How much does it cost to treat prostatitis?

A survey of people in various countries found that 2-10% of adult men experience symptoms suggestive of prostate problems during their lifetime.

Any urinary disorder is a warning bell and self-medication should be ruled out in this case.However, the problems are not always specifically related to prostatitis.

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Our articles are written with a love for evidence-based medicine.We quote reputable sources and seek opinions from reputable doctors.But remember: responsibility for your health belongs to you and your doctor.We don't write prescriptions, we make recommendations.Whether you believe our opinion or not is up to you.

How does the prostate work?

The prostate or prostate is a walnut-shaped organ located just below the bladder.Between the two halves of the “seed” passes the urethra, a tube that carries urine out of the bladder and sperm from the testicles.

The main task of the prostate glandincludes the production of a secretion that is part of the seminal fluid.Thanks to this secretion, sperm can move.The second task of the prostate is to contract, ensuring ejaculation, that is, ejaculation.

Next to the prostate are the seminal vesicles, which are connected to the vas deferens, through which sperm leave the genitals.The seminal vesicles produce the fluid portion of sperm and store prostatic secretions.

Prostate secretion is a mixture of citric acid and enzymes.This fluid liquefies the sperm, which enters the urethra from the testicular vas deferens.

Prostate problems do not always lead to erection problems

In the majority of cases, sexual dysfunction is not related to prostate problems because there is no physical connection between the prostate and the erection mechanism.

But urinary disorders, discomfort due to incomplete bladder emptying, pain or discomfort associated with inflammation lead to a person becoming anxious and embarrassed.Because of this, psychological problems arise - as a rule, they negatively affect erection.

What is prostatitis?

Prostatitis is an inflammation of the prostate gland that is associated with pathogenic bacteria or other non-infectious causes.Sometimes the inflammation also affects the seminal vesicles - this is called seminal vesiculitis.

At the same time, prostatitis does not always lead to pain and difficulty urinating, and the presence of unpleasant symptoms is not necessarily associated with inflammation of the gland.

To avoid confusion, urologists around the world use the classification proposed by the U.S. National Institute of Diabetes and Digestive and Kidney Diseases, or NIDDK.

To simplify a bit, the classification divides prostatitis into bacterial and bacterial, that is, non-bacterial related.This approach helps doctors make important decisions about whether to prescribe antibiotics and supplements.It is inappropriate to use antibiotics in all patients with suspected prostatitis because nonbacterial forms of prostatitis are more common than bacterial forms of prostatitis.Taking antibiotics unnecessarily is harmful to your health.

The NIDDK classification identifies five forms of prostatitis.

Acute bacterial prostatitis.An illness typically caused by pathogens typical of urinary tract infections: for example, E. coli, Klebsiella, and Enterobacter.

As a rule, the disease begins suddenly and is accompanied by a general deterioration in health.Temperature rises to 38-39°C, some people feel weakness, severe pain or burning in the perineum, scrotum or anus, lower abdomen and sometimes muscles.Some people experience pain when ejaculating.Sometimes with bacterial prostatitis, frequent, difficult and painful urination occurs.

Chronic bacterial prostatitis.This disease can also be caused by bacteria typical of acute prostatitis.The disease is considered chronic if symptoms last for at least three months.

Symptoms of chronic bacterial prostatitis are similar to acute prostatitis but may not be as severe or less severe.There is usually no fever or weakness, lower abdominal pain is more than sharp, but difficulty starting to urinate and completely emptying the bladder.Furthermore, unpleasant symptoms may temporarily disappear and reappear after a while.

Any man can develop acute and chronic bacterial prostatitis.But those most at risk are those with a higher risk of exposure to germs: people who have sex, especially anal sex, without using condoms, patients with urinary tract infections, and people who have recently had surgery or a prostate biopsy.

Chronic bacterial prostatitis involves inflammation.Symptoms of nonbacterial prostatitis are very similar to acute and chronic bacterial prostatitis.In this case, there are no pathogenic bacteria in the semen, prostate and urine, but the concentration of white blood cells will be high - this indicates inflammation of the prostate.

Chronic bacterial prostatitis, or chronic pelvic pain syndrome, does not involve inflammation.Symptoms are the same as acute and chronic bacterial prostatitis.At the same time, there are no pathogenic bacteria and a high concentration of leukocytes in semen, prostate and urine - this indicates that the prostate is not inflamed.

In the case of non-bacterial forms of prostatitis, it is not always possible to find the cause that led to the development of the disease.Risk groups are also difficult to identify.

Asymptomatic inflammatory prostatitis.This form of the disease does not cause discomfort.Often, inflammation is discovered incidentally when a patient is being tested for other problems, such as infertility.

