How much does it cost to cure prostatitis?

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

Any urinary tract disorder is an alarm signal and self-medication should be excluded in this case.However, problems are not always specifically associated with prostatitis.

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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” runs the urethra, a tube through which urine is removed from the bladder and sperm from the testicles.

Key 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 and thus ensure ejaculation.

Next to the prostate are the seminal vesicles, which are connected to the vas deferens through which sperm leave the genitals.The seminal vesicles produce the liquid part of the sperm and store prostatic secretions.

Prostatic secretion is a mixture of citric acid and enzymes.This fluid liquefies the sperm that pass from the vas deferens of the testicles into the urethra.

Prostate problems do not always lead to erection problems

In the vast majority of cases, sexual dysfunction is not associated with prostate problems because there is no physical connection between the prostate and the erection mechanism.

But disturbances in urination, discomfort caused by incomplete emptying of the bladder, pain or discomfort associated with inflammation cause a person to become nervous and embarrassed.This causes psychological problems that usually have a negative impact on erections.

How does prostatitis progress?

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 then referred to as vesiculitis.

At the same time, inflammation of the prostate does not always lead to pain and problems with urination, and the presence of unpleasant symptoms is not necessarily associated with 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 (NIDDK).

To simplify it a little, the classification divides prostatitis into bacterial and non-bacterial prostatitis.This approach helps doctors make important decisions about whether to prescribe antibiotics and additional medications.It is incorrect to give antibiotics to all patients with suspected prostatitis, since non-microbial forms of prostatitis are more common than bacterial ones.Taking unnecessary antibiotics is harmful to your health.

The NIDDK classification identifies 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 in health.The temperature rises to 38-39°C, with some people experiencing weakness, severe pain or burning in the perineum, scrotum or anus, lower abdomen and sometimes muscles.Some people experience pain during ejaculation.Sometimes bacterial prostatitis causes frequent, difficult and painful urination.

Chronic bacterial prostatitis.This disease can also be caused by microbes typical of acute prostatitis.The disease is considered chronic if symptoms last at least three months.

Symptoms of chronic bacterial prostatitis are similar to those of acute prostatitis, but may not be as severe or may be less severe.Usually there is no fever or weakness, the pain in the lower abdomen is more aching than stabbing, but it is difficult to start urinating and completely empty the bladder.In addition, unpleasant symptoms may temporarily disappear and reappear after a while.

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

Chronic abacterial prostatitis, which is accompanied by inflammation.The symptoms of inflammatory nonbacterial prostatitis are very similar to those of acute and chronic bacterial prostatitis.In this case, there are no pathogenic bacteria in the semen, prostate and urine, but the concentration of leukocytes is high - this indicates inflammation of the prostate.

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

In nonbacterial forms of prostatitis, it is not always possible to find out what cause led to the development of the disease.Risk groups are also difficult to determine.

Asymptomatic inflammatory prostatitis.This form of the disease does not cause any symptoms.Most often, inflammation is discovered incidentally when the patient is being examined for other problems such as infertility.

How does prostatitis differ from prostate adenoma?

In about 8% of men, the prostate begins to enlarge after the age of 40 - this is known as prostatic adenoma or benign prostatic hyperplasia.The enlarged prostate compresses the urethra, which can lead to problems with urination: too frequent trips to the toilet or loss of urine.Given the symptoms of an adenoma, some patients may assume that they have prostatitis.

While some symptoms of prostatic hyperplasia may actually resemble prostatitis, they are not the same thing.Prostatitis is an inflammation of the prostate.And an adenoma is an age-related uncontrolled proliferation of prostate cells that is not accompanied by inflammation.

An adenoma can cause serious symptoms.Therefore, if you have problems urinating, 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 cancer.

How often is chronic bacterial prostatitis diagnosed?

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

If we carry out a large-scale microscopic examination of the prostate, we will notice certain signs of inflammation in all men over 40 years old, without exception.However, this has nothing to do with the diagnosis of “chronic bacterial prostatitis”.

There are many urological diseases that can hide behind the mask of chronic prostatitis.Some of these are very serious and require immediate treatment.Therefore, I recommend that all patients with symptoms reminiscent of prostatitis undergo a more detailed examination that will clarify the diagnosis.

How is prostatitis diagnosed?

From the patient's perspective, the symptoms of bacterial and nonbacterial prostatitis are very similar.Without consulting a urologist and special tests, it is impossible to distinguish one form of prostatitis from another and receive high-quality treatment.You can make a free appointment with a urologist as part of your statutory health insurance or make an appointment with a doctor in a private clinic. 

The main task of a urologist treating a patient with suspected prostatitis is to rule out other prostate diseases, such as cancer, and determine what form of the disease the patient has.It is very important to differentiate chronic pelvic pain syndrome from bacterial prostatitis with a confirmed or suspected pathogen.Here's what a doctor should do to find out.

Ask the patient about symptoms and health status.To gather more information, your doctor may suggest answering questions from a questionnaire called the Chronic Prostatitis Symptom Index.In order not to waste time during the appointment, in some cases it makes sense to print out the questionnaire and fill it out in advance.

Conduct a physical examination.The doctor will examine the patient, paying particular attention to the groin area.If there are swollen, painful lymph nodes in the groin, the likelihood that there is actually an inflammatory process in the body increases.Typically, the exam includes a digital rectal exam, which allows the doctor to assess the size, shape and condition of the prostate.The study helps to understand whether the prostate is enlarged.If touching the gland is painful, it is most likely inflamed.

