part of a three-part urinalysis.

A PSA test may be taken when checking prostate health. The PSA test measures the level of prostatic specific antigen (PSA) in the blood, which is an important marker for prostate cancer, although it is not cancer specific. The levels of PSA can be raised in benign prostatic diseases, such as prostate enlargement and prostatitis.

What information does the doctor need?
Doctors often need a detailed personal and family medical history in order to diagnose the nature and extent of the problem. Keeping a ‘voiding diary’, where the details of voids over a period of one to three (or up to seven) days are recorded, may also be helpful. Amounts of urine voided, the times for each visit to the toilet and the fluid intake should be noted, which may be useful information for the doctor. Details of any prescription and non-prescription medicines being taken for other conditions should also be given to the doctor.

Who can diagnose prostatitis?
Contact your health professional immediately if you have sudden fever, chills, and urinary symptoms, such as pain or burning with urination or blood or pus in the urine. These symptoms may indicate acute bacterial prostatitis.

Call your doctor if you have: Urinary symptoms and persistent pain in the low back, scrotum, penis, or the area between the scrotum and anus, or if you have pain with ejaculation or with a bowel movement. Recurring urinary tract infections (UTIs). Discharge from your penis or sores on your genitals. Problems urinating, such as excessive nighttime urination, trouble starting urinating, decreased urinary stream, or frequent urination that is not related to drinking lots of fluids.

Watchful Waiting Most men will have some discomfort in their prostate (prostatitis) at some time during their lives. If you do not have a fever and chills or extreme pain, you may try home treatment for a few weeks. Take nonprescription pain medications, such as aspirin, ibuprofen, or acetaminophen, to relieve pain. However, if your urinary symptoms and pain continue, you need to see a health professional.

Who To See Health professionals who can evaluate and treat your prostatitis include: Family medicine doctors. Internists. Urologists. Nurse practitioners. Physician assistants.

How is prostatitis treated?
The treatment is based on the cause. Your doctor may do a rectal exam and test urine samples to find out the cause. In a rectal exam, your doctor may check your prostate by putting a gloved, lubricated finger into your rectum to feel the back of your prostate gland. Antibiotics are used to treat prostatitis that is caused by an infection. You might have to take antibiotics for several weeks or a few months. If prostatitis is severe, you might have to go to a hospital for treatment with fluids and antibiotics

Treatment for prostatitis usually begins with taking an antibiotic for several weeks. If you begin to feel better, you may have to take the medication for 2 to 3 months. If you do not get better while taking antibiotics, more tests may be done.

Acute prostatitis Treatment for acute prostatitis is aimed at curing the infection and preventing complications. Acute bacterial prostatitis is treated with antibiotics, pain and fever medication, stool softeners, fluids, and rest. If you are unable to urinate or need intravenous antibiotics, you may be admitted to a hospital for treatment. Most men recover quickly with treatment, which lasts for 4 to 6 weeks.

Chronic bacterial prostatitis Treatment for chronic bacterial prostatitis is aimed at curing the infection and preventing complications. Antibiotics are given for 6 to 12 weeks. Long-term antibiotic treatment may be needed if the infection returns. Infected prostate stones (prostatic calculi) can make the infection more difficult to cure. If present, they may need to be surgically removed. Surgery may be needed if urinary tract problems, such as narrowing of the bladder neck or urethra, are causing the prostatitis. Surgical removal of the prostate (prostatectomy) for repeated infections is rarely used, and only as a last resort.

Chronic prostatitis/pelvic pain syndrome, inflammatory Treatment of chronic prostatitis/pelvic pain syndrome, inflammatory, may be difficult. Antibiotics are tried first. If your symptoms do not improve, treatment with these medications is usually stopped. Muscle relaxants and alpha-blockers may be used if muscle spasms are causing pain or problems urinating. Medications to reduce inflammation may relieve pain. Finasteride, a medication that slows the growth of the prostate, may be used. Massaging the prostate 3 or 4 times a week may help relieve symptoms. Counseling, biofeedback, or relaxation techniques may help reduce stress that is contributing to the pain.

