Prostatitis

Prostatitis refers to inflammation of the prostate gland and is categorized into acute bacterial prostatitis, chronic bacterial prostatitis, and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Acute Bacterial Prostatitis (ABP)

ABP is a sudden bacterial infection often caused by Escherichia coli and other gram-negative bacteria. Symptoms include urinary frequency, urgency, dysuria, suprapubic or perineal pain, fever, chills, and signs of sepsis.

Diagnosis involves urine cultures and clinical symptoms.

Treatment requires immediate antibiotic therapy to prevent complications like sepsis or prostatic abscess.

Chronic Bacterial Prostatitis (CBP)

CBP is a persistent prostate infection lasting over three months, frequently caused by E. coli and Enterococcus. It presents with recurrent urinary tract infections, low back or pelvic pain, and irritative voiding symptoms.

Between episodes, bacteria persist on diagnostic tests.

Long-term antibiotics are essential for management.

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)

CP/CPPS is the most common type of prostatitis, often unrelated to infection. It is divided into inflammatory (type IIIA) and non-inflammatory (type IIIB) subtypes. Symptoms include chronic pelvic or prostate pain, urinary discomfort, and occasional prostate tenderness. The exact cause is unknown, but factors like autoimmunity, neuromuscular dysfunction, or infection are suspected.

Management focuses on symptom relief through medications, physical therapy, and lifestyle changes.

Symptoms and Causes of Prostatitis

Treatment Options

Acute Bacterial Prostatitis (ABP)

• Empiric Antibiotic Therapy

• Outpatient vs. Inpatient: Mild-to-moderate cases may be treated as outpatients; severe cases or suspected urosepsis require hospitalization with IV antibiotics.

• Duration of Therapy: A minimum of 4 weeks, but 6 weeks is often optimal to prevent bacterial persistence.

  
  

Chronic Bacterial Prostatitis (CBP)

• Antibiotics: Fluoroquinolones (e.g., ciprofloxacin, levofloxacin) are first-line due to their superior prostate tissue penetration.

• Alternative Agents: Doxycycline, azithromycin, or clarithromycin may be used when fluoroquinolones are unsuitable.

• Treatment Duration: Typically 6–12 weeks to eradicate bacteria and prevent recurrence.

Treatment of Prostatitis

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)

• Initial treatment may include:

  • Antimicrobials: Empirical use in case of suspected infection.

  • Alpha Blockers: Reduce urinary symptoms by relaxing prostate and bladder muscles.

  • Anti-Inflammatory Medications: Relieve pain and inflammation.

• Multimodal Therapy: Combination treatments are often needed for symptom management.

  
  

• Adjunctive Non-Pharmacologic Options:

  • Physical Therapy: Pelvic floor relaxation techniques.

  • Stress Management: Cognitive-behavioral therapy.

  • Dietary Changes: Avoid irritants like caffeine and alcohol.