Male reproductive system disorders - Prostate diseases

The prostate is a gland. It helps make semen, the fluid that contains sperm. The prostate surrounds the tube that carries urine away from the bladder and out of the body. A young man's prostate is about the size of a walnut. It slowly grows larger with age. If it gets too large, it can cause problems. This is very common after age 50. The older men get, the more likely they are to have prostate trouble.

Some common problems are:

Prostatitis - an infection, usually caused by bacteria
Benign prostatic hyperplasia, or BPH - an enlarged prostate, which may cause dribbling after urination or a need to go often, especially at night
Prostate cancer - a common cancer that responds best to treatment when detected early

PROSTATITIS

Prostatitis is inflammation or infection of the prostate gland — an organ about the size and shape of a walnut, located just below the bladder in males. The prostate gland produces semen, the fluid that helps nourish and transport sperm. Prostatitis can cause a variety of symptoms, including a frequent and urgent need to urinate and pain or burning when urinating — often accompanied by pelvic, groin or low back pain.

Prostatitis has been classified by the National Institutes of Health (NIH) into four categories.

Category 1 is acute bacterial prostatitis.
Category 2 is chronic bacterial prostatitis.
Category 3 includes the conditions previously known as nonbacterial prostatitis, prostatodynia and chronic pelvic pain syndrome.
Category 4 is asymptomatic inflammatory prostatitis.

Pain relievers and several weeks of treatment with antibiotic are typically needed for category 1 and 2 prostatitis, which are bacterial infections. A variety of treatments as well as self-care measures also can provide relief. Treatment for category 3 prostatitis (nonbacterial) is less clear and mainly involves relieving symptoms. Category 4 prostatitis is usually found during examination for another reason and often doesn't require treatment.

Signs and symptoms

The signs and symptoms vary depending on the various types of prostatitis.

Acute bacterial prostatitis: Category 1
Signs and symptoms of this form of prostatitis usually come on suddenly and may include:

Fever and chills
Flu-like symptoms
Pain in the prostate gland, lower back or groin

Urinary problems, including increased urinary urgency and frequency, difficulty or pain when urinating, inability to completely empty the bladder, and blood-tinged urine
Painful ejaculation

Acute prostatitis can be a serious condition and requires immediate medical treatment. See your doctor right away if you develop any of these signs and symptoms.

Chronic bacterial prostatitis: Category 2
The signs and symptoms of this type of prostatitis develop more slowly and usually aren't as severe as those of acute prostatitis. In addition, times when symptoms are better tend to alternate with times when symptoms are worse. Signs and symptoms of chronic bacterial prostatitis include:

A frequent and urgent need to urinate
Pain or a burning sensation when urinating (dysuria)
Pain in the pelvic area
Excessive urination during the night (nocturia)
Pain in the lower back and genital area
Difficulty starting to urinate, or diminished urine flow
Occasional blood in semen or in urine (hematuria)
Painful ejaculation
A slight fever
Recurring bladder infections

Chronic nonbacterial prostatitis: Category 3
The signs and symptoms of nonbacterial prostatitis are similar to those of chronic bacterial prostatitis, although you probably won't have a fever. The only way to determine whether prostatitis symptoms are caused by bacterial infection or are nonbacterial is through lab tests to find out whether bacteria is present in the urine or prostate gland fluid.

Other conditions

Prostatitis can be difficult to diagnose, in part because its signs and symptoms often resemble those of other conditions, such as bladder infections, bladder cancer or prostate enlargement due to benign or cancerous growth of the prostate.

Causes

Acute bacterial prostatitis: Category 1
Bacteria normally found in your large intestine typically cause acute prostatitis. Most commonly, acute prostatitis originates in the prostate, but occasionally the infection can spread from a bladder or urethral infection.

Chronic bacterial prostatitis: Category 2
It's not entirely clear what causes a chronic bacterial infection. Sometimes it develops after an episode of acute prostatitis when bacteria remain in the prostate. Catheter tubes used to drain the urinary bladder, injury to the urinary system (such as from bike riding or horseback riding ) or infections in other parts of the body can be the source of the bacteria.

