Prostatitis is any form of inflammation of the prostate gland. Because women do not have a prostate gland, it is a condition only found in men.

Prostatitis may account for up to 25 percent of all office visits by young and middle-age men for complaints involving the genital and urinary systems.

Signs and symptoms

Inflammation of the prostate leads to pain, often during voiding but also in back and rectum. Frequent urination and increased urgency may suggest a cystitis. Ejaculation may be painful, as the prostate contracts during emission of semen.

Diagnosis

If prostatitis is suspected, urinalysis may show white blood cells, red blood cells, nitrite positivity and microorganisms. This is mainly so in acute prostatitis and asymptomatic inflammatory prostatitis. In the other types, urinalysis may be unhelpful.

Prostate specific antigen levels may be elevated, although there is no malignancy. In acute prostatitis, a full blood count reveals increased white blood cells. Sepsis from prostatitis is very rare, but may occur in immunocompromised patients; high fever and malaise generally prompt blood cultures, which are often positive in sepsis.

Classification

• There are four forms of prostatitis:
• Acute prostatitis (bacterial)
• Chronic bacterial prostatitis
• Chronic prostatitis/chronic pelvic pain syndrome
• Asymptomatic inflammatory prostatitis

Acute prostatitis

Chronic bacterial prostatitisProstatitis can become chronic, as it is relatively poorly penetrated by antibiotics. The pain symptoms come to the foreground, although episodes of painful micturition may occur. If there is a cyst or abscess that maintains the infection, surgery may be necessary.

Theories behind the disease include autoimmune and neurogenic inflammation. In the latter, dysregulation of the local nervous system due to past traumatic experiences lead to inflammation that is mediated by substances released by nerve cells (such as substance P).

Therapy

Antibiotics are the first line of treatment in infectious prostatitis. Prolonged high-dosed courses are often attempted to eradicate infection in chronic prostatitis. Analgesics may be required to control the pain, and some favour physiotherapy to modify the pain response.