How much does it cost to treat prostatitis?

A survey of residents of various countries showed that 2-10% of adult men experience symptoms suggestive of prostate problems during their lifetime.

Any urinary disorder is a warning sign and self-medication in this case should be excluded.However, problems are not always associated specifically with prostatitis.

Go to the doctor

Our articles are written with love for evidence-based medicine.We cite reliable sources and ask for comments from reputable doctors.But remember: the responsibility for your health lies with you and your doctor.We don't write prescriptions, we give recommendations.It's up to you whether to rely on our point of view or not.

How does the prostate work?

The prostate, or prostate gland, is a walnut-shaped organ located just below the bladder.Between the halves of the “nut” passes the urethra, a tube through which urine is expelled from the bladder and sperm from the testicles.

Key role of the prostateconsists of producing a secretion that is part of the seminal fluid.Thanks to this secretion the spermatozoa are able to move.The second task of the prostate is to contract, ensuring ejaculation, that is, ejaculation.

Next to the prostate are the seminal vesicles, which are connected to the vas deferens, through which sperm leaves the genitals.The seminal vesicles produce the liquid part of the sperm and store prostatic secretions.

Prostate secretion is a mixture of citric acid and enzymes.This fluid liquefies the sperm, which enters the urethra from the vas deferens of the testicles.

Prostate problems do not always lead to erection problems

In the vast majority of cases, sexual dysfunction is not associated with prostate problems, because there is no physical connection between the prostate and the erection mechanism.

But urination disorders, discomfort due to incomplete emptying of the bladder, pain or discomfort associated with inflammation lead the person to become nervous and embarrassed.Because of this, psychological problems arise that, as a rule, negatively affect erection.

What is prostatitis like?

Prostatitis is an inflammation of the prostate gland associated with pathogenic microbes or other non-infectious causes.Sometimes the inflammation also affects the seminal vesicles: it is called vesiculitis.

At the same time, inflammation of the prostate gland does not always lead to pain and problems with urination, and the presence of unpleasant symptoms is not necessarily associated with inflammation of the gland.

To avoid confusion, urologists around the world use the classification proposed by the American National Institute of Diabetes and Digestive and Kidney Diseases, or NIDDK.

To simplify a bit, the classification divides prostatitis into bacterial and abacterial, i.e. not associated with bacteria.This approach helps doctors make the important decision whether to prescribe antibiotics and additional medications.It is not appropriate to give antibiotics to all patients with suspected prostatitis because non-microbial forms of prostatitis are more common than bacterial ones.Taking unnecessary antibiotics is harmful to your health.

The NIDDK classification identifies five forms of prostatitis.

Acute bacterial prostatitis.A disease that is often caused by pathogens typical of urinary tract infections: for example E. coli, Klebsiella and Enterobacter.

As a rule, the disease begins unexpectedly and is accompanied by a general deterioration in health.The temperature rises to 38-39°C, with some people feeling weakness, severe pain or burning in the perineum, scrotum or anus, lower abdomen, and sometimes in the muscles.Some people experience pain during ejaculation.Sometimes with bacterial prostatitis frequent, difficult and painful urination occurs.

Chronic bacterial prostatitis.This disease can also be caused by microbes typical of acute prostatitis.The disease is considered chronic if the symptoms last at least three months.

The symptoms of chronic bacterial prostatitis resemble those of acute prostatitis, but may not be as severe or less severe.There is usually no fever or weakness, the pain in the lower abdomen is more aching than sharp, but it is difficult to start urinating and completely empty the bladder.Furthermore, unpleasant symptoms may disappear temporarily and return after a while.

Any man can contract acute and chronic bacterial prostatitis.But the people at greatest risk are those who have a higher risk of exposure to germs: those who have sex, especially anal sex, without a condom, patients with a urinary tract infection, and people who have recently had surgery or a prostate biopsy.

Chronic abacterial prostatitis associated with inflammation.The symptoms of nonbacterial inflammatory prostatitis are very similar to acute and chronic bacterial prostatitis.In this case, there are no pathogenic bacteria in the sperm, prostate and urine, but the concentration of leukocytes will be high - this indicates inflammation of the prostate gland.

Chronic abacterial prostatitis, or chronic pelvic pain syndrome, not associated with inflammation.The symptoms also resemble acute and chronic bacterial prostatitis.At the same time, there are no pathogenic bacteria and a high concentration of leukocytes in the semen, prostate and urine - this indicates that the prostate gland is not inflamed.

In the case of non-bacterial forms of prostatitis it is not always possible to understand what the cause is that leads to the development of the disease.Risk groups are also difficult to determine.

Asymptomatic inflammatory prostatitis.This form of the disease does not cause any discomfort.Most often, inflammation is discovered accidentally when the patient is examined for other problems, such as infertility.

