Prostatitis is inflammation of the prostate gland, usually affecting men aged between 30 and 50. It is often caused by a bacterial infection that has spread from the urethra. The presence of a urinary catheter increases the risk of prostatitis. The main symptoms of prostatitis are fever, flu-like symptoms, and pain in the lower back. There may also be pain around the rectum, which is particularly troublesome on passing faeces. Diagnosis is made by rectal examination (the prostate gland is very tender to digital pressure) and tests on urine samples. Treatment is with antibiotic drugs such as ciprofloxacin or doxycycline. The condition may be slow to clear up and tends to recur.

Prostatitis in more detail - technical

Prostatitis is one of the more common inflammatory conditions encountered in urological practice. Accurate data on its incidence and prevalence are not available, but recent statistics from the United States indicate that there were more physician visits for prostatitis than for benign prostatic hyperplasia or prostate cancer. Prostatitis may be due to acute or chronic bacterial infection; it can also occur in the absence of bacterial growth, and it has been suggested that 'chronic pelvic pain syndrome' would be a more appropriate term in patients without demonstrable infection.

Demonstration of bacteria in the post-prostatic massage of urine or in expressed prostatic secretions, when the midstream urine shows no growth, is highly diagnostic of bacterial prostatitis. Escherichia coli or Klebsiella and Proteus spp. often cause bacterial prostatitis; pseudomonads and enterococci are less common. Prostatitis is seen in men of all ages, and typically is associated with pain in the perineum and suprapubic areas associated with frequency and urgency of micturition. Abdominal examination is normally unremarkable but the characteristic feature is a very tender prostate on rectal examination. Occasionally, a fluctuant abscess may be palpable within the gland.

Clinical features and treatment

Acute bacterial prostatitis often produces generalized malaise and fever associated with symptoms localized to the prostate and acute cystitis. It responds dramatically to antimicrobial drugs. Sometimes it is necessary to treat the patient in hospital and prolonged oral antibiotic therapy of at least 30 days is recommended to prevent the development of chronic bacterial prostatitis.

Chronic bacterial prostatitis is one of the most common causes of relapsing infection of the urinary tract in men and in the past has been difficult to treat, although the newer fluoroquinolone antibiotics have been shown to be safe and effective in this condition.

Non-bacterial prostatitis is more common than bacterial prostatitis. The cause is unknown and the treatment often empirical and of variable effectiveness; Chlamydia trichomatis remains a possible aetiological agent, although the evidence is far from definite. A trial of tetracycline or one of its derivatives, together with a-adrenergic-blocking agents, is sometimes of help, especially in patients with perineal pain from the prostate, as the prostate is rich in a-adrenergic receptors and symptoms may be relieved by these drugs. A significant number of patients with prostatitis have an underlying anxiety about carcinoma, and reassurance, where appropriate, plays an important part in management.