How is prostatitis different from prostate adenoma?

In about 8% of men after age 40, the prostate begins to increase in size - this is called prostate adenoma or benign prostatic hyperplasia.An enlarged prostate compresses the urethra and this can cause problems with urination: the need to go to the toilet too often or urine leakage.Faced with symptoms of adenoma, some patients may assume they have prostatitis.

Although some symptoms of prostatic hyperplasia may indeed resemble prostatitis, they are not the same.Prostatitis is an inflammation of the prostate gland.And adenoma is an uncontrolled proliferation of prostate cells that is age-related and not associated with inflammation.

Adenomas can cause severe discomfort, so if you have problems urinating, it is important to consult a urologist as soon as possible.However, adenoma is still not as dangerous as prostatitis because it does not increase the risk of developing cancer.

How often is chronic bacterial prostatitis diagnosed?

According to general literature data, worldwide, acute bacterial prostatitis occurs in 5-10% of cases, and chronic bacterial prostatitis - in 6-10% of cases.Furthermore, both variants of chronic bacterial prostatitis account for 80-90% of all cases.

If we carry out a microscopic examination of the prostate, we will find some signs of inflammation in all men over 40 years old, without exception.But this has nothing to do with the diagnosis of “chronic bacterial prostatitis.”

There are many urinary diseases that can hide behind the veneer of chronic prostatitis, some of which are quite serious and require immediate treatment.Therefore, I recommend that all patients with symptoms reminiscent of prostatitis undergo a more detailed examination to clarify the diagnosis.

How is prostatitis diagnosed?

From the patient's perspective, the symptoms of bacterial and nonbacterial prostatitis are very similar.Without consultation with a urologist and special tests, it is impossible to distinguish one form of prostatitis from another and receive quality treatment.You can make an appointment with a urologist for free under your mandatory health insurance policy or make an appointment with a doctor at a private clinic. 

The primary task of a urologist when examining a patient with suspected prostatitis is to rule out other prostate diseases, such as cancer, and determine the type of disease the person has.It is very important to differentiate chronic pelvic pain syndrome from bacterial prostatitis from confirmed or suspected pathogens.Here's what your doctor should do to find it.

Ask the patient about symptoms and health.To gather more information, your doctor may suggest answering questions from a questionnaire called the Chronic Prostatitis Symptom Index.In some cases, in order not to waste time at the appointment, you should print out the questionnaire and fill it out in advance.

Conduct a physical examination.The doctor will examine the patient, paying special attention to the groin area.If there are swollen and painful lymph nodes in the groin, this increases the likelihood that there is actually an inflammatory process in the body.Typically, the exam includes a digital rectal exam, which allows the doctor to evaluate the size, shape, and condition of the prostate.This study helps find out whether the prostate is enlarged in size or not.If you feel pain when touching this gland, it is likely that the gland is inflamed.

Can you do without a digital rectal examination?

Digital rectal examination and prostate massage are not the most pleasant procedures.In acute inflammation, this can cause pain.Some patients want to avoid these procedures so much that they refuse to make an appointment with a urologist.

Digital rectal examination is a diagnostic method, but transrectal prostate massage is performed to obtain material for laboratory analysis - prostatic secretions.If the secretion cannot be obtained, the doctor may replace the analysis of prostatic secretions with an analysis of the first part of the urine or a two- and three-cup urine test.These tests can determine the approximate location of the problem area in the urinary tract.

Sometimes, instead of this test, sperm image analysis is prescribed for the same purpose.It helps to understand whether prostatitis is part of an infection of the male reproductive gland and provides information about the quality of ejaculation.In addition, counting leukocytes in semen helps distinguish between inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.

If a patient is concerned about an upcoming digital exam or prostate massage, I recommend discussing this with their healthcare provider.Perhaps analysis of prostatic secretions, which requires massage, could be replaced by urine or semen analysis.

Order blood, urine and prostate secretion tests.Diagnostic criteria include microscopic examination of prostatic secretions, general blood tests, general urinalysis with sediment microscopy, as well as microbiological examination of urine and prostatic secretions.

During microbiological research, the patient's biological material is placed on a nutrient medium and it is observed which bacteria grow on it - this allows clarifying the diagnosis.You can get tested for free at a private clinic or for free under mandatory health insurance.

Other tests and examinations — for example, total prostate-specific antigen (PSA) blood testing and transrectal prostate ultrasound (TRUS) — are usually not done if prostatitis is suspected.In some cases, TRUS of the prostate can reveal fibrosis, that is, scars or foci similar to melanoma, but such studies are not indicated for all patients, without exception.

