January 28, 2008 -- Prostatitis, an inflammation of the prostate gland, typically causes intense pain and urinary bother. It may also cause sexual dysfunction, and even sterility. Prostatitis is alarmingly common. Half of all men, urologists estimate, will experience prostatitis at some point during their lifetimes. Some types of prostatitis are acute; others are chronic.
According to The Prostatitis Foundation, prostatitis can involve four significant symptoms: pain, urination problems, sexual dysfunction, and general health problems, such as feeling tired and depressed. Today, commonly accepted variations of the disease include nonbacterial, acute, and chronic. One recognized type is categorized as asymptomatic.
This variety of causes, symptoms, intensity and duration makes prostatitis a frustratingly amorphous condition. When prostatitis is bacterial, a prescription for a powerful antibiotic like Cipro may clear it up, though more than one course of drugs may be required. But chronic nonbacterial prostatitis may respond no better to antibiotics and urinary flow agents like Flomax and Cardura than to plain old medical concern and passage of time.
Prostatitis reduces a man's quality of life. Additonally, chronic inflammation in prostate tissues may play a role in prostate cancer development. Genetic factors may play a role in linking inflammation with prostate cancer risk.
Stress and other factors
Some evidence suggests that chronic non-bacterial prostatitis may be stress-related. Discomfort or pain plus impact on sexual activity may make primary stress worse. Anxiety and depression may set in. If so, the patient may benefit from help with stress reduction to put the condition in perspective and reduce the pain.
Today, from 5 to 10 percent of men are experiencing prostatitis at any one time, specialists calculate, making it one of the most common urologic diseases in the U.S. Research to improve diagnosis and cure rates has sped up in the last ten years since doctors and drug developers have begun focusing more on men's sexual and urinary health following introduction of the PSA (prostate specific antigen) test and the discovery of Viagra.
Unlike prostate cancer and benign prostatic hyperplasia (BPH), prostatitis often affects the lives of young men. In middle-aged and older men, prostatitis needs to be clearly identified so as to make sure the signs and symptoms don't mask a life-threatening condition.
Prostatitis acute v. chronic, bacterial v. nonbacterial
Dr. Leroy Nyberg, Jr., director of Urology Programs at the National Institutes of Health, says that by far the most common type of prostatitis is nonbacterial. Symptoms may include frequent urination and pain in the lower abdomen or lower back area. Causes may be stress and irregular sexual activity. Even though bacteria can and often do infect the prostate, Dr. Nyberg says, most men with prostatitis have a negative midstream urine culture, indicating that bacteria may not be the cause of their symptoms.
Treatments for nonbacterial prostatitis, Nyberg says, may include anti-inflammatory medications or muscle relaxants, hot baths, drinking extra fluids, learning to relax when urinating, and ejaculating frequently. "Some physicians also may recommend some changes in a patient's diet," Dr. Nyberg says. Other doctors are studying whether traditional techniques such as acupuncture have any better than placebo affect on prostatitis.
Acute bacterial prostatitis can be the result of bacteria, a virus, or a sexually transmitted disease. Symptoms may include fever and chills, low back pain, frequent and painful urination, weak stream urination, and infrequent urination. Dr. Nyberg explained that these infections often are treated with antibiotics, bed rest, stool softener, and increased fluid intake.
Chronic prostatitis (distinct from the acute variety) may be bacterial or the result of an inflammation of the prostate. Symptoms may include frequent bladder infections, frequent urination, and persistent pain in the lower abdomen or back. Currently, it is treated with medications (often antibiotics), changes in the diet, biofeedback, and nonprescription supplements, according to Dr. Nyberg.
In a randomized clinical trial sponsored by the VA, Dr. Nyberg and his colleagues found, surprisingly, that for chronic nonbacterial prostatitis involving chronic pelvic pain, a 6 weeks' treatment with either Cipro antibiotic of Flomax (tamulosin) showed no better effect than no active drug treatment. "Ciprofloxacin and tamsulosin did not substantially reduce symptoms in men with long-standing CP/CPPS who had at least moderate symptoms."
