Prostatitis is the inflammation or infection of the male prostate, a walnut-shaped gland that sits just below the urinary bladder. Because there are several distinct kinds of prostatitis, treatment varies by the type and severity of the symptoms.
Treating Bacterial Prostatitis by Type
Bacterial infection can cause two types of prostatitis—acute (short-term) and chronic (ongoing).
Acute Bacterial Prostatitis
The main treatment for acute bacterial prostatitis is the use of antibiotics (such as ampicillin, levofloxacin or clindamycin) to kill the bacteria. Depending on the antibiotic and the type of bacteria, this treatment can last anywhere from several weeks to a few months. Escherichia coli infections are one of the most common causes, with this species of bacteria found in 65 to 80 percent of cases.
Severe infections may require hospitalization for monitoring and additional antibiotics. In addition, the infection can cause the prostate to grow bigger and block the urethra, the tube that removes urine from the body. Such blockages are especially important to treat so as to prevent urine from backing up in the urinary tract and damaging the kidneys.
Chronic Bacterial Prostatitis
With chronic bacterial prostatitis, bacteria can linger in the prostate even after treatment; about 5 percent of men with acute bacterial prostatitis end up with the chronic type. E. coli has been implicated in chronic prostatitis, too, as has a species of Corynebacterium. When these bacteria hang around, they can also cause occasional urinary tract infections.
Treatment for this type of prostatitis requires antibiotic therapy. The medication may need to be taken long-term in order to prevent the infection from recurring. Treatment success depends upon the type of infection and the antibiotic used. Levofloxacin, ofloxacin and ciprofloxacin have been found to provide relief in about 50 percent of patients. Success may be lower, however, than with acute bacterial infections because the antibiotics can have a hard time getting into all parts of the prostate.
Treating Prostatitis Not Caused By Infection
Chronic non-bacterial prostatitis, also known as chronic pelvic pain syndrome (CPPS), is inflammation of the prostate without any detectable infection. The cause is unknown, making it difficult to treat.
Even though no bacteria are implicated in this kind of prostatitis, a physician will sometimes prescribe antibiotics in case there is a hidden infection. Most often, however, therapy involves treating the symptoms. Options include:
- Over-the-counter pain medications like ibuprofen (Advil, Motrin) or naproxen (Aleve)
- Soaking in a hot bath
- Medications such as phenazopyridine (Pyridium), oxybutynin, or tolterodine to help with frequent, urgent, or painful urination
- Psychological counseling to help with the ongoing pain
Treating Asymptomatic Prostatitis
In men who have prostatitis but no symptoms, antibiotics are used only when a man also has elevated PSA (prostate specific antigen) levels. PSA levels should return to normal four to six weeks after treatment with antibiotics.
Surgery for Prostatitis
The risks of surgery for prostatitis outweigh the benefits, and such an approach is rarely necessary. During acute bacterial prostatitis, surgery may be done to drain an abscess (a collection of pus) in the prostate.
Surgery may also be used to remove prostate tissue infected with bacteria, which sometimes occurs with chronic bacterial prostatitis. When such a surgery is deemed necessary, a laparoscopic prostatectomy (partial or radical) may be performed. During this minimally invasive procedure, small incisions are made in the abdomen and carbon dioxide gas is injected through a narrow tube into the abdominal cavity. The gas lifts the abdominal wall so that a viewing instrument called a laparoscope can be inserted into the cavity and guide the surgeon as he removes the gland. The procedure typically requires an overnight hospital stay, and patients are often also sent home with a catheter that must remain in place for five to seven days to allow for proper drainage.
Risks include infertility, blood clots, infection, heart attack, organ damage, incontinence, erectile dysfunction, bleeding, pain, or scarring of the bladder neck. Bacterial prostatitis may reoccur when only part of the prostate is removed. In this case, bacteria can infect the remaining tissue. In addition, bacterial prostatitis can also lead to bacteria infecting tissues surrounding the prostate. When the gland is removed, those bacteria can remain behind and cause similar symptoms to the original prostate infection.
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Nickel, JC. (2011). Prostatitis and related conditions, orchitis, and epididymitis. Campbell-Walsh Urology, 10th. ed.
Stevermer JJ, & Easley SK. (2000). Treatment of prostatitis. Am Fam Physician. 61(10):3015-3022.