Chronic prostatitis usually affects men in their early 40s, and it is one of the leading reasons why men visit a urologist. According to one study, men with prostatitis have a diminished quality of life that is on par with those who have recently suffered a heart attack.
Prostatitis is a common condition in which the prostate becomes infected or inflamed, causing severe pain in the perineum -- the area between the rectum and scrotum. Prostatitis is often difficult to treat, and part of the problem is that the disease comes in several forms. Some prostatitis patients experience acute flare-ups, with sudden and continuous pain that lasts for several days. More common, however, is chronic prostatitis, which may last for several weeks, only to disappear and then start up again.
Prostatitis is further differentiated by bacterial and nonbacterial causes. Nearly 95% of patients are thought to develop prostatitis from nonbacterial causes, which have yet to be identified. In addition, some men have signs of inflammation, such as white blood cells in their semen, but none of the painful symptoms of prostatitis. A related condition, called prostatodynia, causes the same symptoms as prostatitis, but with no signs of infection or inflammation on laboratory tests.
While the causes of bacterial prostatitis are obvious and easy to detect, researchers are unsure why men develop the more prevalent, nonbacterial form. Some men find that stress, emotional problems, or even coffee may trigger flare-ups. Other possible culprits include zinc deficiency, tight urinary sphincter muscles, infrequent ejaculation, and dehydration.
Some experts suggest that nonbacterial prostatatis is not really a prostate problem at all. Rather, flare-ups could be the result of a pelvic muscle spasm or some other cause that mimics symptoms originating in the prostate.
Another theory under investigation is that prostatitis is caused by an autoimmune disorder, in which the immune system mistakenly attacks healthy prostate tissue and promotes inflammation -- not unlike the way rheumatoid arthritis targets the joints. Indeed, researchers recently found that men with chronic prostatitis had increased levels of the same pro-inflammatory molecules that are elevated in the joint tissue of people with rheumatoid arthritis.
What to do. Treatment is fairly straightforward for bacterial prostatitis. A patient is given antibiotics for a period of 4 to 16 weeks. Appropriate antibiotics include carbenicillin (Geocillin), trimethoprim/sulfamethoxazole (Bactrim ), doxycycline (Doryx), fluoroquinolones like ciprofloxacin (Cipro), and others.
Treatment of nonbacterial prostatitis is more difficult, and no one treatment has been proven to improve symptoms for most men. It may take some trial and error to find a combination of therapies and self-care techniques to obtain symptom relief.
While antibiotics typically are reserved only for bacterial diseases, many patients with nonbacterial prostatitis receive antibiotics and a prostate massage, followed by high doses of alpha-blocker drugs (typically used for BPH). Emerging evidence suggests that exercise may improve symptoms.
