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.