How much is the treatment of prostatitis?

A survey of residents of various countries showed that 2-10% of adult men experience symptoms of prostate problems during their lifetime.

Any urinary disorder is an alarm signal, and self-medication in this case should be excluded.But problems are not always related to prostatitis.

Go to the doctor

Our articles are written with a love of evidence-based medicine.We cite reputable sources and get comments from reputable doctors.But remember: the responsibility for your health lies with you and your doctor.We do not write prescriptions, we give recommendations.It's up to you whether you trust our point of view or not.

How does the prostate work?

The prostate or prostate gland is a walnut-shaped organ located just below the bladder.Between the halves of the "nut" passes the urethra, a tube that carries urine from the bladder and sperm from the testicles.

The main task of the prostateconsists of the production of a secretion that is part of the seminal fluid.Thanks to this secretion, sperm can move.The second task of the prostate is to contract, to provide ejaculation, that is, ejaculation.

Next to the prostate are the seminal vesicles, which connect with the vas deferens, where sperm leave the genitals.Seminal vesicles form the liquid part of the sperm and store prostate secretions.

Prostate secretion is a mixture of citric acid and enzymes.This fluid liquefies the sperm entering the urethra from the vas deferens of the testicles.

Prostate problems do not always cause erectile problems

In most cases, sexual dysfunction is not related to prostate problems because there is no physical connection between the prostate and the erectile mechanism.

But urinary incontinence, discomfort caused by incomplete emptying of the bladder, pain or discomfort related to inflammation cause a person to be upset and embarrassed.Because of this, psychological problems arise - as a rule, they have a negative effect on erection.

What is prostatitis?

Prostatitis is an inflammation of the prostate gland associated with pathogenic microbes or other non-infectious causes.Sometimes the inflammation also affects the seminal vesicles - this is called vesiculitis.

At the same time, inflammation of the prostate gland does not always cause pain and problems with urination, and the presence of unpleasant symptoms is not necessarily related to inflammation of the gland.

To avoid confusion, urologists around the world use the classification proposed by the American National Institute of Diabetes and Digestive and Kidney Diseases, or NIDDK.

To simplify a little, the classification divides prostatitis into bacterial and bacterial, that is, non-bacterial.This approach helps doctors make important decisions about whether to prescribe antibiotics and additional drugs.It is not appropriate to give antibiotics to all patients with suspected prostatitis, as non-microbial forms of prostatitis are more common than bacterial ones.Taking unnecessary antibiotics is bad for your health.

The NIDDK classification defines five forms of prostatitis.

Acute bacterial prostatitis.A disease most often caused by typical pathogens of urinary tract infections: for example, E. coli, Klebsiella and Enterobacter.

As a rule, the disease begins unexpectedly and is accompanied by a general deterioration of health.The temperature rises to 38-39 °C, some people feel weakness, severe pain or burning in the perineum, testicle or anus, lower abdomen and sometimes in the muscles.Some people experience pain during ejaculation.Sometimes with bacterial prostatitis there is frequent, difficult and painful urination.

Chronic bacterial prostatitis.This disease can also be caused by microbes characteristic of acute prostatitis.If the symptoms last for at least three months, the disease is considered chronic.

Symptoms of chronic bacterial prostatitis are similar to those of acute prostatitis, but may not be as severe or less severe.There is usually no fever or weakness, the pain in the lower abdomen is more painful than sharp, but it is difficult to initiate urination and empty the bladder completely.Moreover, unpleasant symptoms may disappear temporarily and reappear after a while.

Any man can get acute and chronic bacterial prostatitis.But the people most at risk are those at high risk of exposure to germs: those who have sex without a condom, especially anal sex, patients with urinary tract infections, and people who have recently had surgery or a prostate biopsy.

Chronic abacterial prostatitis associated with inflammation.Symptoms of inflammatory non-bacterial prostatitis are very similar to acute and chronic bacterial prostatitis.In this case, there are no pathogenic bacteria in sperm, prostate gland and urine, but the concentration of leukocytes will be high - this indicates inflammation of the prostate gland.

Chronic abacterial prostatitis or chronic pelvic pain syndrome not associated with inflammation.Symptoms are similar to acute and chronic bacterial prostatitis.At the same time, there is no high concentration of pathogenic bacteria and leukocytes in sperm, prostate gland and urine - this indicates that the prostate gland is not inflamed.

In the case of non-bacterial forms of prostatitis, it is not always possible to understand what causes the development of the disease.It is also difficult to identify risk groups.

Symptomatic inflammatory prostatitis.This form of the disease does not cause any concern.Often, inflammation is discovered accidentally when the patient is examined for other problems, such as infertility.