Chronic prostatitis/pelvic pain syndrome, noninflammatory Chronic prostatitis/pelvic pain syndrome, noninflammatory, is difficult to treat because it is not clear what causes this form of prostatitis. The primary goal of treatment is to relieve symptoms. Nonnarcotic pain medications, muscle relaxers, and alpha-blockers are used. Physical therapy, medications to reduce anxiety, exercise, massage therapy, biofeedback, or stress reduction may help some men. It may be helpful to avoid alcohol, caffeine, and spicy foods such as hot peppers, chili, pickles, and salsa, especially if they make your symptoms worse.

Acute or chronic bacterial prostatitis If you have prostatitis caused by a bacterial infection (acute or chronic bacterial prostatitis), contact a health professional about your symptoms, especially if you have a fever. Antibiotics and other medications will be prescribed as needed.

However, there are some things you can do at home that may help you be more comfortable: Take nonprescription pain relievers, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or acetaminophen. Sit in a tub of warm water with the water just covering your buttocks, or try a sitz bath. Take care of yourself when you have an infection. Get plenty of rest, and drink lots of fluids. This will make you feel better and may speed your recovery. Eat plenty of high-fiber foods, such as fruit, vegetables, and whole-grain breads and cereal, and drink enough water to avoid constipation. Straining to pass a bowel movement may be very painful when your prostate is inflamed, so use a stool softener if necessary.

Chronic prostatitis/pelvic pain syndrome, inflammatory or noninflammatory Home treatment may help control symptoms and relieve pain if you have chronic prostatitis/pelvic pain syndrome, inflammatory or noninflammatory. In addition to trying the above home treatment tips for acute and chronic bacterial prostatitis: Avoid alcohol, caffeine, and spicy foods such as hot peppers, chili, pickles, and salsa, especially if they make your symptoms worse. Try stress management: deep breathing, relaxation, exercise, and elimination of stressful circumstances. Stress and anxiety may cause your symptoms to get worse. For more information, see the topic Stress Management. Ask your health professional about plant extracts, such as saw palmetto, quercetin (Prosta-Q), or bee pollen extract (Cernilton), which may provide some relief.

What if my prostatitis is not caused by infection?
Because doctors do not yet understand what causes prostatitis without infection, it can be hard to treat. Your doctor might try an antibiotic to treat a hidden infection. Other treatments are aimed at making you feel better. Nonsteroidal anti-inflammatory medicines, such as ibuprofen (two brand names: Advil, Motrin) or naproxen (one brand name: Aleve), and hot soaking baths may help you feel better. Some men get better by taking medicines that help the way the bladder or prostate gland work.

What else could be causing my symptoms?
Other conditions with symptoms similar to prostatitis Other conditions that may need to be ruled out when diagnosing prostatitis include:

A bladder infection. Urethritis, especially if caused by a sexually transmitted disease, such as chlamydia.

A kidney infection.

Prostate enlargement (benign prostatic hyperplasia [BPH] or prostate cancer).

Presence of a bladder or kidney stone.

A narrow spot in the urethra.

Inflammation or irritation of the bladder (interstitial cystitis), which is rare in men.

Complete inability to urinate (acute urinary retention).

Bladder cancer.

Can prostatitis be passed on during sex?
Sometimes prostatitis is caused by a sexually transmitted organism, such as chlamydia. However, most cases of prostatitis are caused by infections that are not sexually transmitted. These infections can't be passed on to sexual partners

What increases my risk?
Factors that can increase your risk of developing prostatitis include:
A recent urinary tract infection (UTI).
Insertion of a urinary catheter or having a cystoscopy.
Sexually transmitted diseases (STDs). Injury, such as from riding a bicycle or horse.
If you have had chronic bacterial prostatitis, you have an increased chance of developing it again.

Can i prevent prostatitis?
You may be able to prevent prostatitis.
Practice good hygiene, and keep your penis clean.
Drink enough fluids to cause regular urination.
Seek early treatment of a possible urinary tract infection.

