Articles - Prostatitis

PROSTATITIS: A Difficult Diagnosis

Jay D. Burstein, M.D.
Board-Certified Urologist
DeKalb Clinic Chartered

Prostatitis means inflammation of the prostate. This is a poorly understood condition, yet surprisingly, there are over 2 million diagnoses of prostititis reported annually in the United States. Prostatitis is one of the most common reasons men visit their physician: it is estimated that 20% of men aged 40 years and 40% of men aged 60 years have at one time experienced the symptoms of prostatitis.

Symptoms of prostatitis may include painful urination, urinary frequency and pain in the lower abdomen, back and rectal area. A recent study has documented that those with long-term symptoms often suffer a significant decrease in quality of life that may be associated with fatigue, emotional problems and functional impairment.

A new classification system developed by the National Institutes of Health is now being used to define prostatitis. This is an easier way to match patients symptoms and clinical findings and can make treatment plans more specific. The causes of prostatitis can be divided into 4 categories:

1. Acute bacterial prostatitis. Patients have fever and difficulty urinating. Acute prostatitis is associated with urinary tract infection that is caused by bacteria and is treated with antibiotics. Only about 5% of patients are diagnosed with this least common form of prostatitis.
2. Chronic bacterial prostatitis. Patients have long- term symptoms of perineal pain (area between anus and scrotum), urinary frequency and burning associated with intermittent acute urinary tract infections. Bacteria continue to be present and long courses of antibiotics are needed for treatment. This type of prostititis is also uncommon representing about 5-10% of cases.
3. Male chronic pelvic pain syndrome/chronic prostatitis. These patients have symptoms of prostatitis but laboratory tests fail to show any evidence of infection. Up to 90 % of men with prostititis fall into this category.
   • This was previously called non-bacterial prostatitis. Laboratory tests show inflammation cells, but no evidence of bacteria.
   • This used to be called prostatodynia. In this situation patients have all the signs and symptoms of prostate infection but testing shows no evidence of inflammation or bacteria.
4. Asymptomatic inflammatory prostatitis. These patients have no symptoms at all. This diagnosis is made after a patient has had biopsies of the prostate to rule out cancer. No cancer is found, but instead there is a significant presence of inflammatory cells.

Chronic pelvic pain syndrome can be difficult to treat because the cause of this disorder is unknown. Recent studies have shown that spasm of the pelvic floor muscles that support the bladder and prostate may be a cause of symptoms. Our treatment strategies emphasize patient education and empowerment. Options include medications such as alpha-blockers, muscle relaxants and anti-inflammatory agents. Other strategies include biofeedback, stress and pain management techniques, diet modification and complimentary medicine alternatives.

A certain type of bladder disorder is called interstitial cystitis. It occurs mostly in women and just like chronic pelvic pain syndrome in men (type III) there is no known cause.

Because these two conditions share the same symptoms of urinary frequency, urgency and pelvic pain, it is important for men who fail treatment of prostatitis to be tested for interstitial cystitis.

DeKalb Clinic Urology
Jay D. Burstein, M.D.
Sajit Bux, M.D.

www.jaybursteinmd.com

217 Franklin St
DeKalb, IL 60115
Tel: 815.758.8671 ext. 4600
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