Chronic nonbacterial prostatitis: Category 3
The cause or causes of this condition are not well-defined. Some theories regarding the causes are as follows:

Other infectious agents. Some experts believe nonbacterial prostatitis may be caused by an infectious agent or agents that do not show up in standard laboratory tests.

Heavy lifting. Lifting heavy objects when your bladder is full may cause urine to back up into your prostate causing inflammation.

Interstitial cystitis. This condition that's more frequently diagnosed as a cause of chronic pelvic pain in women is being more frequently recognized in men.

Physical activity. Although regular exercise, especially jogging or biking, is great for the rest of your body, it may irritate your prostate gland.

Pelvic muscle spasm. Urinating in an uncoordinated fashion with the sphincter muscle not relaxed may lead to high pressure in the prostate and the development of inflammation and prostatitis symptoms.

Structural abnormalities of the urinary tract. Narrowings (strictures) of your urethra may cause increased pressure during urination and result in inflammation and symptoms.

Prostatitis is not contagious and is not a sexually transmitted disease.

Risk factors

Unlike other prostate problems, you're more likely to develop prostatitis when you're younger, even before age 40. You may also be at increased risk if you:

Recently had a bladder infection or an infection of your urethra
Recently had a urinary catheter inserted during a medical procedure
Do not empty your bladder frequently enough and you perform vigorous activities with a full bladder
Jog or bicycle on a regular basis or ride horses
Men with HIV also are at increased risk of bacterial prostatitis. It's not clear why.

When to seek medical advice

See your doctor if you develop any of the signs and symptoms of prostatitis, such as persistent urinary discomfort and pain, blood-tinged urine or semen, or pain while ejaculating — especially if these signs and symptoms come on suddenly. When untreated, prostatitis can lead to more serious problems such as infection throughout your body. It's also important to see your doctor to rule out other conditions that eventually may cause bladder or kidney damage.

If you're being treated for acute bacterial prostatitis, see your doctor when you've finished your course of antibiotics to make sure the infection has cleared. This is also a good time to discuss what you can do to prevent a recurrence.

In addition, most men have a prostate checkup in conjunction with a regular physical exam. If your doctor doesn't perform a digital rectal exam when you have a routine physical, ask whether you should have one.

Screening and diagnosis

Diagnosing prostatitis involves ruling out any other conditions that may be causing your signs and symptoms and then determining what kind of prostatitis you have.

Your doctor will likely begin by taking a medical history and performing a physical exam. You may be asked to complete a questionnaire about your symptoms. The physical exam may include checking your abdomen and pelvic area for tenderness and a digital rectal exam of your prostate.

Digital rectal exam
During a digital rectal exam, your doctor manually examines your prostate gland by gently inserting a lubricated, gloved finger into your rectum. Because the prostate gland is in front of the rectum, your doctor can feel the back surface of the gland this way. If it seems enlarged and tender to the touch, you may have prostatitis.

Urine and semen test
Your doctor may want to evaluate samples of your urine and semen for bacteria and white blood cells — key cells in your immune system's response — to help establish a diagnosis of prostatitis.

Complications

There's no evidence that having acute or chronic prostatitis increases your risk of prostate cancer, but it may increase the level of prostate-specific antigen (PSA) in your bloodstream. PSA is a substance naturally produced in your prostate gland, and high levels in your blood may sometimes — but not always — be a sign of prostate cancer. For that reason, if you have an elevated PSA level and also have acute prostatitis, you should be rechecked after you've been treated with antibiotics and all prostate inflammation has resolved.

Because prostatitis interferes with the transport of sperm cells and may interfere with normal ejaculation, it can sometimes affect fertility. In addition, untreated acute prostatitis can lead to an inability to urinate, and in severe cases may result in bacteria in your bloodstream (bacteremia).

Treatment

The main treatment for bacterial prostatitis (category 1 and 2) is antibiotics to cure the infection. If you have acute prostatitis, you may need to be hospitalized for a few days to receive antibiotics intravenously. Some of these treatments may also be tried for chronic nonbacterial prostatitis. However, there's no strong evidence that antibiotic therapy is useful for nonbacterial or category 3 prostatitis.

