Prostatitis

How Is Prostatitis Diagnosed?

Prostatitis is a major issue for the male population. With a prevalence rate of 8.2%, it is affecting people’s quality of life.

In fact, the condition accounts for 8% of all urologist visits and over 1% of visits to general physicians. 

But, the problem is, not everyone knows how to recognize this urinary condition.

If you have no idea how the diagnostic procedure looks like, you’ve come to the right place. This is a detailed bacterial prostatitis guide on what to expect when booking a visit with your local doctor. 

What is Prostatitis – Exactly?

Prostatitis is an inflammation (swelling) of the prostate gland – a gland the size of a walnut located just under the male bladder. This gland is responsible for producing semen, a fluid that can help transport and nourish the sperm. 

While the seminal vesicle (also known as seminal or vesicular glands) secrete a fluid that partly makes up the semen, all the prostate fluids that are clinically collected are known as seminal plasma and EPS fluids (expressed-prostatic secretion). 

Prostatitis is an uncomfortable condition that can cause bladder pain and urinary problems. Those affected by prostatitis feel pain in their genital area, pelvis, or groin, as well as other symptoms that are quite similar to that of the flu. 

Although numerous reasons can result in prostatitis, it is often challenging to identify the exact cause for the urine issue.

If the prostate problem results from a bacterial infection, then patients will need adequate antibiotic treatment. Based on what’s causing bacterial prostatitis, people can experience a range of different symptoms. Some of them can appear suddenly or overtime. 

Patients may also recover quickly from the urinary infection, or they will need multiple treatments to get their bacterial prostatitis under control.  

Note: Anyone can have prostatitis. However, such prostate or urinary problems are often more prevalent among the elderly generation-particularly those over the age of 50. 

The 4 Different Types of Prostatitis

Four unique prostatitis subtypes will affect the type of treatment you receive. Some people think that this urinary infection is a clear sign of prostate cancer. But that couldn’t be more wrong.

Bacterial prostatitis doesn’t increase the odds of contracting prostate cancer. The inflammation is not a sign of prostate cancer either. Instead, it is a highly prevalent urinary problem divided into different types. Each of these prostatitis types will uniquely affect the body. 

Chronic Nonbacterial Prostatitis

90% of patients who have prostatitis have this type of chronic pelvic pain.

Also known as chronic pelvic pain syndrome, this is the most prevalent form of prostatitis. Although patients may not be infected with bacteria in the urine, they could still encounter various inflammation symptoms. 

The chronic pelvic pain syndrome symptoms include:

  • Pelvis, genital, and abdominal pain
  • Discomfort when urinating

The symptoms tend to cycle in stages from moderate to severe and vice versa. However, it’s very hard to identify the exact reason that’s causing these symptoms. 

What matters is that patients acquire proper treatment, like antibiotics, pain meds, or alpha-blockers. 

The antibiotics will calm the spread and impact of the bacteria, the pain meds will reduce the chronic pelvic pain, while the alpha-blockers will focus on relaxing the muscles around the prostate gland. 

This is a key strategy for treating chronic pelvic pain syndrome and curbing the symptoms. Overall, this particular urinary problem’s present treatment options are an efficient chronic pelvic pain management strategy. 

Chronic Bacterial Prostatitis

Around 10% of prostatitis patients suffer from an acute infection or chronic bacterial prostatitis. Chronic prostatitis is easy to recognize from the moderate to mild pelvic pain and bearable urinary tract infection. 

Based on studies, antimicrobial therapy has proved as an effective solution for 60%-80% of affected patients. But, when antibiotic treatment can’t get rid of the bacteria, that’s when patients develop chronic prostatitis. 

Chronic bacterial prostatitis symptoms include:

  • Burning urination

  • Constant need to urinate

  • Discomfort

  • Pain

This subacute infection is typically marked by pain and recurrent urinary tract infection. In most cases, chronic prostatitis is difficult to diagnose, especially because the bacteria has affected the urine. So, patients need to provide doctors with a sample of their prostatic fluid for testing. 