How does prostatitis differ from prostatic adenoma?

In about 8% of men after the age of 40, the prostate begins to increase in size: this is called prostatic adenoma or benign prostatic hyperplasia.The enlarged prostate compresses the urethra and this can cause problems with urination: needing to go to the bathroom too frequently or leaking urine.Faced with the symptoms of an adenoma, some patients may assume they have prostatitis.

Although some symptoms of prostatic hyperplasia may indeed resemble prostatitis, they are not the same.Prostatitis is an inflammation of the prostate gland.And an adenoma is an uncontrolled proliferation of prostate cells that is age-related and not associated with inflammation.

An adenoma can cause serious discomfort, so if you have problems with urination it is important to see a urologist as soon as possible.However, adenoma is not as dangerous as prostatitis, because it does not increase the risk of developing cancer.

How often is chronic bacterial prostatitis diagnosed?

According to data from generalized literature, worldwide, acute bacterial prostatitis occurs in 5-10% of cases, and chronic bacterial prostatitis in 6-10% of cases.Furthermore, both variants of chronic abacterial prostatitis account for 80-90% of all cases of the disease.

If we carry out a massive microscopic examination of the prostate gland, we will find some signs of inflammation in all men over the age of 40, without exception.But this has nothing to do with the diagnosis of “chronic bacterial prostatitis”.

There are many urological diseases that can hide behind the mask of chronic prostatitis, and some of them are quite serious and require immediate treatment.Therefore, I advise all patients with symptoms reminiscent of prostatitis to undergo a more thorough examination, which will clarify the diagnosis.

How is prostatitis diagnosed?

From the patient's point of view, the symptoms of bacterial and non-bacterial prostatitis are very similar.Without consulting a urologist and special tests, it is impossible to distinguish one form of prostatitis from another and receive quality treatment.As part of your compulsory medical insurance you can arrange a visit to the urologist free of charge or arrange a visit to the doctor in a private clinic. 

The main task of a urologist examining a patient with suspected prostatitis is to exclude other prostate diseases, such as cancer, and determine what form of the disease the person has.It is very important to distinguish chronic pelvic pain syndrome from bacterial prostatitis with a confirmed or suspected pathogen.Here's what a doctor should do to figure it out.

Ask the patient about symptoms and health.To gather more information, your doctor may suggest answering questions on a questionnaire called the Chronic Prostatitis Symptom Index.In some cases, in order not to waste time at the appointment, it makes sense to print the questionnaire and fill it out in advance.

Perform a physical exam.The doctor will examine the patient, paying particular attention to the groin area.If there are swollen and painful lymph nodes in the groin, this increases the likelihood that there is actually an inflammatory process in the body.Typically, the exam involves a digital rectal examination, which allows the doctor to evaluate the size, shape and condition of the prostate.The study helps to understand if the prostate is enlarged in size.If touching the gland is painful, it is most likely inflamed.

Is it possible to do without the digital rectal exam?

Digital rectal exam and prostate massage are not the most pleasant procedures.In acute inflammation, this can cause pain.Some patients are so eager to avoid these procedures that they refuse to make an appointment with a urologist at all.

Digital rectal examination is a diagnostic method, but massage of the prostate gland through the rectum is carried out to obtain material for laboratory analysis - prostatic secretion.If it is not possible to obtain the secretion, the doctor can replace the analysis of prostatic secretion with the analysis of the first portion of urine or with the two- and three-glass urinalysis.These tests can determine approximately where the problem area is located in the urinary tract.

Sometimes, instead of this examination, a spermiogram analysis is prescribed for the same purpose.It helps to understand whether prostatitis is an infection of the male reproductive glands and provides information on the quality of the ejaculate.Furthermore, ejaculate leukocyte counting allows differentiation of inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.

If a patient is concerned about an upcoming digital exam or prostate massage, I would suggest discussing it with their doctor.Perhaps the analysis of prostatic secretions, which requires massage, can be replaced by a urine or semen analysis.

Prescribe blood, urine and prostate secretion tests.The diagnostic standard includes a microscopic examination of prostatic secretion, a general blood test, a general urinalysis with sediment microscopy, as well as a microbiological examination of urine and prostatic secretion.

During microbiological studies, the patient's biological material is placed on a nutrient medium and it is observed which bacteria grow on it - this allows you to clarify the diagnosis.You can get tested in a private clinic for a fee or for free with compulsory medical insurance.

Other tests and examinations, such as blood total prostate specific antigen (PSA) concentration testing and transrectal ultrasound of the prostate (TRUS), are usually not performed if prostatitis is suspected.In some cases, TRUS of the prostate gland can reveal fibrosis, that is, a scar or foci resembling a malignant tumor, but such studies are not indicated for all patients without exception.