Can prostatitis come back?
Men who have had prostatitis once are more likely to get it again. Antibiotics may not get into the prostate gland well. Small amounts of bacteria might "hide" in the prostate and not be killed by antibiotics. Once you stop taking the antibiotic, the infection can get bad again. If this happens, you might have to take antibiotics for a longer period of time to prevent another infection. Prostatitis that is not caused by infection is often chronic. If you have this kind of prostatitis, you might have to take medicine for a long time.

What Are the Long-Term Effects of Chronic Prostatitis?
Chronic prostatitis affects men differently, with varying degrees of discomfort or pain. Prostatitis is not a contagious disease. You can live your life normally and continue sexual relations without passing it on. Having prostatitis does not increase your risk of developing prostate cancer or any other prostate or kidney disease. But even if your prostatitis is cured, you should continue to have regular examinations to detect prostate cancer

Should I have my prostate gland taken out if I have prostatitis?
Prostatitis can usually be treated with medicine. Most of the time, surgery is not needed.

Does prostatitis cause cancer?
Although prostatitis can cause you discomfort, it does not cause cancer. Some doctors use a blood test called the prostate-specific antigen (PSA) to test for prostate cancer. If you have prostatitis, your PSA level might go up. This does not mean you have cancer. Your doctor will treat your prostatitis and may check your PSA level again.

Are the symptoms bothersome?
The doctor may also discuss how much the symptoms affect quality of life and well-being. The degree of bother may be checked or scored using questionnaires. This will help the doctor understand how much the urinary symptoms bother the patient, and decide the best way to manage the urinary symptoms.

What is involved in a physical examination?
As part of a physical examination, a doctor may do the following tests: Medical history Digital rectal examination (DRE) Blood and urine tests PSA test Transrectal ultrasound guided (TRUS) biopsy

A digital rectal examination (DRE) is the main part of a physical examination to check the size, shape and feel of the prostate.

Your doctor may refer you to an urologist (a doctor who specialises in the urinary tract) after an initial assessment to look at the severity of the prostate problem. The specialist will ask more detailed questions and may do further tests. Other tests may include further blood tests, special x ray testing, or tests to assess how blocked the urine flow is. These tests will help in deciding what type of treatment is best for your prostate problem.

Medical history Detailed questioning by the doctor is done to find out the extent, if any, of urination problems. Some men may have no symptoms, but present to the doctor for a general prostate check up. Even if no symptoms are present, this does not take away the possibility of a diagnosis of prostate disease.

Digital rectal examination (DRE) Digital rectal examination (DRE) is an important part of any physical examination for the assessment of the size, shape and feel of the prostate. The doctor places a gloved finger in the back passage (rectum), and presses on the abdomen to feel for any problems with the prostate gland. If prostatitis is present, the prostate may feel tender, enlarged, firm and warm. If BPH is present, the doctor may feel an enlarged prostate gland that tends to feel smooth, firm and elastic. If prostate cancer is present, the prostate gland may be abnormally large and its shape and hardness may become more uneven, and may make the doctor think it is prostate cancer.

Blood tests Blood tests may be done to look for evidence of infection in the blood or urinary tract. The diagnosis of prostatitis may be made if these tests show that an infection is present. It is also possible to test for infection from a sample of the secretions from the prostate gland. This is obtained by the doctor pressing on the prostate gland through the rectum as part of the digital rectal examination.

Other blood tests (for example, urea, creatinine, glucose) may be done to check that the kidneys are working normally.

