Health and Prostate

Inflammation of the prostate gland may have bacterial or non-bacterial origins. Prostatitis is a broad term used to identify perianal and lower urinary tract symptoms in men. Prostatitis rarely occurs in males less than 30 years of age; however, it is a common problem in older males. Epidemiological data reveal that up to 50% of all males will develop an episode of prostatitis. Disorders involving inflammation of the prostate gland and its surrounding tissue may be classified into three distinct types: acute bacterial prostatitis, chronic bacterial prostatitis and nonbacterial prostatitis. Since the prostate is a privileged site (an area in which antimicrobial penetration is generally poor), the efficacy of antimicrobial agents is limited, a long duration of treatment is required, and failure rates are high (30%–40%). Furthermore, the diagnosis of prostatitis is both nebulous and controversial. As a result, the diagnosis and therapy of prostatitis remains a challenge. In this review we will discuss the pathophysiology, diagnosis and treatment of bacterial and nonbacterial prostatitis. Pathophysiology Read more [...]

Cultures. In acute cases, documentation of a significant infection of the bladder urine is all that is required for definitive diagnosis. However, a urine culture is insufficient to differentiate chronic bacterial prostatitis from non-bacterial prostatitis or prostatodynia, as specimens are usually sterile in all three disorders. Culture evidence of prostatic infection is necessary to accurately diagnose bacterial prostatitis in the chronic stage. The absolute key to diagnosis of chronic prostatitis is investigation of expressed prostatic secretion or, if this cannot be obtained, of seminal fluid. (If acute infection of the prostate gland is suspected, expressed prostatic secretions should not be obtained, as the patient could become septic.) Microscopic examination of the expressed prostatic secretion is extremely helpful. Excessive leukocytes (more than 10 per high-power field in an unspun specimen) and macrophages containing fat or oval fat bodies indicate prostatic inflammation. However, other genitourinary conditions, such as urethritis, urethral condylomata, and strictures, Read more [...]

The history and physical examination can suggest the diagnosis, but most signs and symptoms of bacterial prostatitis, non-bacterial prostatitis, and even prostatodynia are indistinguishable. The necessary diagnostic routine is difficult and time-consuming, but if it is not initiated at the first presentation (usually by the primary care physician) and if the patient is started on antibiotics for bacterial prostatitis speculatively, it becomes almost impossible to sort out a proper diagnosis and a management plan later. History and physical examination. A detailed analysis of the type and duration of symptoms, the results of prior investigations, and the response to previous treatments are critical components of the history. Physical examination should not be limited to the external genitalia and the prostate, but should be complete. Sometimes neglected aspects of patient evaluations disclose an alternate explanation for the apparent prostatic symptoms (neurologic, diabetic, malignant, etc). Patients with acute prostatitis have sudden onset of urinary frequency, urgency, nocturia, Read more [...]

Bacterial. An understanding of the etiology and pathogenesis of prostatitis is essential in the investigation and treatment of these syndromes. The bacteria causing both acute and chronic bacterial prostatitis are similar in type and incidence to those that cause simple urinary tract infections (UTIs). As in cystitis, Gram-negative bacteria are the most common, with Escherichia coli predominating. Gram-positive bacteria, such as enterococci, can also be implicated in this disease. Whether other Gram-positive bacteria, such as coagulase-negative staphylococci, streptococci, and diptheroids, are implicated is controversial. However, a number of investigators, including my own group, have found Gram-positive bacteria in significant numbers in the prostatic secretion and have further confirmed this by culturing prostatic biopsy specimens. Thus I believe that these bacteria are occasionally implicated in chronic inflammation of the prostate gland. The bacteria can enter the prostate gland by a number of routes. Although the hematogenous and lymphatic routes of bacterial spread are theoretically Read more [...]

The related syndromes of prostatitis remain a frustrating clinical entity both for clinicians, especially primary care physicians, and for their patients. The primary problem facing physicians is differentiating between bacterial and non-bacterial prostatitis. Although non-bacterial prostatitis appears to be far more common, the bacterial disease is deemed more important because it is the leading cause of relapse in urinary tract infections in men. Much of the confusion about the etiology and significance of prostatitis relates to improper diagnostic plans that lead clinicians to lump together as prostatitis diseases of variable type and sequelae. But proper therapy varies considerably for different syndromes with different underlying causes. While many prostatitis syndromes have a very similar clinical presentation, several distinct types are recognized. Inflammation of the prostate can be acute or chronic and can be bacterial or non-bacterial in origin. Patients with prostatodynia have no demonstrable prostatic inflammation, and symptoms might not be related to the prostate at Read more [...]