How much does it cost to cure prostatitis?

A cross-national survey shows that 2-10% of adult men experience symptoms suggestive of prostate problems during their lifetime.

Any violation of urination is an alarm signal and self-medication in this case should be excluded.However, problems are not always related specifically to prostatitis.

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

How does the prostate function?

The prostate, 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 discharged from the bladder and sperm from the testicles.

A key function of the prostateconsists in the production of secretion, which is part of the seminal fluid.Thanks to this secretion, the spermatozoa can move.The second task of the prostate is to contract, providing 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 liquid part of the sperm and store prostatic secretions.

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

Prostate problems do not always lead to erectile 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 mechanism of erection.

But a violation of urination, discomfort from incomplete emptying of the bladder, pain or discomfort associated with inflammation lead to a person's nervousness and embarrassment.Because of this, psychological problems arise - as a rule, they negatively affect the erection.

How is prostatitis?

Prostatitis is an inflammation of the prostate gland that is 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 related to inflammation of the gland.

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

For a little simplification, the classification divides prostatitis into bacterial and abacterial, i.e.not associated with bacteria.This approach helps doctors make the important decision 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 unnecessary antibiotics is bad for your health.

The NIDDK classification identifies five forms of prostatitis.

Acute bacterial prostatitis.A disease most often caused by typical pathogens of urinary tract infections: eg E. coli, Klebsiella and Enterobacter.

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

Chronic bacterial prostatitis.This disease can also be caused by microbes characteristic 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 be less severe or milder.There is usually no fever or weakness, the pain in the lower abdomen is more aching than sharp, but it is difficult to start urination and completely empty the bladder.In addition, unpleasant symptoms may temporarily disappear and reappear after some time.

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 a condom, patients with a urinary tract infection, and people who have recently had surgery or a prostate biopsy.

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

Chronic abacterial prostatitis or non-inflammatory chronic pelvic pain syndrome.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 seminal fluid, 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 understand what cause leads to the development of the disease.Risk groups are also difficult to define.

Asymptomatic inflammatory prostatitis.This form of the disease does not cause discomfort.Most often, the inflammation is discovered incidentally when the patient is 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 a prostate adenoma or benign prostatic hyperplasia.An enlarged prostate presses on the urethra and this can cause problems with urination: too frequent urges to go to the toilet or leakage of urine.Faced with the symptoms of an adenoma, some patients may assume that they have prostatitis.

Although some symptoms of prostatic hyperplasia may indeed resemble prostatitis, they are not the same thing.Prostatitis is an inflammation of the prostate gland.An adenoma is an age-related uncontrolled 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 consult 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 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 the disease.

If we do a massive microscopic examination of the prostate gland, we will find certain signs of inflammation in all men over 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 that 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 to receive quality treatment.You can make an appointment with a urologist for free under your compulsory medical insurance or make an appointment with a doctor in a private clinic. 

The main task of a urologist who receives a patient with suspected prostatitis is to exclude other diseases of the prostate, such as cancer, and to determine what 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 needs to do to find out.

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

Perform 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 likelihood that there is actually an inflammatory process in the body.Typically, the exam includes a digital rectal exam, which allows the doctor to assess the size, shape and condition of the prostate.The study helps to understand whether the prostate has increased in size.If the gland is painful to the touch, 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 anxious to avoid these procedures that they refuse to make an appointment with a urologist at all.

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

Sometimes, instead of this study, a spermogram analysis is prescribed for the same purpose.It helps to understand if prostatitis is part of the infections of the male reproductive glands and gives information about the quality of the ejaculate.In addition, counting leukocytes in the ejaculate makes it possible to distinguish between inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.

If the patient is concerned about an upcoming digital exam or prostate massage, I would suggest discussing this with his healthcare provider.Perhaps the analysis of prostate secretions, which requires massage, can be replaced by a urine or semen analysis.

Order blood, urine and prostate secretion tests.The diagnostic standard includes a microscopic examination of prostatic secretions, a general blood test, a general urine test with sediment microscopy, as well as a 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 what bacteria grow on it - this allows to clarify the diagnosis.You can be examined in a private clinic for money or for free under mandatory medical insurance.

Other tests and examinations - for example, a test for the concentration of total prostate-specific antigen (PSA) in the blood and a transrectal ultrasound of the prostate (TRUS) - are not usually done when prostatitis is suspected.In some cases, TRUS of the prostate gland can reveal fibrosis, ie.a scar 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, the doctor will prescribe antibiotics.And if the bacteria have nothing to do with it, you will need drugs to help you cope with the unpleasant symptoms of the disease.

Acute bacterial prostatitisthey start treatment without waiting for test results - this is called empiric antibacterial therapy.In this approach, antibiotics are prescribed based on the knowledge of which microbes most commonly 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 fever who are treated in hospital are more often prescribed antibiotic injections.With this treatment, in most patients with acute prostatitis, fever and pain subside within the second to sixth day after starting treatment.

When the patient's temperature normalizes and signs of inflammation disappear, the doctor can switch 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 method.It was once believed that this could help release excess secretions accumulated in the gland and thus reduce its swelling. However, today most experts have reached a consensus that prostate massage should be avoided in 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 penetrate into adjacent, non-infected tissues.

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

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

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

Since it is not clear what exactly causes abacterial prostatitis, treatment is mainly aimed at relieving pain during urination.To achieve this, doctors prescribe alpha-1 blockers - drugs that help relax the prostate muscles that compress the urethra.If the pain persists, the doctor may prescribe non-steroidal anti-inflammatory drugs.The dosage 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 during which a person learns to manage pain without drugs.However, there is no scientific evidence for the effectiveness of psychological help in abacterial prostatitis.

Studies in which 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's impossible to say whether all this helps or not.

How to avoid prostatitis: prevention

The main cause of discomfort in the prostate gland is a sedentary lifestyle and lack of regular sex life.Doctors believe that men who:

1. Practice safe sex regularly.
2. Engage in moderate exercise regularly.
3. Avoid hypothermia.
4. After reaching the age of 40, they undergo a urological examination annually.

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

Most importantly, 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 where exactly he works.

Unfortunately, doctors in private clinics do not always follow the standards of medical care.This can lead to overdiagnosis and unnecessary treatment, putting the patient at risk of overpayment.In a public medical organization, the probability of meeting all standards for diagnosis and treatment is higher.But patients should keep in mind that a complete examination will take more time - sometimes significantly longer than with an examination in a private clinic.

Remember

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