Prostate Specific Antigen (PSA) Test A blood test to measure the level of prostate-specific antigen (PSA) in the blood is often done. PSA is a protein that is made mainly in the prostate gland. It is mostly used as a marker of prostate cancer, but because it is not cancer-specific, BPH can raise PSA levels two to three times higher than normal. However, the higher the PSA level, the greater the chance that prostate cancer is present. More information: PSA test

Transrectal ultrasound guided (TRUS) biopsy A transrectal ultrasound guided (TRUS) biopsy of the prostate gland will be done if the doctor suspects that prostate cancer is present from the results of other tests performed. To perform the biopsy an ultrasound probe is placed in the rectum and "sound" waves are used to obtain an image of the prostate. This image helps the doctor choose which area of the prostate to biopsy. A TRUS biopsy collects tissue from certain parts of the prostate gland which are then looked at under the microscope and can help to confirm the presence of prostate cancer.

A small degree of discomfort may be experienced during and after a TRUS biopsy, but this usually improves within 48 hours of the procedure. There may be some bleeding after the biopsy in the rectum, in the urine or sometimes noticed in the semen for up to two weeks. Antibiotics are usually given before the biopsy to lower the risk of infection, which, although quite rare, can be life-threatening.

If there is evidence of prostate cancer, other tests may be done to check if the cancer has spread to other parts of the body. A bone scan will look at whether the cancer has spread to the bones and a CT scan can be used to investigate any spread to other parts of the body.

What other tests may be done? To find out more about the problem, doctors sometimes do other tests. These may include:

Urine tests Urine is often tested to check for signs of infection or cancer (malignancy) in the urinary tract or kidneys. Cancer in the urinary tract or kidneys is quite rare.

Urinary Tract Ultrasound This examination checks the health of the kidneys and also helps find out how well the bladder is emptying. Using sound waves, an ultrasound takes images or pictures by painlessly moving a special instrument across the stomach. It is a safe and non-invasive procedure. No anaesthetic or cuts (incisions) are needed.

Voiding flow rate This involves voiding, or passing a full bladder of urine, into a special measuring device to test how quickly the urine is flowing. Feeling a need to strain is a symptom of BPH and the pattern of urination this produces can be a sign that an obstruction (blockage) is present. It is therefore important not to strain when passing urine in this test as this can produce misleading results.

Cystoscopy This examination is normally only needed if diagnosis is unclear or if there appears to be bleeding or repeated infection. Under anaesthetic, a thin-tube like instrument (a cystoscope) is inserted into the penis via the urethra. A small camera on the end of the tube takes an image of the bladder and urethra from the inside to check if there is any other cause for the bleeding (for example, bladder cancer).

What are urodynamics and how useful are they? Urodynamics involve a series of tests that look at problems of blockages from the outlet of the bladder (Bladder Outlet Obstruction, BOO). These tests can be invasive and do not always give accurate information or predict the outcome of treatments. However, urodynamics can be very useful to help decide the cause, and the best treatment options, for some incontinence problems in men.

Could it be cancer? The only reason that an urologist may think that cancer is present, is if there is an abnormal PSA and/or DRE result. In these cases, a biopsy may be recommended. Men with long-term prostatitis need to be aware that this condition might be linked with prostate cancer. These men should have regular prostate checks.

Is there a link between prostatitis and prostate cancer? Studies have suggested that for men with long-term prostatitis, there could be a relationship with prostate cancer. Although a definite link has not been shown, men with long-term prosatitis should have regular prostate checks.

Do pelvic floor exercises help prevent urinary problems? Men who have gone through various types of prostate surgery are often encouraged to do pelvic floor muscle exercises to help strengthen the muscles of their pelvic floor. Pelvic floor muscles support both the bladder and the bowel and stretch from one side of the pelvis to the other.

Pelvic floor muscle exercises (also known as Kegel exercises) may help to control the bladder and prevent urine leaking. It may be helpful for men to learn these exercises before surgery so that they are familiar with them. These exercises are generally recommended after prostate surgery because the muscles that control opening and closing of the bladder (urinary sphincter) can be affected during operations on the prostate. This is especially true after a radical prostatectomy.

