Chronic Prostatitis: Causes, Symptoms, Treatment

• Chronic prostatitis (sometimes called prostatodynia or chronic pelvic pain syndrome, CPPS) is a condition characterised by persistent pain or discomfort in the pelvic region, often associated with urinary symptoms and sexual dysfunction, lasting for at least 3 months.

2. Causes

• Multifactorial Aetiology: The exact cause of chronic prostatitis is often unclear, but it may involve a combination of infectious agents, pelvic floor muscle dysfunction, and psychological factors.

3. Risk Factors

• Previous Prostate Infection: A history of acute bacterial prostatitis or previous episodes of acute prostatitis can increase the risk of developing chronic prostatitis.

4. Symptoms

• Pelvic Pain: Pain or discomfort in the pelvic region is the hallmark symptom.
  • This may be felt anywhere around the genital area
  • This includes the perineum (the area between the scrotum and the anus), testicles, penis, groin area, lower abdomen, upper thighs and back passage
  • The pains usually come and go, and may be dull and aching, or sharp and stabbing.
• Urinary disturbances. Urinary symptoms like frequency, urgency, and nocturia may also occur, or a poor or variable urine stream. Mild stinging sensations and watery discharge from the penis may also sometimes occur.
• Ejaculatory disturbances. Pain or discomfort may occur at the moment of ejaculation, or may occur after ejaculation and last for a period of minutes or hours. Chronic prostatitis sometimes causes the semen to change colour, or have blood in it.

5. Diagnosis

• Clinical Evaluation: Diagnosis is primarily based on a thorough medical history, physical examination (including a digital rectal examination, DRE). But other tesys may be done: blood tests (including PSA), urine tests (MSU), ultrasound (prostate and urinary tract), and symptom assessment using tools like the NIH-CPSI (National Institutes of Health Chronic Prostatitis Symptom Index).

Notes

• Prostatitis can cause a raised Prostate-Specific Antigen (PSA) blood level. However, a biopsy is not normally done; but can help determine if this is due to an inflammatory process (prostatitis) rather than cancer.
• A negative MSU does not rule out prostatitis – i.e. a bacterium is not always grown (positive in 5-10% cases).
• Specialised tests (like the Meares and Stamey four-glass test or semen cultures with specific instructions to the lab) are often required to localise the infection and detect bacteria that don’t show up on a routine MSU.
• Here is further information from NICE on investigation.

6. Treatment

Multidisciplinary Approach: Treatment often involves a combination of medication, physioherapy, and lifestyle modifications.

• Anti-inflammatory painkillers (NSAIDs) – such as ibuprofen (Brufen), or diclofenac (Voltarol).
• Antibiotics – long courses of antibiotics (between 1 and 3 months of treatments) are occasionally used to treat prostatitis. Suitable antibiotics include doxycycline or ciprofloxacin.
• Amitriptyline (or imipramine) – this is a painkiller, which in other patients and in higher dosage, is sometimes used as an antidepressant. Duloxetine is an alternative.
• Alpha blockers (e.g. Doxazosin) – these are tablets which reduce muscular spasm in the bladder neck.
• Other things which may help include:
  • Physiotherapy (pelvic floor physical therapy)
  • Drinking plenty of water
  • Frequent ejaculation – thought to be beneficial as it ‘flushes out’ the prostate gland
  • Hot baths – thought to help by improving the circulation and relaxing the pelvic muscles.

7. Complications

• Impact on Quality of Life: Chronic prostatitis can significantly affect a patient’s quality of life, leading to sexual dysfunction, anxiety, and depression.

8. Prognosis

• Variable Course: The prognosis varies among individuals, with some experiencing significant symptom improvement, while others may have persistent or recurrent symptoms.

9. Prevention

• Lifestyle Modifications: While prevention is not always possible, maintaining a healthy lifestyle, managing stress, and avoiding prolonged sitting may help reduce the risk or severity of symptoms.

10. Referral

• Multidisciplinary Approach: Referral to a consultant in urology, STD +/- (later) pain management may be necessary; and psychological support should be considered to address associated mental health issues.

Other resource

Chronic prostatitis