To put it simply, prostatitis is inflammation of the prostate gland.
There are four main classifications of prostatitis
- Acute bacterial prostatitis - acute infection of the prostate gland, usually occurs in men aged 40 to 60 years. Caused by a bacterial infection and comes on suddenly. There is often blood in the urine and the PSA blood test result may be higher than normal.
- Chronic bacterial prostatitis - recurrent infection of the prostate, occurs in men aged 50 to 80 years. It is associated with chronic urinary infection and, commonly, calcifications in the prostate (prostatic stones). In the cases of bacterial prostatitis, the culprit usually is a bacteria known as Escherichia coli. The cause of bacterial prostatitis is not well defined, but one theory suggests a reflux of urine from the bladder into prostatic ducts. This reflux of urine may lead to prostatitis. The most common symptom is recurrent bladder infections.
- Chronic prostatitis - the most common yet least understood form. Found in men of any age, the symptoms include pain in the groin or bladder, and come and go without warning.
- Asymptomatic inflammatory prostatitis - this form of prostatitis has no symptoms, and is often found when undergoing tests for other conditions.
Symptoms of prostatitis
Each form of prostatitis has a slight variation in signs and symptoms.
Acute bacterial prostatitis
- Sudden onset of fever and chills
- Pain in lower back or rectum
- Irritative or obstructive urinary symptoms
- Prostate is warm, swollen, and tender upon examination
Chronic bacterial prostatitis
- Relapsing urinary tract infections
- Painful urination or other voiding problems
- Ejaculatory pain
- Pelvic or genital pain
- Some men may not have any symptoms
- Chronic pelvic pain (testicular, penile, lower abdominal, ejaculatory)
- Persistent inflammation of the prostate
- Absence of infectious bacteria in urine
The gold standard for diagnosing prostatitis would be to perform a biopsy of the prostate, but this is rarely done. Instead, doctors may diagnose prostatitis by examining prostatic secretions for bacteria. To do this, a "four-cup" test may be conducted. To start, the patient must have a full bladder. The doctor will clean the penis with soap and water and will then collect two cups of urine. Next, the prostate will be massaged by a digital rectal examination (DRE) to allow prostatic fluid to travel through the urethra. Two more cups of urine will be collected, and the expressed prostatic secretion (EPS) in the urine is examined for the presence of bacteria. Some physicians may not perform the "four-cup" test, and may just obtain urine before and after massaging the prostate. Sometimes EPS secretions from the urethra can be collected from the tip of the penis after massaging the prostate. After the physician collects these secretions, they can be examined under a microscope. Nonbacterial prostatitis is more difficult to diagnose. With these patients, the EPS will have evidence of inflammation, but bacteria will not be present. The lack of recurrent urinary tract infections distinguishes nonbacterial prostatitis from chronic bacterial prostatitis.