However, when the lower urinary tract symptoms (LUTS) are also linked to pain, as is the case with bacterial prostatitis, it can have an even bigger impact on your quality of life. More than any other LUTS published the National Institutes of Health. 

Urinary tract symptoms like bloody pee, pain, or burning during urination can be a severe problem. That’s why the treatment approach must be tailored to fit each individual. 

Asymptomatic Inflammatory Prostatitis        

Asymptomatic prostatitis can be a real problem for some patients. Because those affected experience no symptoms of typical bacterial prostatitis, like severe pelvic pain, for example, they will need to do a regular prostate biopsy. 

If the patient has a heavy inflammation in the prostate, then an analysis of their semen can help identify the root of the urinary problem. 

A prostate biopsy is a quick sample extraction process. The urologist will take 10 to 12 samples directly from the prostate’s suspicious tissue. The whole process lasts for around 10 min. After the prostate biopsy, the doctor will examine the samples under a microscope and look for any serious abnormalities. 

Affected individuals feel no sudden changes to their genitourinary tract (urogenital system). If necessary, a doctor will prescribe antimicrobial therapy to reduce the risk of infertility

Acute Bacterial Prostatitis

Acute prostatitis is an abrupt type of inflammation and bacterial infection of the prostate. Even though it’s not as common as any other type of bacterial prostatitis on this list, it is often a severe urinary problem. 

Since this urinary issue is a milder form of any other prostatitis type, no research claims patients must use any therapy. 

Acute bacterial symptoms include:

This condition can cause a prostate abscess. It may even result in acute urinary retention. The bacteria is the one that results in a prostate abscess. 

Because of the collection of pus, it becomes difficult to urinate. Therefore, people must understand how to recognize the problem. The most typical prostate abscess symptoms are trouble urinating, painful urination, urinary retention. 

With acute bacterial prostatitis, patients require immediate treatment. Since the urinary issue could also cause sepsis, the sooner the treatment, the better the outcome; if the patient doesn’t get on-time treatment, acute prostatitis could reduce their blood pressure or cause extreme confusion.

On rare occasions, acute bacterial prostatitis could prove deadly. For acute prostatitis, the typical treatment methods involve antibiotics, fluids, or pain relievers. 

How Does Prostatitis Diagnosis and Treatment Look Like? 

Before you can start with the treatment, a doctor will need to find the bacteria causing the urinary infection. They can test the urine, blood, or prostate fluid. 

For prostatitis to be diagnosed, the doctor will first rule out any urinary conditions that may also be the cause of your pain and discomfort. They will then decide which prostatitis type you are suffering from and choose the ideal treatment. 

Here is more about the process in detail. 

Step 1: Clinical Assessment

The doctor will start with a typical investigation of your current health state. You will talk about your medical history or point out any underlying symptoms or prostate gland issues. 

This is where you are supposed to mention the pelvic pain (if you are having any). After that, the doctor will do a physical exam. This includes a digital rectal examination, usually with a Transrectal prostate biopsy

Doctors insert an ultrasound probe directly into the patient’s rectum to help create images of their prostate. It can be briefly uncomfortable, but the sensations will pass.  

Other diagnosis options include:

  • Urine testing – Urine tests are the go-to choice for spotting urinalysis (infection in the urine). 

  • Prostatic massage – When a doctor needs to analyze the secretions, they may massage the prostate.

  • Blood sample – Blood can help identify any tracks of prostate infection, bladder problems, or other issues in the urinary tract. It can help identify bacterial prostatitis. That’s what makes blood tests sometimes a better option than a simple urine test.

  • X-ray – A detailed visual imagery or sonogram is necessary to determine prostatitis or any urinary tract problems. That’s why a doctor may suggest you do a CT scan. With an ultrasound image, doctors can scan the prostate or urinary tract for a possible infection.

Depending on your diagnostics results, you may receive empirical antibiotics or alpha-blockers for 4 to 6 weeks. If you feel any pain from the infection, the doctor may suggest NSAIDs with simple analgesics. 

