How much does it cost to cure prostatitis?

Population surveys of various countries show that 2-10% of adult men experience symptoms suggestive of prostate problems during their lifetime.

Any urinary disturbance is an alarm bell, and self-medication in this case should be excluded.However, problems are not always specifically linked to prostatitis.

Go to the doctor

Our articles are written with love for evidence-based medicine.We cite reputable sources and get comments from reputable doctors.But remember: the responsibility for your health lies with you and your doctor.We do not write prescriptions, we give recommendations.Whether you rely on our view or not is up to you.

How does the prostate work?

The prostate, or prostate gland, is a walnut-shaped organ located just below the bladder.Between the parts of the "bean" there passes the urethra, the tube through which urine is removed from the bladder and sperm from the testicles.

The main function of the prostateconsists of producing 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 is the seminal vesicle, which is connected to the vas deferens, where sperm leave the genitals.The seminal vesicles produce the fluid portion of the sperm and store prostate secretions.

Prostatic secretions are a mixture of citric acid and enzymes.This fluid dilutes the sperm, which enters the urethra from the vas deferens of the testicles.

Prostate problems do not always lead to erectile problems

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

But urinary disorders, discomfort from incomplete emptying of the bladder, pain or discomfort associated with inflammation cause a person to become nervous and embarrassed.Because of this, psychological problems arise - as a rule, they have a negative effect on erection.

What is prostatitis?

Prostatitis is 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, inflammation of the prostate gland does not always lead to 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 important decisions about whether to prescribe antibiotics and additional drugs.It is incorrect to give antibiotics to all patients with suspected prostatitis because non-microbial forms of prostatitis are more common than bacterial ones.Taking antibiotics that don't need to harm your health.

The NIDDK classification identifies five forms of prostatitis.

Acute bacterial prostatitis.Diseases most often caused by common pathogens 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 feeling weak, severe pain or burning in the perineum, scrotum or anus, lower abdomen and sometimes 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 the symptoms last for at least three months.

Symptoms of chronic bacterial prostatitis resemble those of acute prostatitis, but may not be as severe or less severe.Usually there is no fever or weakness, the pain in the lower abdomen is more painful than sharp, but it is difficult to start urinating and empty the bladder completely.In addition, unpleasant symptoms may disappear temporarily and reappear after a while.

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

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

Chronic abacterial prostatitis, or chronic pelvic pain syndrome, is 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 gland and urine - this indicates that the prostate gland is not inflamed.

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

Asymptomatic inflammatory prostatitis.This form of the disease does not cause any discomfort.Often, the inflammation is discovered by chance when the patient is being examined for another problem, such as infertility.

How does prostatitis differ from prostate adenoma?

In about 8% of men after the age of 40, the prostate begins to grow 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 urge to go to the toilet too often or leakage of urine.Facing symptoms of adenoma, some patients may think that they have prostatitis.

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

Adenomas can cause serious discomfort, so if you have problems with urination, it is important to consult a urologist as soon as possible.However, adenomas are still not as dangerous as prostatitis, because they do not increase the risk of 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.In addition, both variants of chronic abacterial prostatitis account for 80-90% of all cases of this disease.

If we conduct a massive microscopic examination of the prostate gland, we will find certain signs of inflammation in all men over the age of 40 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 tests, it is impossible to distinguish one form of prostatitis from another and receive quality treatment.You can get an appointment with a urologist for free under your compulsory medical insurance policy or make an appointment with a doctor at a private clinic. 

The main task of a urologist who sees a patient with suspected prostatitis is to rule out other prostate diseases, such as cancer, and determine the form of the disease that 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 find out.

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 on the appointment, it is desirable to print the questionnaire and fill it in advance.

Conduct a physical examination.The doctor will examine the patient, paying special attention to the groin area.If there are swollen, painful lymph nodes in the groin, this increases the possibility that there is actually an inflammatory process in the body.Usually, the examination includes a digital rectal examination, which allows the doctor to assess the size, shape and condition of the prostate.This study helps to understand whether the prostate is growing in size.If touching the gland hurts, it is most likely inflamed.

Is it possible to 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 are so eager to avoid this procedure that they refuse to make an appointment with a urologist at all.

