How much does it cost to cure prostatitis?

A survey of residents of several countries showed that 2 to 10% of adult men experience symptoms suggesting prostate problems during their lifetime.

Any urinary disorder is an alarm signal and self-medication in this case should be excluded.However, problems are not always associated specifically with prostatitis.

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Our articles are written with a love for evidence-based medicine.We cite reputable sources and seek comments from reputable doctors.But remember: the responsibility for your health lies with you and your doctor.We do not prescribe recipes, we give recommendations.Whether you trust our point of view or not is up to you.

How does the prostate work?

The prostate gland, or prostate gland, is a walnut-shaped organ located just below the bladder.Between the halves of the “nut” passes the urethra, a tube through which urine is removed from the bladder and sperm from the testicles.

Main task of the prostateconsists of producing a secretion that is part of the seminal fluid.Thanks to this secretion, sperm are able to 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 exit the genitals.Seminal vesicles produce the liquid part of sperm and store prostate secretions.

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

Prostate problems don't always lead to erection problems

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

But the disturbance while urinating, the discomfort caused by incomplete emptying of the bladder, the pain or discomfort associated with inflammation make the person nervous and embarrassed.Because of this, psychological problems arise - as a rule, they negatively affect the erection.

What does prostatitis look like?

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

At the same time, prostate inflammation does not always cause pain and problems with urination, 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 American National Institute of Diabetes and Digestive and Kidney Diseases, or NIDDK.

To simplify a little, the classification divides prostatitis into bacterial and abacterial, that is, not associated with bacteria.This approach helps doctors make the important decision to prescribe antibiotics and additional medications.It is incorrect to administer antibiotics to all patients with suspected prostatitis because nonmicrobial forms of prostatitis are more common than bacterial forms.Taking unnecessary antibiotics is harmful to your health.

The NIDDK classification identifies five forms of prostatitis.

Acute bacterial prostatitis.Disease that is most often caused by pathogens typical of urinary tract infections: for example, E. coli, Klebsiella and Enterobacter.

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

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

The symptoms of chronic bacterial prostatitis resemble those of acute prostatitis, but may not be as severe or less severe.There is usually no fever or weakness, the pain in the lower abdomen is more aching than sharp, but it is difficult to start urinating and completely empty the bladder.Furthermore, unpleasant symptoms may temporarily disappear and reappear after some time.

Any man can contract acute and chronic bacterial prostatitis.But the people most at risk are those who are most at risk for exposure to germs: those who have sex, especially anal sex, without a condom, patients with a urinary tract infection, and people who have recently had prostate surgery or biopsy.

Chronic bacterial prostatitis associated with inflammation.The symptoms of nonbacterial inflammatory prostatitis are very similar to those of acute and chronic bacterial prostatitis.In this case, there are no pathogenic bacteria in the semen, prostate and urine, but the concentration of leukocytes will be high - this indicates inflammation of the prostate gland.

Chronic bacterial prostatitis, or chronic pelvic pain syndrome, not associated with inflammation.Symptoms also resemble acute and chronic bacterial prostatitis.At the same time, there are no pathogenic bacteria and a high concentration of leukocytes in the 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 know the cause that leads to the development of the disease.Risk groups are also difficult to determine.

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

How does prostatitis differ from prostate adenoma?

In about 8% of men after the age of 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 when urinating: a very frequent urge to go to the bathroom or loss of urine.Given the symptoms of an adenoma, some patients may assume they have prostatitis.

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

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

How often is chronic bacterial prostatitis diagnosed?

According to widespread literature data, throughout the world, 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 represent 80-90% of all cases of the disease.

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

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

How is prostatitis diagnosed?

From the patient's point of view, the symptoms of bacterial and non-bacterial prostatitis are very similar.Without consultation with a urologist and special examinations, it is impossible to distinguish one form of prostatitis from another and receive quality treatment.You can make an appointment with a urologist free of charge under your compulsory medical insurance policy or make an appointment with a doctor in a private clinic. 

The main task of a urologist caring for a patient with suspected prostatitis is to rule out other prostate diseases, such as cancer, and to determine which form of the disease the person has.It is very important to distinguish chronic pelvic pain syndrome from bacterial prostatitis with a confirmed or suspected pathogen.Here's what a doctor should do to figure it out.

Ask the patient about symptoms and health.For more information, your doctor may suggest answering questions on a questionnaire called the Chronic Prostatitis Symptom Index.In some cases, in order not to waste time during the consultation, it makes sense to print the questionnaire and fill it out in advance.

Get a physical exam.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 examination, which allows the doctor to assess the size, shape, and condition of the prostate.The study helps to understand whether the prostate is enlarged.If touching the gland is painful, it is probably inflamed.

Is it possible to do without a digital rectal exam?

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

Digital rectal examination is a diagnostic method, but prostate massage through the rectum is done to obtain material for laboratory analysis - prostate secretion.If the secretion cannot be obtained, the doctor may replace the prostate secretion analysis with an analysis of the first portion of urine or a two- and three-cup urine test.These tests can determine approximately where the problem area is in the urinary tract.