How does prostatitis differ from prostate adenoma?

About 8% of men develop an enlarged prostate after the age of 40 - this is called a prostate adenoma or benign prostatic hyperplasia.An enlarged prostate compresses the urethra, which can cause problems with urination: the urge to go to the toilet too often or leakage of urine.Some patients who experience symptoms of adenoma may think they have prostatitis.

Although some of the symptoms of prostatic hyperplasia are indeed similar to prostatitis, they are not the same.Prostatitis is an inflammation of the prostate gland.And adenoma is an age-related uncontrolled proliferation of prostate cells that is not associated with inflammation.

An adenoma can cause serious discomfort, so if you have problems with urination, it is important to see a urologist as soon as possible.However, adenoma is still not as dangerous as prostatitis, because it does not increase the risk of developing cancer.

How often is chronic bacterial prostatitis diagnosed?

According to aggregated literature data, acute bacterial prostatitis occurs in 5-10% of cases and chronic bacterial prostatitis in 6-10% of cases worldwide.Moreover, both variants of chronic abacterial prostatitis account for 80-90% of all cases of the disease.

If we conduct a mass microscopic examination of the prostate gland, we will find certain signs of inflammation in all men over 40 without exception.But this has nothing to do with the diagnosis of "chronic bacterial prostatitis".

There are many urological diseases that can be hidden behind the mask of chronic prostatitis, and some of them are quite serious and require immediate treatment.Therefore, I recommend all patients with symptoms reminiscent of prostatitis to undergo a more detailed examination that will clarify the diagnosis.

How is prostatitis diagnosed?

From the patient's point of view, the symptoms of bacterial and non-bacterial prostatitis are very similar.It is impossible to distinguish one form of prostatitis from another and get quality treatment without consulting a urologist and passing special tests.You can make an appointment with a urologist for free under your compulsory health insurance or make an appointment with a doctor in private clinics. 

The main task of a urologist who receives a patient with suspected prostatitis is to exclude other prostate diseases such as cancer and to determine what form of the disease the person has.It is very important to distinguish chronic pelvic pain syndrome from bacterial prostatitis with a confirmed or suspected pathogen.What should a doctor do to figure this out?

Ask the patient about symptoms and health.To gather more information, your doctor may suggest answering questions on a questionnaire called the Chronic Prostatitis Symptom Index.In some cases, it makes sense to print and fill out the form in advance to save time during the meeting.

Perform a physical examination.The doctor will examine the patient, paying special attention to the groin area.If there are swollen, painful lymph nodes in the groin, this actually increases the likelihood of an inflammatory process in the body.Typically, the examination includes a digital rectal examination, which allows the doctor to assess the size, shape and condition of the prostate.The study helps to understand that the prostate is not enlarged in size.If the gland is painful to the touch, it is most likely inflamed.

Is it possible to do without a digital rectal examination?

Digital rectal examination and prostate massage are not the most pleasant procedures.In acute inflammation, this can cause pain.Some patients are so eager to avoid these procedures that they refuse to see a urologist at all.

Digital rectal examination is a diagnostic method, but massage of the prostate gland through the rectum is done to obtain material for laboratory analysis - prostate secretion.If secretions cannot be obtained, the doctor may substitute the analysis of prostate secretions with either the analysis of the first part of the urine or the two- and three-glass urine test.These tests can determine roughly where the problem area is in the urinary tract.

Sometimes, instead of this examination, a spermogram analysis is prescribed for the same purpose.It helps to understand whether prostatitis is part of male reproductive gland infections and provides information about the quality of ejaculation.In addition, counting leukocytes in ejaculation allows to distinguish between inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.

If a patient is concerned about an upcoming digital exam or prostate massage, I would suggest discussing this with their healthcare provider.Perhaps the analysis of prostate secretion, which requires massage, can be replaced by urine or sperm analysis.

Assign blood, urine and prostate secretion tests.The diagnostic standard includes microscopic examination of prostate secretion, general blood test, general urine test with sediment microscopy, as well as microbiological examination of urine and prostate gland secretions.

During microbiological studies, the biological material of the patient is placed in the food medium and it is observed which bacteria grow there - this allows to clarify the diagnosis.With compulsory medical insurance, you can be examined at a private clinic for a fee or for free.

Other tests and examinations - such as a test for the concentration of total prostate-specific antigen (PSA) in the blood and a transrectal ultrasound of the prostate (TRUS) - are usually not performed when prostatitis is suspected.In some cases, TRUS of the prostate gland can reveal fibrosis, that is, foci similar to a scar or a malignant tumor, but such studies are not indicated for all patients without exception.