How is prostatitis treated?

Treatment depends on the type of prostatitis.If the inflammation is caused by bacteria, your doctor will prescribe antibiotics.And if bacteria have nothing to do with it, you will need medication to help cope with the unpleasant symptoms of the disease.

Acute bacterial prostatitisthey start treatment without waiting for test results - this is called empirical antibacterial therapy.In this method, antibiotics are prescribed based on knowledge of which bacteria most commonly cause prostate infections.

As a rule, patients are prescribed antibacterial drugs that penetrate well into prostate tissue and act on the most "common" pathogens - prostatitis and genital tract infections.

People who feel more or less normal and are treated at home usually receive antibiotics.And high fever patients treated in hospitals are often prescribed more antibiotic injections.With this treatment, in most patients with acute prostatitis, fever and pain subside within the second to sixth day after starting the medication.

Once the patient's temperature returns to normal and signs of inflammation disappear, the doctor can switch the patient from injection to tablet form.The total duration of antibiotic treatment is usually about 2-4 weeks.

Sometimes prostate massage is used not only as a diagnostic method, but also as a therapeutic technique.It was once thought that this could help release excess secretions that have accumulated in the gland and thus reduce swelling.However, today most experts agree that prostate massage should be avoided for bacterial prostatitis.This is not only painful and useless, but can also worsen the course of the disease, because during massage, bacteria can penetrate into neighboring, uninfected tissues.

Chronic bacterial prostatitisare also treated with antibiotics that act on gram-negative bacteria.Fluoroquinolones are commonly used for treatment;These antibiotics are considered quite safe.But if your doctor suspects that prostatitis is caused by another microorganism, he or she may prescribe additional antibacterial drugs without waiting for test results.

With chronic prostatitis, antibiotics need to be taken longer than with acute prostatitis.On the recommendation of a urologist, they are prescribed for a course lasting 4-6 weeks.

Chronic bacterial prostatitisis not related to bacteria, so patients with this disease are prescribed antibiotics only if, in addition to prostatitis, they also have a urinary tract infection.

Because it's unclear exactly what causes bacterial prostatitis, treatment is primarily aimed at reducing pain during urination.To achieve this, doctors prescribe alpha-1 blockers - drugs that help relax the prostate muscles that are compressing the urethra.If pain persists, your doctor may prescribe nonsteroidal anti-inflammatory drugs.Dosage is selected individually for each patient.

Some patients with bacterial prostatitis benefit from cognitive behavioral therapy, which is the name given to sessions with a psychologist in which a person learns how to cope with pain without medication.However, there is no scientific evidence of the effectiveness of psychological support for bacterial prostatitis.

Studies in which researchers have attempted to demonstrate the effectiveness of other interventions, such as acupuncture, electromagnetic chair therapy, prostate massage, or transrectal heat therapy, have been poorly designed and of too short duration—often less than 12 weeks.So it's impossible to say whether all of this helps or not.

How to avoid prostatitis: prevention

The main cause of prostate discomfort is a sedentary lifestyle and lack of regular sex life.Doctors believe the best chance of avoiding prostatitis is in men who:

1. Practice safe sex regularly.
2. Regularly engage in moderate exercise.
3. Avoid hypothermia.
4. Once they turn 40, they must have annual urological examinations.

Where is it better to treat prostatitis - in a public or private clinic?

It is most important that evidence-based medical principles be followed when diagnosing and treating prostatitis.It depends only on the doctor - and it doesn't matter where he works.

Unfortunately, doctors in private clinics do not always comply with medical standards of care.This can lead to overdiagnosis and unnecessary treatment, putting patients at risk of paying too much.In a public medical institution, the likelihood of meeting all diagnostic and treatment criteria is higher.But patients should be aware that a comprehensive examination will take longer - sometimes significantly longer - than in a private clinic.

Memorize

1. Urinary tract problems in men are common but not always caused by prostatitis.To understand exactly what is happening with a person, you need to undergo a thorough examination.
2. Prostate problems rarely lead to erection difficulties.Often, with prostatitis, it weakens due to psychological problems that arise based on unpleasant symptoms.
3. Not all forms of prostatitis are caused by bacteria: 80-90% of them have nothing to do with bacteria.If a person suspected of having prostatitis is prescribed antibiotics without additional testing, this is bad.Before taking them, you should consult another doctor.
4. A person with acute or chronic prostatitis may be prescribed prostate massage to collect the gland's secretions for analysis.
5. The best way to prevent prostatitis is to have protected sex, a healthy lifestyle, and after 40 years, see a urologist regularly.