Prostatitis

Prostatitis is the name given to a set of symptoms which are thought to be caused by an infection or by inflammation of the prostate gland.

Prostatitis is not a form of prostate cancer. It is also not the same as having an enlarged prostate.

It’s a common condition which can affect men of any age, but it’s most common in younger and middle aged men, typically between 30 and 50.

Prostatitis can cause a wide range of symptoms, which vary from man to man. Common symptoms include problems passing urine and pain or discomfort around your testicles, back passage or lower abdomen.

It’s a complicated condition. There are four types of prostatitis, listed below. Some types are not well understood, which make it difficult for doctors to know what causes it and know how best to treat it. This can be frustrating for men who have it, but there are things you can do to help yourself.

For more practical tips read our How to manage chronic prostatitis guide.

Chronic pelvic pain syndrome (CPPS)

Chronic pelvic pain syndrome (CPPS) is the most common type of prostatitis. It can go on for a long time - chronic means long-lasting. The symptoms vary but it usually causes pain in the pelvic area (the area below your stomach).

Nobody knows for certain what causes CPPS - unlike the other types of prostatitis, it’s not caused by a bacterial infection. There could be a number of causes, which makes it difficult to diagnose and treat. Possible causes include urine getting into the prostate gland, an infection which doesn’t show up in tests, and problems with the nerves around the prostate.

Some research shows a connection between high levels of stress and anxiety and CPPS. Feeling stressed or depressed may cause physical symptoms that trigger CPPS or make it worse.

There is no single test to diagnose CPPS. Your doctor will need to rule out other possible causes of your symptoms to make a diagnosis. You will be asked to give some samples and you may need some tests.

Treatment varies from man to man – just like CPPS does. The treatments won’t get rid of CPPS, it’s about finding what works best to control your symptoms. You’ll probably have a number of different treatments, and there are things you can do to help yourself.

Acute bacterial prostatitis

Acute bacterial prostatitis is an infection of the prostate gland which is caused by bacteria. ‘Acute’ means that the symptoms develop very quickly. It’s not common, but it can be a serious infection - causing a high temperature and sweating - that needs treating in hospital.

It’s caused by certain types of bacteria getting into the prostate - for example bacteria from your bowel, bladder or blood stream. This can happen if you have a urine infection, difficulty emptying your bladder, a biopsy of your prostate, or if you use a catheter.

Your doctor can check for bacteria and other signs of infection to diagnose acute bacterial prostatitis, for example with a urine test. It's treated with a course of antibiotics which you can usually take at home. If the infection is more severe you might need to spend some time in hospital.

Chronic bacterial prostatitis

Chronic bacterial prostatitis is an infection of the prostate that can last for a long time – at least three months. It tends to come and go, causing episodes or flare-ups. Like acute bacterial prostatitis, it’s not common.

It’s caused by a bacterial infection, and tends to affect people who have had urine infections or inflammation of the urethra (urethritis) in the past. It can develop from acute bacterial prostatitis if antibiotics don’t get rid of all the bacteria.

Like acute bacterial prostatitis, your doctor can check for signs of infection to diagnose it. It's also treated with antibiotics, and there are other treatments available and things you can do to help yourself.

Asymptomatic prostatitis

It is possible to have prostatitis and not have any symptoms – the word ‘asymptomatic’ means that there aren’t any symptoms. It's usually detected by chance when you are having tests for other conditions such as infertility or prostate cancer.

Because it doesn’t cause symptoms, asymptomatic prostatitis doesn’t usually need any treatment. But you might get a course of antibiotics if you have high levels of a protein called prostate specific antigen (PSA) in your blood, or you have high levels of white blood cells in your urine or semen.

References

Last updated April 2016
To be reviewed December 2018

List of references
- Anderson RU, Orenberg EK, Morey A, Chavez N, Chan CA. Stress Induced Hypothalamus-Pituitary-Adrenal Axis Responses and Disturbances in Psychological Profiles in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome. J Urol. 2009 Nov;182(5):2319–24
- Clearinghouse TNNK and UDI. Prostatitis: Disorders of the Prostate [Internet]. [cited 2013 Sep 11]. Available from: http://kidney.niddk.nih.gov/KUDiseases/pubs/prostatitis/index.aspx#types
- Clinical Effectiveness Group, British Association of Sexual Health and HIV. United Kingdom national guidelines for the management of prostatitis. London: 2008.
- Davis SN, Morin M, Binik YM, Khalife S, Carrier S. Use of pelvic floor ultrasound to assess pelvic floor muscle function in Urological Chronic Pelvic Pain Syndrome in men. J Sex Med. 2011 Nov;8(11):3173–80
- Doggweiler R, Stewart AF. Pelvic Floor Therapies in Chronic Pelvic Pain Syndrome. Curr Urol Rep. 2011 May 6;12(4):304–11
- Engeler D, Baranowski AP, Elneil S, Hughes J, Messelink EJ, Oliveira P, et al. EAU Guidelines on Chronic Pelvic Pain. UPDATE [Internet]. 2012 [cited 2013 Sep 11]; Available from: http://imop.med.auth.gr/sites/default/files/25_chronic_pelvic_pain_lr.pdf
- Habermacher GM, Chason JT, Schaeffer AJ. Prostatitis/chronic pelvic pain syndrome. Annu Rev Med. 2006;57:195–206.
- McNaughton C, Mac Donald R, Wilt T. Interventions for chronic abacterial prostatitis. Cochrane Database Syst Rev. 2001;(1):CD002080
- McNaughton-Collins M, Joyce GF, Wise M, Pontari MA. Prostatitis. In: Litwin MS, Saigal CS, editors. Urologic Diseases in America. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: U.S. Government Publishing Office, 2007; NIH Publication No. 07-5512 pp. 9-42.
- Ozden E, Bostanci Y, Yakupoglu KY, Akdeniz E, Yilmaz AF, Tulek N, et al. Incidence of acute prostatitis caused by extended-spectrum beta-lactamase-producing Escherichia coli after transrectal prostate biopsy. Urology. 2009 Jul;74(1):119–23
- Perletti G, Marras E, Wagenlehner FM, Magri V. Antimicrobial therapy for chronic bacterial prostatitis. Cochrane Database Syst Rev. 2013;12;8:CD009071.
- Pontari MA, Ruggieri MR. Mechanisms in prostatitis/chronic pelvic pain syndrome. J Urol. 2008 May;179(5 Suppl):S61-7
- Rosebud O. Roberts, Michael M. Lieber, David G. Bostwick, Steven J. Jacobsen. A review of clinical and pathological prostatitis syndromes. Urology 1997: 49 (6);809-821
- Thakkinstian A, Attia J, Anothaisintawee T, Nickel JC. α-blockers, antibiotics and anti-inflammatories have a role in the management of chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 2012 Oct;110(7):1014–22

Personal stories

“It felt like a painful wave, rushing from my feet upwards"

Prostatitis is a common condition that can affect men of any age but it's also something that can be difficult to diagnose and treat. For James, 26, from Sheffield, it took a number of unusual symptoms, two trips to A&E and referral to a specialist before he was finally diagnosed with prostatitis. This is his story.