Prostatitis

Written by Urologist Arnon Krongrad, MD, 

An Overview of Prostatitis

 

Prostate cancer is most commonly a painless but potentially life threatening illness of aging men. Prostate enlargement is most commonly a painless but potentially debilitating illness of aging men. Prostatitis is neither prostate cancer nor prostate enlargement: It is a painful condition that in its acute form is potentially life threatening and in its chronic form is potentially debilitating. Prostatitis, the third major disease of the prostate, can occur in adult men of all ages.

Classification of Prostatitis

There are several ways to classify prostatitis. Perhaps the simplest classification is:

Pathological prostatitis: This asymptomatic form of prostatitis exists when prostate inflammation is discovered, generally as an incidental finding while managing another medical problem. Because it is not associated with symptoms, pathological prostatitis is found incidentally upon examination of prostate samples by a pathologist. For example, a bladder cancer operation removed the bladder and prostate. In such a specimen, the prostate may be found to be full of inflammatory cells (leukocytes, white blood cells). Pathological prostatitis is generally not of any interest to patients.

Clinical Prostatitis: Clinical prostatitis is of interest to patients because it is very common: General estimates are that it accounts for up to 2 million doctor visits every year. It is of interest because it can be very bothersome. This clinical forms of prostatitis are further sub-classified as: 1) acute prostatitis and 2) chronic prostatitis.

In simple terms, acute prostatitis is generally a disease of young, sexually active men. In its most common form, it is caused by bacterial infection and is associated with fever, burning on urination, bleeding on urination, chills, sweats, and malaise. If not treated appropriately with antibiotics, acute bacterial prostatitis can cause sepsis and death. As such, any man with signs and symptoms consistent with acute bacterial prostatitis should seek immediate medical care.

Chronic prostatitis, on which the rest of this article will focus, can be bacterial or non-bacterial. The former can be treated with antibiotics as clinical episodes recur. The latter is an elusive and commonly very difficult clinical problem that accounts for an estimated 90% of all cases of prostatitis and that can in some patients last for decades. It is usually characterized by a symptomatic triad that can markedly interfere with quality of life and that consists of:

  • Perineal, lower abdominal, lower back, rectal, scrotal, and leg pain
  • Pain upon ejaculation and/or urination
  • Urinary dysfunction

These direct, organ-specific prostatic symptoms may commonly be associated with:

  • Impaired thinking
  • Social isolation
  • Chronic fatigue
  • Irritable bowels
  • Depression