How is prostatitis treated?

Treatment depends on the type of prostatitis.If the inflammation is caused by bacteria, the doctor will prescribe antibiotics.And if the bacteria have nothing to do with it, you will need drugs that will help fight the unpleasant symptoms of the disease.

Acute bacterial prostatitisthey start treatment without waiting for test results - this is called empiric antibacterial therapy.In this approach, antibiotics are prescribed based on information about which microbes are most likely to cause prostate infections.

As a rule, patients are prescribed antibacterial drugs that penetrate well into prostate tissue and affect the most "famous" pathogens of prostatitis and genitourinary infections.

People who feel more or less normal and are treated at home usually take antibiotic tablets.And patients with high fever who are treated in the hospital are prescribed antibiotic injections more often.With this treatment, most patients with acute prostatitis have fever and pain relief within the second to sixth day after starting medication.

When the patient's temperature normalizes and the signs of inflammation disappear, the doctor can switch the patient from injections to tablets.The total duration of antibiotic treatment is usually about 2-4 weeks.

Sometimes prostate massage is used not only as a diagnostic method, but also as a therapeutic technique.It was once believed that it could help release excess secretions that had accumulated in the gland, thereby reducing its swelling.However, most experts today agree that prostate massage should be avoided for bacterial prostatitis.This is not only painful and useless, but also can worsen the course of the disease, because as a result of the massage, bacteria can enter the neighboring, non-infected tissues.

Chronic bacterial prostatitisit is also treated with antibiotics that affect gram-negative bacteria.Fluoroquinolones are usually used for treatment;these antibiotics are considered quite safe.But if the doctor suspects that prostatitis is caused by other microorganisms, he can prescribe additional antibacterial drugs without waiting for the test results.

With chronic prostatitis, antibiotics should be taken for a longer period of time than with acute prostatitis.According to the recommendations of urologists, they are prescribed in a course lasting 4-6 weeks.

Chronic bacterial prostatitisIt is not related to bacteria, so antibiotics are prescribed to patients with this disease only if they have a urinary tract infection in addition to prostatitis.

Since it is not clear what exactly causes abacterial prostatitis, treatment is mainly aimed at relieving pain during urination.To achieve this, doctors prescribe alpha-1 blockers - drugs that help relax the prostate muscles that compress the urethra.If the pain persists, the doctor may prescribe non-steroidal anti-inflammatory drugs.The dosage is selected individually for each patient.

Some patients with abacterial prostatitis benefit from cognitive-behavioral therapy, which is the name given to sessions with a psychologist in which a person learns to cope with pain without medication.However, there is no scientific evidence for the effectiveness of psychological help for abacterial prostatitis.

Studies in which researchers have tried to prove the effectiveness of other interventions such as acupuncture, electromagnetic chair therapy, prostate massage, or transrectal thermotherapy have been poorly designed and conducted for very short periods of time (usually less than 12 weeks).So it's impossible to tell if all of this helped.

How to prevent prostatitis: prevention

The main cause of prostate problems is a sedentary lifestyle and lack of regular sex life.Doctors believe that men have the best chance of being protected from prostatitis:

1. Practice safe sex regularly.
2. Do regular moderate exercise.
3. Avoid hypothermia.
4. After reaching the age of 40, they undergo a urological examination every year.

Where is it better to treat prostatitis - in a public or private clinic?

Most importantly, the principles of evidence-based medicine are followed in the diagnosis and treatment of prostatitis.It depends only on the doctor - and it does not matter exactly where he works.

Unfortunately, doctors in private clinics do not always follow the standards of medical care.This can lead to overdiagnosis and unnecessary treatment, putting the patient at risk of overpayment.It is more likely to meet all diagnostic and treatment standards in a public medical institution.However, patients should be aware that a complete examination will take longer - sometimes much longer than during an examination at a private clinic.

Remember

1. Urinary tract problems are common in men, but they are not always caused by prostatitis.To understand what exactly happened to a person, you need to undergo a thorough examination.
2. Prostate problems rarely cause erectile difficulties.Usually, with prostatitis, it weakens due to psychological problems arising against the background of unpleasant symptoms.
3. Not every form of prostatitis is caused by bacteria: in 80-90%, they have nothing to do with it.It is bad if a person suspected of prostatitis is prescribed antibiotics without further tests.It is wise to consult another doctor before taking them.
4. A person with acute or chronic prostatitis may be prescribed a prostate massage to collect glandular secretions for analysis.
5. The best way to prevent prostatitis is protected sex, a healthy lifestyle and regular urological examinations by a doctor after 40 years.