Finding pelvic floor muscles can be done while urinating by tightening up and trying to stop urine flow. Pulling up or lifting the muscles of the rectum (back passage) can sometimes help. The correct muscles are found once urine flow is stopped. It should feel like the muscles are pulling inward and upward. To exercise pelvic floor muscles, tighten the pelvic floor muscles for up to a count of five, and then let them go and relax for ten seconds. Repeat the exercise 5 to 15 times. This exercise set should be done 3 to 5 times a day. These exercises should NOT be done while urinating as this can make the bladder keep hold of urine and increase the chance of an urinary tract infection.

How does prostate disease affect relationships? Prostate disease can have a major effect on relationships. Not only does the nature of the disease affect physical activity levels, but studies have shown that prostate disease can be a major worry for partners.

For men with incontinence associated with prostate disease, bed-wetting or frequent visits to the toilet can disrupt a partner’s sleep. Social life can also be limited by the man’s need to have easy access to toilets. The partners of men with prostate disease also report reduced sex life.

Concern about a partner’s long-term health is also a serious problem. Partners who do not have a good understanding of the problem can be worried that the disease may be cancer and potentially fatal.

What measures can help partners? Keeping partners fully informed about the disease can help them understand and cope. Having more information about prostate problems may remove their fears. Awareness of what to expect after surgery can also prepare partners, so the couple can jointly manage possible problems with erections or toileting.

What are the different types of prostatitis? There are four main types of prostatitis that fall under two groups, bacterial and nonbacterial prostatitis:

Bacterial Prostatitis Acute bacterial prostatitis is caused by bacteria and is the easiest to diagnose and effectively treat, although severe complications may develop if not treated quickly. The least common form of prostatitis, acute bacterial prostatitis can be life-threatening if the infection is left untreated. Antibiotics can treat this form of prostatitis. Chronic bacterial prostatitis is quite a common form of prostatitis, and is caused by an underlying problem in the prostate which becomes the focus for bacteria in the urinary tract. It is a common cause of frequent urinary tract infections in men. Antibiotics can be used to treat this condition.

Nonbacterial prostatitis Chronic nonbacterial prostatitis (chronic pelvic pain syndrome) is an inflamed prostate without bacteria and is the form of prostatitis least understood. Urinary tract infections are not experienced by men with this form of prostatitis. Symptoms may disappear and then reappear later on, and there is no specific treatment for it, so management is usually aimed at symptom relief such as anti-inflammatory drugs. For each individual with this form of prostatitis there may be a different treatment. Stress often aggravates this condition, and measures to reduce stress including pelvic floor physiotherapy or relaxation are often needed. Asymptomatic inflammatory prostatitis (prostatodynia) is a form of prostatitis without inflammation and without bacteria; however, the man often feels the same discomfort as experienced with more common forms of prostatitis. Diagnosis for this type of prostatitis is made when cells that fight infection are found in the man’s semen.

What are the treatments for prostatitis?
Prostatitis can be treated in a number of ways depending on the cause of the prostatitis, but it cannot always be cured. If there is an underlying cause of prostatitis, this should be treated first. Acute bacterial prostatitis can be treated with antibiotics. Symptoms of non-bacterial prostatitis can be relieved by taking warm baths. The other treatment options are:

Oral medications Some men can get relief from their symptoms using antibiotics, when used for treatment of bacterial forms of prostatitis. A type of medication called ‘alphablockers’ can be used to relax the muscles in the upper urethra which helps relieve pain. Other medications that can reduce symptoms are drugs that cause the inflammation to go down (anti-inflammatory agents), muscle relaxants, analgesics and 5alpha-reductase-inhibitors such as Finasteride. Back to top

Transurethral resection of the prostate (TURP) This procedure involves removing the prostate in small pieces through the penis. A small camera (endoscope) and device for cutting and removing tissue from the body (resectoscope) is guided through the urethra to avoid cuts and wounds on the outside of the body. About nine out of ten men report less symptoms after a TURP; however, major side-effects from this surgery such as erectile dysfunction and retrograde ejaculation can be experienced. Back to top

Prostatectomy Prostatectomy is the surgical removal of the whole prostate gland. It is not often considered for treatment of prostatitis. In the case of severe prostatitis where no other treatments have worked, this procedure may be used, albeit rarely. Back to top