How is prostatitis treated?

Treatment depends on the type of prostatitis.If the inflammation is caused by bacteria, the doctor will prescribe antibiotics.And if bacteria have nothing to do with it, you will need medications to cope with the unpleasant symptoms of the disease.

Acute bacterial prostatitisthey begin to treat without waiting for test results - this is called empiric antibacterial therapy.In this approach, antibiotics are prescribed based on knowledge of which microbes most often cause prostate infection.

As a rule, patients are prescribed antibacterial drugs that penetrate well into the prostate tissue and act on the most "popular" pathogens of prostatitis and genitourinary infections.

People who feel more or less normal and are treated at home usually receive antibiotic tablets.And patients with high fever who are treated in hospital are more often prescribed antibiotic injections.With this treatment, in most patients with acute prostatitis, fever and pain decrease within the second to sixth day after starting treatment.

When the patient's temperature returns to normal and signs of inflammation disappear, the doctor can switch the patient from injections to tablets.The total duration of antibiotic treatment is usually around 2-4 weeks.

Sometimes prostate massage is used not only as a diagnostic method, but also as a therapeutic technique.It was once thought that this could help release excess secretions accumulated in the gland and therefore reduce swelling.However, today most experts have reached a consensus that prostate massage should be avoided in case of bacterial prostatitis.This is not only painful and unnecessary, but can also worsen the course of the disease, because through massage the bacteria can penetrate into nearby, uninfected tissues.

Chronic bacterial prostatitisalso treated with antibiotics that act on gram-negative bacteria.Fluoroquinolones are usually used for treatment;these antibiotics are considered quite safe.But if the doctor suspects that prostatitis is caused by other microorganisms, he can prescribe additional antibacterial drugs without waiting for test results.

In chronic prostatitis antibiotics must be taken for longer than in acute prostatitis.According to the recommendations of urologists, they are prescribed in a course lasting 4-6 weeks.

Chronic abacterial prostatitisit is not associated with bacteria, so patients with this disease are prescribed antibiotics only if, in addition to prostatitis, they have a urinary tract infection.

Since it is unclear what exactly causes abacterial prostatitis, treatment is primarily aimed at relieving pain during urination.To achieve this, doctors prescribe alpha-1 blockers, drugs that help relax the prostate muscles that compress the urethra.If pain persists, your doctor may prescribe nonsteroidal anti-inflammatory drugs.The dosage is selected individually for each patient.

Some patients with nonbacterial prostatitis benefit from cognitive behavioral therapy, which is the name given to sessions with a psychologist during which a person learns to cope with pain without drugs.However, there is no scientific evidence of the effectiveness of psychological assistance for abacterial prostatitis.

Studies in which researchers have attempted to demonstrate the effectiveness of other interventions, such as acupuncture, electromagnetic chair therapy, prostate massage, or transrectal heat therapy, have been poorly designed and too short in duration, usually less than 12 weeks.So it's impossible to say whether all this helps or not.

How to avoid prostatitis: prevention

The main cause of discomfort in the prostate gland is a sedentary lifestyle and lack of regular sex life.Doctors believe that men are most likely to avoid prostatitis who:

1. Practice safe sex regularly.
2. Do moderate physical activity regularly.
3. Avoid hypothermia.
4. Once they reach the age of 40, they undergo an annual urological examination.

Where is it better to treat prostatitis: in a public or private clinic?

The most important thing is that the principles of evidence-based medicine are followed when diagnosing and treating prostatitis.It just depends on the doctor and it doesn't matter where exactly you work.

Unfortunately, doctors in private clinics do not always comply with the standards of medical care.This can lead to overdiagnosis and unnecessary treatment, putting the patient at risk of overpaying.In a public medical organization, the probability of meeting all diagnostic and therapeutic standards is higher.But patients should keep in mind that a comprehensive examination will take longer, sometimes much longer than an examination in a private clinic.

Remember

1. Urinary tract problems in men are common, but are not always due to prostatitis.To understand what exactly is happening to a person, it is necessary to undergo a thorough examination.
2. Prostate problems rarely lead to erection difficulties.Usually, with prostatitis, it weakens due to psychological problems that arise against the background of unpleasant symptoms.
3. Not all forms of prostatitis are caused by bacteria: in 80-90% they have nothing to do with it.If a person with suspected prostatitis is prescribed antibiotics without further testing, this is negative.Before taking them, it makes sense to consult another doctor.
4. A person with acute or chronic prostatitis may be prescribed prostate massage to collect secretions from the glands for analysis.
5. The best way to prevent prostatitis is safe sex, a healthy lifestyle and, after the age of 40, regular urological checks by a doctor.