Prostatitis

Prostatitis is a condition which troubles a large number of men. It isn’t dangerous or serious, but the symptoms can be disabling and a major problem to the sufferer. Unfortunately it is a condition which is relatively poorly understood, and often difficult to treat.

What is prostatitis?

It literally means “inflammation of the prostate” – just as tonsillitis is inflammation of the tonsils and appendicitis is inflammation of the appendix. The prostate is a gland which is situated at the base of the bladder in men. Its job is to produce fluid which is released at the time of ejaculation. The commonest disorders of the prostate are benign prostatic hyperplasia (BPH) and prostate cancer. Prostatitis is not linked to these conditions, and can’t cause prostate cancer.

Acute prostatitis is an illness with symptoms very similar to urinary tract infection, often associated with flu-like symptoms and a high temperature. It comes on quickly and is treated with antibiotics. It is relatively uncommon.

Chronic prostatitis, on the other hand, tends to develop slowly. The symptoms are variable and because of this the disease may be difficult to diagnose. Because the symptoms are so variable the disease has been renamed by some people as “chronic pelvic pain syndrome”.

What are the symptoms of chronic prostatitis?

Most men suffering from prostatitis complain of pain. This is sometimes severe, but may be a nagging persistent ache. The pain is often in the perineum (the area between the testicles and anus) but may be in the penis, testicles, upper thighs, bladder area or low back. The pain varies in intensity – this is one of the hallmarks of the disease. It may be worst after or during sexual activity – particularly immediately after ejaculation, or whilst passing urine.

Many men also complain of urinary problems. These may be similar to the symptoms of infection with some burning or stinging; or similar to the symptoms of BPH with difficulty passing urine, frequency and urgency.

Some men complain of passing blood with their sperm when they ejaculate.

The symptoms of prostatitis tend to come and go, often with no particular pattern. No two cases are identical, which makes the diagnosis difficult.

What causes prostatitis?

In many cases we don’t know. There may be an associated urinary infection, and this is usually the case in acute prostatitis. In chronic prostatitis it may be possible to find evidence of a urinary infection but this isn’t usually the case. However many people think that prostatitis is caused by an infection deep within the prostate, where it is difficult to diagnose. Some specialists recommend taking specimens of semen or of prostate secretions which can be obtained by massaging the prostate at rectal examination, but in practical terms these specimens are rarely helpful. In the past people have divided prostatitis into “bacterial” (i.e. with evidence of infection) and “abacterial” (without evidence of infection) but these distinctions don’t usually make a great deal of difference to the management of the problem.

Is prostatitis serious?

Prostatitis is not a serious condition, it is not linked in any way to prostate cancer or any other serious disease. The only problem is the symptoms which can be a major problem to patients.

Are any tests needed to confirm the diagnosis?

There are no tests which prove that someone has prostatitis. A urine specimen is usually checked to make sure there is no obvious infection. As the symptoms are sometimes so vague and varied, tests are usually performed to exclude any other condition which has similar symptoms. The tests which may be requested include an ultrasound scan, a urinary flow rate, flexible cystoscopy and PSA blood test. Occasionally tests such as a CT or MRI scan are performed.

What is the treatment?

Treatment can be difficult. It is usual to start treatment with a course of antibiotics in case the condition is infective in origin. A long (at least 4 week) course of antibiotics is needed, and some antibiotics are better than others as they get into the prostate gland in higher concentrations. Ciprofloxacin, Ofloxacin, Doxycycline and Trimethoprim are the commonest antibiotics used.

If antibiotics fail to help there are a number of other things which can be tried. Anti-inflammatory drugs such as ibuprofen and diclofenac sometimes help. The drug allopurinol, which is more often used for gout, is sometimes of benefit for reasons which are not completely clear. Alpha-blocker drugs, such as Tamsulosin, may help particularly if there are associated urinary problems.

Are herbal and other treatments of any use?

There are a lot of herbal preparations and similar treatments which have are sometimes advertised for the treatment of prostatitis, particularly on the internet. In general terms the results of these are disappointing.

Often when an internet search brings about lots of different treatments for a condition it means that none of them work particularly well. If one of them was a good treatment, it would be used all the time and there wouldn’t be any need for the others. Some men do resort to alternative treatments for their symptoms, but if you are considering doing this it would be sensible to try and get some accurate scientific information about the reliability and success rate of the treatment before making an investment!

What about GreenLight laser surgery or removing the prostate gland?

Whilst it might seem logical to perform surgery on the prostate to reduce the symptoms of prostatitis, it isn’t usually recommended. The GreenLight laser operation, which reduces the size of the prostate, still leaves some of the gland behind and experience tells us that men who have this operation for prostatitis still continue to have symptoms, sometimes worse than before. Radical prostatectomy, or complete removal of the prostate, is too major an operation with too great a risk of side effects to make it appropriate for men with prostatitis.

The only exceptions to this are men who have significant symptoms of BPH along with those of prostatitis, when a GreenLight laser operation might be helpful. Your urologist can discuss this with you if necessary.

What if none of the above treatments works?

If no treatment seems to work, which is occasionally the case, prostatitis can be a difficult condition to manage. However most if not all cases eventually “burn themselves out”. Symptoms can continue for a long time, sometimes years, but almost always improve spontaneously eventually. It symptoms do become a long term problem it is important to remember that prostatitis is not a serious or life threatening condition.