Prostate massage Prostate massage can be used for chronic pelvic pain syndrome when medicines are not successful. This procedure is done under anaesthetic by a specialist (urologist). The prostate is massaged by pressure through the rectum until any infected fluids in the prostate are pushed out. This technique is not always helpful. Back to top

Pelvic floor exercises Pelvic floor muscles help control the bladder and bowel. For some men, pelvic floor muscle relaxation techniques may be helpful when prostatitis is caused by the pelvic floor muscles or bladder not working properly. Pelvic floor relaxation techniques are exercises that can be helpful for symptom relief, and can be taught by a health professional such as a physiotherapist.

Other tips for relieving the symptoms of prostatitis include cutting out caffeine, alcohol, and spicy foods from the diet. Taking hot baths, or if heat does not work, applying ice packs to the perineum can help. Avoiding constipation can be of benefit as large, hard bowel movements can press on the sore prostate and can be quite painful. Lifestyle changes such as avoiding activity that involves vibration or trauma to the perineum e.g. bike riding, tractor driving, long-distance driving can also help reduce symptoms.

What are some of the most important facts about prostatitis?

When should I call a professional?
Contact a health care professional if you develop:

Why do physicians have trouble diagnosing prostatitis?
The diagnosis of the various types of prostatitis can be very difficult and sometimes quite frustrating for the patient and his physician. The symptoms are variable and there is much overlap in symptoms between the various types of prostatitis. Once the patient has been treated with antibiotics, it can be difficult to differentiate a bacterial prostatitis from a nonbacterial prostatitis.

How will prostatitis affect a patient?
Prostatitis is an extremely frustrating disease for both the patient and his physician. It can seriously affect a patient's quality of life. The correct diagnosis of the prostatitis problem is difficult and it cannot always be cured. However, prostatitis is a treatable disease and one can usually get relief from major symptoms by following the recommended treatment.

Why are some patients not cured after they have been diagnosed with prostatitis?
Most cases of acute bacterial prostatitis respond completely to therapy. Unfortunately, the treatment for the chronic prostatitis syndrome is far from perfect. Patients with chronic bacterial prostatitis can have persistence of their infectious problem despite antibiotic use. This is because of the difficulty antibiotics having in penetrating the prostate gland to completely kill all the bacteria deep within the prostatic ducts. Repetitive or frequent prostate massages may be helpful in these cases. The patients who have had chronic bacterial prostatitis and have been cured are susceptible to recurrences and each recurrence may be more difficult to treat than the last. Many patients with chronic prostatitis/chronic pelvic pain syndrome (non-bacterial prostatitis and prostatodynia) fail therapy. The physician may employ a multi-modal approach to therapy (more than one treatment at a time). Patients may find that they have to learn to live, and cope with their symptoms while the inflammation hopefully "burns itself out."

Can prostatitis be passed on during sex?
Sometimes prostatitis is caused by a sexually transmitted organism, such as chlamydia. Most cases are caused by infections that are not sexually transmitted. These infections can't be passed on to sexual partners.

Can prostatitis come back?
Men who have had prostatitis once are more likely to get it again. Antibiotics may not get into the prostate gland well. Small amounts of bacteria might "hide" in the prostate and not be killed by the antibiotic. Once you stop taking the antibiotic, the infection can get bad again. If this happens, you might have to take antibiotics for a long time to prevent another infection. Prostatitis that is not caused by infection is often chronic. If you have this kind of prostatitis, you might have to take medicine for a long time.

Should I have my prostate gland taken out if I have prostatitis?
Prostatitis can usually be treated with medicine. Most of the time, surgery is not needed.

Does prostatitis cause cancer?
Although prostatitis can cause you trouble, it does not cause cancer. There is a blood test some doctors use for prostate cancer. It is called the prostate-specific antigen (PSA) test. If you have prostatitis, your PSA level might go up. This does not mean you have cancer. Your doctor will treat your prostatitis and may check your PSA level again



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