Step 2: Follow Up 

Some patients can get rid of the prostatitis symptoms in just 4 to 6 weeks after antibiotic therapy. But, if the symptoms persist, you will need additional management strategies. The doctor will work on the cause of the problem. 

If the bacteria creates only a partial response to the treatment, you will need to get a different antibiotic dosage based on your needs. When the doctor finds the cause, they will readjust your treatment and help you get the results you need. 

But, if the bacteria don’t respond to the treatment and the symptoms persist, you will need to continue with more potent medications. 

Step 3: Controlling Persistent Symptoms

There are many reasons why antibiotics don’t work. If bacterial prostatitis is more serious than you think, the doctor will suggest a different treatment type. Take a look at the table below. Here is how the treatment looks based on your symptoms.  

  • Urinary Symptoms

  • Psychosocial Symptoms

  • Pain

  • Sexual Symptoms

Because of urinary problems, the doctor will do a complete LUTS assessment. 

The doctor will suggest a complete assessment of your mental health state.

If the pain doesn’t go away with antibiotic therapy, it could mean that the patient is dealing with neuropathic pain.

If the treatment is not working due to sexual symptoms, the doctor will suggest that you get psychosexual counseling. 

You will get referred to a specialist who will tailor the treatment to your needs. 

Mental health problems can affect the treatment of bacterial prostatitis. Sexual abuse, stress, anxiety, or trauma can reduce the efficacy of prostatitis treatment.

The patient will stop taking NSAIDs or simple analgesics and work on reducing the inflammation. In most cases, they will receive neuropathic pain treatment.

Anything from andrology services or urology specialists can help keep the condition under control.

Consider working on your mental health to increase the chances of successful prostatitis treatment.

Prostatitis and PSA

The prostate gland cells are known for producing a protein called PSA or prostate-specific antigen. When there are high levels of PSA in the system, it could indicate prostate cancer. However, that’s not always the case.

Other things could affect the PSA in the male body. For example, an infection, benign prostatic hyperplasia (gland enlargement), or ejaculation. Just looking at the PSA levels is not enough to know how well your prostate health is doing. That’s why you need to test the multiple factors around PSA that will help you figure out what kind of urinary problem you are dealing with. 

Such as:

Prostatitis and PSA go hand in hand. Since the condition can irritate, inflame, or enlarge the prostate, it can also increase the PSA levels. But, do have in mind that the PSA levels tend to rise with age. Thus, having prostatitis on top of that can drastically affect the PSA levels. 

To manage bacterial prostatitis, patients need to get their PSA levels back on track. They will receive antibiotics and anti-inflammatory treatment that can get the job done. 

Risk Factors

There are a couple of factors that can put you at risk of prostatitis. Some of them are:

  • Pelvic trauma or injury

  • AIDS or HIV

  • Old age

  • Urethra infection (the urethra is a tube responsible for carrying the urine and semen to the penis)

  • Having a tube inserted inside the urethra (typical procedure for draining the bladder)

Conclusion 

There are multiple types of prostatitis with a range of various symptoms. Although the condition can take a toll on your emotional and physical health, you can get the symptoms under control with on-time treatment and proper antibiotic therapy. Consult with your doctor to find the ideal management option for your health state. 

Sources

  1. https://prostatecanceruk.org/prostate-information/further-help/prostatitis/prostatitis-tests
  2. https://www.guidelinesinpractice.co.uk/mens-health/new-guideline-will-aid-gps-in-diagnosis-and-treatment-of-prostatitis/352551.article
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202001/
  4. https://medlineplus.gov/ency/article/000524.htm
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708243/
  6. https://www.aafp.org/afp/2010/0815/p397.html
  7. https://www.guidelinesinpractice.co.uk/mens-health/new-guideline-will-aid-gps-in-diagnosis-and-treatment-of-prostatitis/352551.article
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720443/
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481939/
  10. https://en.wikipedia.org/wiki/Seminal_vesicles

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