Can a digital rectal examination be dispensed with?

Digital rectal examination and prostate massage are not the most pleasant procedures.In the case of acute inflammation, this can lead to pain.Some patients are so interested in avoiding these procedures that they refuse an appointment with a urologist altogether.

Digital rectal examination is a diagnostic method, but massage of the prostate through the rectum is performed to obtain material for laboratory analysis - prostatic secretion.If the secretion cannot be obtained, the doctor may replace the analysis of the prostate secretion with an analysis of the first portion of urine or a two- and three-glass urine test.These tests can be used to roughly determine 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 an infection of the male genital glands and provides information about the quality of the ejaculate.In addition, counting leukocytes in the ejaculate allows differentiation 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 doctor.It is possible that the analysis of prostatic secretions, which requires massage, can be replaced by a urine or semen analysis.

Prescribe blood, urine and prostate secretion tests.The diagnostic standard includes a microscopic examination of the prostate secretion, a general blood test, a general urine test with sediment microscopy and a microbiological examination of the urine and prostate secretion.

During microbiological examinations, the patient's biological material is placed on a culture medium and the bacteria that grow on it are observed - this way the diagnosis can be clarified.You can be tested in a private clinic for a fee or free of charge as part of statutory health insurance.

Other tests and examinations - for example, a test for the concentration of total prostate-specific antigen (PSA) in the blood and a transrectal ultrasound scan of the prostate (TRUS) - are usually not performed if prostatitis is suspected.In some cases, TRUS of the prostate can reveal fibrosis, i.e. a scar, or foci similar to a malignant tumor, although such examinations 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 bacteria have nothing to do with it, you need medications that will help cope with the unpleasant symptoms of the disease.

Acute bacterial prostatitisYou start treatment without waiting for test results - this is called empirical antibacterial therapy.In this approach, antibiotics are prescribed based on knowledge of which microbes most commonly cause prostate infections.

As a rule, patients are prescribed antibacterial drugs that penetrate well into the prostate tissue and are effective against the “most popular” pathogens of prostatitis and genitourinary infections.

Anyone who feels more or less normal and is treated at home usually receives antibiotic tablets.And patients with high fever who are hospitalized are more likely to be prescribed antibiotic injections.With this treatment, most patients with acute prostatitis experience resolution of fever and pain within the second to sixth day of starting medication.

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

Sometimes prostate massage is used not only as a diagnostic method, but also as a therapeutic technique.It was previously thought that this could help loosen excess secretion that had accumulated in the gland, thereby reducing its swelling.However, today most experts agree that prostate massage should be avoided if you have bacterial prostatitis.This is not only painful and useless, but can also worsen the course of the disease, as the massage can introduce bacteria into neighboring, uninfected tissues.

Chronic bacterial prostatitisalso treated with antibiotics that work against gram-negative bacteria.Fluoroquinolones are commonly used for treatment;These antibiotics are considered quite safe.However, if the doctor suspects that prostatitis is caused by other microorganisms, he may prescribe additional antibacterial drugs without waiting for test results.

With chronic prostatitis, antibiotics have to be taken longer than with acute prostatitis.According to the recommendations of urologists, they are prescribed in a 4-6 week course.

Chronic abacterial prostatitisis not associated with bacteria, therefore, patients with this disease are prescribed antibiotics only if they have a urinary tract infection in addition to prostatitis.

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

Some patients with nonbacterial prostatitis benefit from cognitive behavioral therapy.These are sessions with a psychologist in which a person learns to deal with pain without medication.However, there is no scientific evidence of the effectiveness of psychological help for nonbacterial prostatitis.

Studies in which researchers have tried to demonstrate the effectiveness of other interventions such as acupuncture, electromagnetic chair therapy, prostate massage or transrectal thermotherapy have been poorly designed and of too short duration - usually less than 12 weeks.So it's impossible to say whether all this helps or not.

How to avoid prostatitis: prevention

The main cause of prostate problems is a sedentary lifestyle and lack of regular sex life.Doctors believe that the highest chances of preventing prostatitis are in men who:

1. Practice safe sex regularly.
2. Get regular moderate exercise.
3. Avoid hypothermia.
4. From the age of 40 onwards, they undergo an annual urological examination.

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

The most important thing is that the principles of evidence-based medicine are followed when diagnosing and treating prostatitis.It only depends on the doctor - and it doesn't matter where exactly he works.

Unfortunately, doctors in private clinics do not always adhere to the standards of medical care.This can lead to overdiagnosis and unnecessary treatments, putting the patient at risk of overpaying.In a public medical facility, the likelihood of meeting all diagnostic and treatment standards is higher.However, patients must expect that a complete examination will take longer - sometimes significantly longer than an examination in a private clinic.

Remember that

1. Urinary tract problems are common in men, but they are not always due to prostatitis.To understand what exactly is happening to a person, you need to undergo a thorough examination.
2. Prostate problems rarely lead to erection difficulties.Usually prostatitis weakens due to psychological problems that arise 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 at all.If a person with suspected prostatitis is prescribed antibiotics without additional tests, this is bad.Before taking it, it is advisable to consult another doctor.
4. A person with acute or chronic prostatitis may be prescribed prostate massage to collect glandular secretions for analysis.
5. The best prevention of prostatitis is protected sex, a healthy lifestyle and regular urological examinations with a doctor after 40 years.