Medications
Antibiotics. Antibiotics are usually the first choice of treatment for category 1 and 2 prostatitis. Your doctor will likely begin right away with an antibiotic that fights a broad spectrum of bacteria. He or she will also proceed with testing to determine the exact bacteria causing your infection. Once the exact bacterium is identified, your doctor can prescribe a specific antibiotic that is more likely to kill the particular bacteria present.

How long you take antibiotics depends on how well you respond to the drug. If you have category 1 prostatitis, you may need medication for a few weeks. Category 2 prostatitis is more resistant to antibiotics and takes longer to treat. You may need to continue taking medication for as long as six to 12 weeks. In some cases the infection may never be eliminated, and you could have a relapse as soon as the drug is withdrawn. If this happens, you may need to take a low-dose antibiotic indefinitely.
Some doctors may prescribe an antibiotic for category 3 prostatitis to see if symptoms improve. For unknown reasons, some men with this condition seem to benefit from a continuous low dose of an antibiotic.

Alpha blockers. If you're having difficulty urinating, your doctor may prescribe an alpha blocker — an oral medication that helps relax the bladder neck and the muscle fibers where your prostate joins your bladder. This may help you urinate more easily and empty your bladder more completely.

Pain relievers. Sometimes an over-the-counter pain reliever, such as aspirin or ibuprofen (Motrin, Advil, others), can make you more comfortable. Keep in mind, however, that taking too much of any of these medications can cause serious side effects including abdominal pain, intestinal bleeding or ulcers.

Muscle relaxants. Spasms of the pelvic muscles can accompany prostatitis. A combination of a muscle relaxant medication and other medications used to treat prostatitis may be helpful.

Physical therapy
Special exercises and relaxation techniques can improve symptoms of prostatitis in some men, perhaps because tight or irritated muscles can contribute to the condition. Common techniques include:

Exercise. Stretching and relaxing the lower pelvic muscles — sometimes with the addition of heat to make the muscles more limber — may help relieve your symptoms. A physical therapist can show you which exercises will benefit you the most and how to perform them. You can then do the exercises yourself at home.

Biofeedback. This technique teaches you how to control certain body responses, including relaxing your muscles. During a biofeedback session, a trained therapist applies electrodes and other sensors to various parts of your body. The electrodes are attached to a monitor that displays your heart rate, blood pressure and degree of muscle tension. You'll see changes on the monitor and learn to control these changes on your own.

Sitz baths. Named from the German word "sitzen," which means "to sit," this type of bath simply involves soaking the lower half of your body in a tub of warm water. Warm baths can relieve pain and relax the lower abdominal muscles. Few treatments are easier or as relaxing.

Prostate massage. Some men have found that having their prostate massaged helps relieve congestion by unplugging the small ducts blocked by inflammation. The massage is performed using a gloved finger, similar to what is done during a digital rectal exam. This procedure is used less commonly today than it once was.

Surgical procedures
Surgical removal of the infected part of the prostate is an option in a few severe cases when other treatments don't work. The chances of responding to a major surgical procedure for any type of prostatitis are quite low. For this reason most doctors are very hesitant to perform surgery for these conditions and generally discourage surgery even as a last resort.

Other treatments
Finasteride (Proscar), a drug that lowers hormone levels in the prostate, and microwave thermotherapy (heat therapy) have been used successfully in a few men with prostatitis, but there's little long-term experience with these treatments.

Self-care

Because traditional treatments aren't always effective for prostatitis, many men experiment with various lifestyle changes to control their symptoms. Although no scientific evidence proves these practices are beneficial, you may want to try one or more of the following suggestions:

Drink plenty of water.
Limit or avoid alcohol, caffeine and spicy foods.
Urinate at regular intervals.
Have regular sexual activity.
If you're a cyclist, use a "split" bicycle seat, which reduces the pressure on your prostate.

Men with category 3 prostatitis can learn to live with the disease by limiting the things that make their symptoms worse and emphasizing the things that make them feel better.

Complementary and alternative medicine

Although how they work is poorly understood, some natural remedies — including saw palmetto preparations, zinc supplements and quercetin — have helped some men manage the symptoms of prostatitis

Adapted from: Mayo Foundation for Medical Education and Research