Chronic prostatitis is an inflammation of the prostate gland that develops gradually and continues for a prolonged period, often with subtle or vague symptoms. Men can develop prostatitis at any age, beginning in the 30s, but it is most common after age 50 to 60.
While chronic prostatitis can diminish a man’s quality of life, the ailment, by itself, is not life-threatening. Unfortunately, there are no known cures and many doctors tend to ignore or minimize the disorder. Most often, a patient will receive a prescription for an antibiotic to “manage” the disease.
However, antibiotics are not a cure but only temporary relief from an infection that may reoccur with progressively worsening symptoms over time. Increasingly, many researchers are finding that chronic prostatitis may be a preliminary stage in the development of prostate cancer.
What Is Chronic Prostatitis?
Chronic prostatitis is a disorder in which fluid accumulates or becomes congested in the male prostate gland and may become subject to bacterial infection. The most common causes are escherichia coli and proteus, enterobacter, and klebsiella bacteria.
The chronic nature of the ailment is what makes it potentially dangerous. New research suggests that persistence of this condition can lead to the prostate becoming cancerous. “The theory is that inflammation—perhaps triggered by chronic infection, in conjunction with dietary or hereditary factors—leads to the DNA damage and the gene mutations that set prostate cancer in motion," according to John Hopkins Health Alerts (January 11, 2007).
Some urologists believe that the most effective treatment for such prostatitis is to massage the prostate at regular intervals to stimulate it to discharge accumulated fluid. For example, in the book The Prostatitis Syndrome, by Bradley R. Hennenfent, President of the Prostatitis Foundation, regular prostatic drainage is recommended for long-term medical treatment of bacterial prostatitis, non-bacterial prostatitis, prostatodynia, benign prostatic hyperplasia (BPH), and possibly preventing prostate cancer.
Symptoms
Recognizing and accurately reporting prostatitis symptoms is the first step in obtaining a correct diagnosis. Here are the most common:
- History of recurrent urinary tract infections
- Low-grade or subtle symptoms may include low back pain, perineal or pelvic floor pain, testicular pain, pain and burning with urination, pain with ejaculation, pain with bowel movement
- Recurrent low-grade fever
- Decreased urinary stream
- Urinary hesitancy (delayed start of urination)
- Frequent urination
- Blood in the urine
- Incontinence
Tests
After taking a detailed history of a patient's symptoms, a urologist will conduct a number of diagnostic tests to rule out other possible conditions. Common tests include:
- Digital rectal exam (DRE) will tell the physician whether the prostate is swollen, tender, warm, and firm (suggesting an acute bacterial infection) or enlarged and either soft or firm (suggesting a chronic bacterial infection).
- Urine analysis establishes the presence of bacteria. If chronic prostatitis is suspected, another urine sample may be collected after prostate massage.
- Prostate secretion analysis, in which a sample of prostate fluid is obtained with prostate massage and will be examined for signs of infection or inflammation.
- Prostate-specific antigen (PSA) test, if elevated, can indicate an inflamed prostate or prostate cancer.
Treatment Options
As mentioned, common treatment for bacterial prostatitis is a round of antibiotics. Appropriate antibiotics include carbenicillin (Geocillin), trimethoprim/sulfamethoxazole (Bactrim ), doxycycline (Doryx), fluoroquinolones like ciprofloxacin (Cipro), and others.
The course of antibiotic therapy is generally fairly long -- frequently 4 to 8 weeks -- but may be continued much longer. Most antibiotics are not able to adequately penetrate the prostate tissue. Often, infectious organisms persist despite long periods of treatment – hence, the chronic nature of this frustrating ailment.
Common Suggestions for Prevention
To help ward off episodes of chronic prostatitis, the most common advice is to avoid substances that irritate the bladder, such as alcohol, caffeinated food and beverages, citrus juices, and hot or spicy foods. Also, by increasing the intake of fluids (64 to 128 ounces per day), it encourages frequent urination that will help flush the bacteria from the bladder.
Contributing background information for this article: John Hopkins Medical white papers 2007 and 2008, the New York Times online, and the American Cancer Society website
Other articles by Steve Vogel on prostate disease and prostate cancer.
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