Digital rectal examination is a diagnostic method, but prostate gland massage through the rectum is performed to obtain material for laboratory analysis - prostate secretions.If secretions cannot be obtained, the doctor can replace the analysis of prostate secretions with either an analysis of the first part of the urine, or a two- and three-glass urine test.This test can roughly determine where the problem area is in the urinary tract.

Sometimes, instead of this examination, spermogram analysis is prescribed for the same purpose.It helps to understand whether prostatitis is part of male reproductive gland infection and provides information about the quality of ejaculation.In addition, counting leukocytes in the ejaculate makes it possible to distinguish inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.

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

Prescribing blood, urine and prostate secretion tests.Diagnostic standards include microscopic examination of prostate secretions, general blood tests, general urine tests with a sediment microscope, as well as microbiological examination of urine and prostate secretions.

During a microbiological study, the patient's biological material is placed on a nutrient medium and it is observed what bacteria grow on it - this allows the diagnosis to be clarified.You can undergo the test in a private clinic for money or for free under compulsory medical insurance.

Other tests and examinations - for example, tests for the total concentration of prostate-specific antigen (PSA) in the blood and transrectal ultrasound of the prostate (TRUS) - are usually not performed if prostatitis is suspected.In some cases, TRUS of the prostate gland can reveal fibrosis, that is, scars, or foci similar to malignant tumors, 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, the doctor will prescribe antibiotics.And if bacteria has nothing to do with it, you need drugs to help cope with the unpleasant symptoms of the disease.

Acute bacterial prostatitisthey start treating without waiting for test results - this is called empirical antibacterial therapy.In this approach, antibiotics are prescribed based on knowledge of the microbes that most often cause prostate infections.

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

Those who feel more or less normal and are treated at home usually receive antibiotic tablets.And patients with high fever who are treated in hospital are more often given antibiotic injections.With this treatment, in most patients with acute prostatitis, fever and pain subside in the second to 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 tablets.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 may help release excess secretions that accumulate in the gland and thereby reduce swelling.However, today most experts have reached a consensus 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 as a result of the massage, bacteria can enter neighboring tissues that are not infected.

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

With chronic prostatitis, antibiotics need to be taken longer than with acute prostatitis.In accordance with the recommendations of the urologist, they are prescribed in a course lasting 4-6 weeks.

Chronic abacterial prostatitisis not associated with bacteria, so patients with this disease are only given antibiotics if, in addition to prostatitis, they have a urinary tract infection.

Since it is not clear what exactly causes abacterial prostatitis, treatment is mainly aimed at relieving pain during urination.To achieve this goal, doctors prescribe alpha-1 blockers - drugs that help relax the prostate muscle that compresses the urethra.If the pain persists, the doctor may prescribe non-steroidal anti-inflammatory drugs.The dose is selected individually for each patient.

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

Studies where researchers have tried 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—usually less than 12 weeks.So it is impossible to say whether all this helps or not.

How to avoid prostatitis: prevention

The main cause of discomfort in the prostate gland is an inactive lifestyle and lack of a regular sex life.Doctors believe that the highest chance of avoiding prostatitis is in men who:

1. Practice safe sex regularly.
2. Always do moderate exercise.
3. Avoid hypothermia.
4. After reaching the age of 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 when diagnosing and treating prostatitis.It just depends on the doctor - and it doesn't matter where he works.

Unfortunately, doctors in private clinics do not always adhere to medical care standards.This can lead to overdiagnosis and unnecessary treatment, putting patients at risk of overpaying.In a public medical organization, the possibility to meet all diagnostic and treatment standards is higher.But patients should take into account that a complete examination will take longer - sometimes much longer than during an examination in a private clinic.

Remember

1. Problems with the urinary tract in men are common, but they are not always caused by prostatitis.To understand what really happened to a person, you need to undergo a thorough examination.
2. Prostate problems rarely cause erectile difficulties.Usually, with prostatitis, it is weak 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% they have nothing to do with it at all.If a person suspected of prostatitis is given antibiotics without additional tests, this is bad.Before taking it, it makes sense to consult with another doctor.
4. A person with acute or chronic prostatitis may be given prostate massage to collect glandular secretions for analysis.
5. The best way to prevent prostatitis is protected sex, a healthy lifestyle, and after 40, a regular urological examination by a doctor.