Longer than a 6 weeks' course of drug treatment might clear up stubborn nonbacterial chronic prostatitis for some patients, Dr. Nyberg concedes. In his study, "patients had long-standing, refractory CP/CPPS and received trial treatments for only 6 weeks. Patients with new diagnoses who are given longer courses of the trial treatments might respond differently." In any case, his study found that "Ciprofloxacin and tamsulosin were not effective treatments or CP/CPPS."
What to expect in the doctor's office
If you have symptoms, expect your physician to test a sample of your urine and to examine your prostate gland by means of a digital rectal examination (DRE). The DRE involves inserting a well lubricated gloved finger into the rectum to check for any abnormalities of the gland. Also the physician may massage the prostate briefly to collect a sample of prostate fluid so that it can be analyzed.
Since ejaculation and prostate manipulation can elevate PSA, it's advisable to refrain from sexual activity for a couple of days before the PSA test and to schedule the test before the rectal exam or a few days after.
Seek accurate and complete tests, not just a quick once-over and routine prescription. As noted, prostatitis, BPH and prostate cancer all can affect urinary functions and all can increase a patient's PSA level. If you are in range of the age for early onset prostate cancer, it's time in any case for a baseline PSA and follow-ups to watch effects of treatment. Another blood test for the ratio of "free" to "total" PSA can help make doubly sure that you are not dealing with prostate cancer.
A recent study finds that in some men nonbacterial prostatitis involves muscle tenderness in and beyond the prostate without signs of inflammation. Or what looks at first like a nonbacterial prostate inflammation in some cases turns out to be much more serious.
Overall, prostatitis calls for close medical attention. Inflammation is implicated in a range of liefthreatening diseases from heart disease to cancer. Cancer researchers believe chronic inflammation in prostate tissues may play a role in prostate cancer development; and according to a study from Wake Forest University, genetic factors may be linked with both inflammation and prostate cancer
More information about prostatitis can be found at the Prostatitis Foundation's web site: http://www.prostatitis.org .
Sources referenced for this article include:
Psychosocial variables affect the quality of life of men diagnosed with chronic prostatitis/chronic pelvic pain syndrome . BJU Int . 2008 Jan; 101 ( 1 ): 59-64 . Epub 2007 Oct 8. Nyberg L , Kusek J, et al. NIH-CPCRN Study Group. Department of Urology, Queen's University, Kingston, Ontario, Canada Ciprofloxacin or Tamsulosin in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome Annals of Internal Medicine, 2004 , full text free .pdf ( opens in new browser window ). Nyberg L, et al.
Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: the chronic prostatitis cohort study . Chronic Prostatitis Collaborative Research Network Study Group . Cleveland Clinic, Cleveland, Ohio, USA.
Psychometric Profiles and Hypothalamic-Pituitary-Adrenal Axis Function in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome J Urol. 2008 Jan 18 Anderson RU , Orenberg EK , Chan CA , Morey A , Flores V . Department of Urology, Stanford University School of Medicine, Stanford, California
Genetic variability in inflammation pathways and prostate cancer risk. Urol Oncol. 2007 May-Jun;25(3):250-9. Sun J, Turner A, Xu J, Grönberg H, Isaacs W.
Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: the chronic prostatitis cohort study . Chronic Prostatitis Collaborative Research Network Study Group . Cleveland Clinic, Cleveland, Ohio, USA.
Cyclooxygenase-2 Expression Correlates with Local Chronic Inflammation and Tumor Neovascularization in Human Prostate Cancer Clinical Cancer Research Vol. 11, 3250-3256, May 1, 2005
This page made and last edited by J. Strax, February 4, 2008.
Information on this website is not intended as medical advice nor to be taken as such. Consult qualified physicians specializing in the treatment of prostate cancer. Neither the editors nor the publisher accepts any responsibility for the accuracy of the information or consequences from the use or misuse of the information contained on this web site.