Sometimes, instead of this examination, a spermogram analysis is prescribed for the same purpose.It helps to understand whether prostatitis is part of male reproductive gland infections and provides information about ejaculate quality.Furthermore, the leukocyte count in the ejaculate makes it possible to differentiate 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 suggest discussing this with their doctor.Perhaps the analysis of prostate secretions, which requires massage, can be replaced by an analysis of urine or semen.

Prescribe blood, urine and prostate secretion tests.The diagnostic standard includes a microscopic examination of prostate secretion, a general blood test, a general urine test with sediment microscopy, as well as a microbiological examination of urine and prostate secretion.

During microbiological studies, the patient's biological material is placed in a nutrient medium and it is observed which bacteria grow in it - this makes it possible to clarify the diagnosis.You can get tested in a private clinic for money or free of charge in accordance with compulsory medical insurance.

Other tests and examinations - for example, a test for the concentration of total prostate-specific antigen (PSA) in the blood and transrectal prostate ultrasound (TRUS) - are usually not performed if prostatitis is suspected.In some cases, TRUS of the prostate may reveal fibrosis, that is, scarring or foci similar to a malignant tumor, 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 medications that will help cope with the unpleasant symptoms of the disease.

Acute bacterial prostatitisthey begin treatment without waiting for test results - this is called empirical antibacterial therapy.In this approach, antibiotics are prescribed based on knowledge of which microbes most often cause prostate infection.

As a rule, patients are prescribed antibacterial drugs that penetrate well into the prostate tissue and act on the most “popular” pathogens of prostatitis and genitourinary infections.

Those people who feel more or less normal and are treated at home are usually given antibiotic tablets.And patients with high fevers treated in hospital are more often given antibiotic injections.With this treatment, in most patients with acute prostatitis, fever and pain decrease from the second to the sixth day after starting the medication.

When the patient's temperature returns to normal and signs of inflammation disappear, the doctor can switch the patient from injections to pills.The total duration of antibiotic treatment is usually 2 to 4 weeks.

Sometimes prostate massage is used not only as a diagnostic method, but also as a therapeutic technique.It was previously thought that this could help release excess secretions built up in the gland and thus reduce its swelling.However, today most experts have reached a consensus that prostate massage should be avoided in the case of bacterial prostatitis.This is not only painful and useless, but can also worsen the course of the disease, because as a result of the massage, bacteria can enter neighboring uninfected tissues.

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

In chronic prostatitis, antibiotics need to be taken longer than in acute prostatitis.According to the recommendations of urologists, they are prescribed in a course lasting 4 to 6 weeks.

Chronic bacterial prostatitisit is not associated with bacteria, therefore, patients with this disease are prescribed antibiotics only if, in addition to prostatitis, they have a urinary tract infection.

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

Some patients with abacterial prostatitis benefit from cognitive behavioral therapy, the name given to sessions with a psychologist during which the person learns to deal with pain without medication.However, there is no scientific evidence of the effectiveness of psychological assistance for abacterial prostatitis.

Studies in which researchers have attempted to prove the effectiveness of other interventions, such as acupuncture, electromagnetic chair therapy, prostate massage or transrectal thermotherapy, have been poorly designed and too short in duration – generally less than 12 weeks.Therefore, it is impossible to say whether all 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 that the greatest chances of avoiding prostatitis are in men who:

1. Practice safe sex regularly.
2. Practice moderate exercise regularly.
3. Avoid hypothermia.
4. When they turn 40, they undergo an annual urological examination.

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

The most important thing is that the principles of evidence-based medicine are followed in the diagnosis and treatment of prostatitis.It just depends on the doctor - and it doesn't matter exactly where he works.

Unfortunately, doctors in private clinics do not always meet the standards of medical care.This can lead to overdiagnosis and unnecessary treatments, leaving the patient at risk of overpaying.In a public medical organization, the probability of meeting all diagnostic and treatment standards is greater.But patients need to take into account that a complete examination will take more time - sometimes significantly longer than during an examination in a private clinic.

Remember

1. Problems with the urinary tract in men are common, but are not always caused by prostatitis.To understand exactly what is happening to a person, you need to undergo a thorough examination.
2. Prostate problems rarely lead to erection difficulties.Typically, with prostatitis, it weakens due to psychological problems that arise against the background of unpleasant symptoms.
3. Not all forms of prostatitis are caused by bacteria: in 80-90% of them they have nothing to do with it.If a person with suspected prostatitis is given antibiotics without further testing, this is bad.Before taking them, it makes sense to consult another doctor.
4. A person with acute or chronic prostatitis may receive a prostate massage to collect glandular secretions for analysis.
5. The best way to prevent prostatitis is protected sex, a healthy lifestyle and, from the age of 40, regular urological examinations carried out by a doctor.