What is the prostate gland?
The prostate gland is part of the male reproductive system and is similar in shape and size to a chestnut and is located between the bladder and the base of the penis. The urethra passes through the center of the prostate, and urine from the bladder and semen from the gonads pass through the urethra to exit the body. If the prostate is enlarged, it can compress the urethra and interfere with the flow of urine, causing much discomfort and pain; if the prostate is inflamed, there will be a burning sensation during urination.
What diseases are likely to occur in the prostate gland?
There are three main types of diseases that occur in the prostate gland.
The first is prostate cancer. The incidence rate is extremely high in Europe and the United States, and it ranks second only to skin cancer among American men. In recent years, with the aging of our population and the continuous improvement of clinical detection techniques in hospitals, the number of prostate cancer detections has also shown a significant upward trend.
Second, benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy. bph is a non-cancerous increase in the size of the prostate gland, and the chances of bph increasing with age, it can cause a variety of urinary symptoms, including urinary tract obstruction.
Third, prostatitis. That is, inflammation that occurs in the prostate gland and is the disease that will be discussed in this brochure. Like BPH, prostatitis is not associated with cancer, but can produce a range of bothersome symptoms.
What is prostatitis?
Prostatitis is an inflammation involving the prostate and its surrounding area and can be divided into several types based on clinical presentation and laboratory tests, each of which has a corresponding set of symptoms. The symptoms caused by prostatitis are mild and severe and vary greatly. Some patients have significant pain, while others suffer from prostatitis but have no significant discomfort, and the rest of the patients have symptoms that fall somewhere between the two. Even patients with only mild symptoms can have a negative impact on quality of life, especially if symptoms persist or recur. Some patients with chronic prostatitis have recurrent symptoms that come and go. Although not all cases of prostatitis can be completely cured, symptoms can usually be effectively relieved with treatment.
What are the symptoms of prostatitis?
Some people have prostatitis but have no obvious symptoms of discomfort; others have symptoms similar to those of a urinary tract infection. These symptoms include painful urination, inability to empty the bladder or a significant increase in the frequency of urination compared to normal (also called frequency). When urinary frequency is significant, patients urinate more often at night, often disrupting sleep.
There are other symptoms of prostatitis, including pain in the penis, testicles or other parts of the pelvis, pain during or after ejaculation, and in some patients with acute prostatitis, chills and fever.
Of course, other diseases can also present the symptoms mentioned above, which is why it is necessary to see a medical professional to determine if you have prostatitis, what type of prostatitis you have, and what treatment is best to choose.
How is prostatitis diagnosed?
Doctors often use the National Institutes of Health Chronic Prostatitis Symptom Inventory (NIH-CPSI) when diagnosing prostatitis, and this scoring system is described in more detail later in this booklet. The scoring system lists a series of questions about the symptoms of prostatitis and the degree of distress the patient is experiencing. By filling out the form carefully and discussing the results with your doctor, you are able to participate in the diagnosis process. During treatment, your doctor will also ask you to answer the questions listed on the form again to determine the effectiveness of the treatment by comparing the results of the symptom scores before and after treatment.
In addition to asking you to fill out a rating form, your doctor will also ask you about your medical history and perform a physical examination, which includes a DRE (rectal examination). The doctor may massage your prostate during the examination to obtain a sample of prostate fluid. After prostate massage, prostatic fluid (EPS) is drained through the external urethral opening, collected and examined under a microscope. The urine can also be examined and cultured under a microscope. Some doctors will also examine a sample of your blood or semen. The doctor’s goal with these tests is to see if there are microorganisms, white blood cells, or other evidence of infection.
When a patient does not have an acute infection, cystoscopy may also be applied to rule out other conditions with symptoms similar to prostatitis. A cystoscope has a light source and a magnifying lens that is inserted into the urethra and eased into the bladder under direct vision, allowing visualization of the bladder and prostate.
The doctor may also perform other tests if needed, such as uroflowmetry (the rate of urine flow during urination) and residual urine volume measurement (the amount of urine left in the bladder after urination).
Types of Prostatitis
Diagnosing prostatitis is a challenging task because its symptoms overlap with many other diseases. It is important to determine not only whether the patient has prostatitis, but also what type of prostatitis the patient has. The following are the four common types.
1. Acute bacterial prostatitis
This is the least common but the easiest type to diagnose. As the name suggests, it is caused by a bacterial infection and has a very sudden onset. Patients have severe symptoms and usually present to the hospital soon. Symptoms include painful urination, inability to urinate, pain in the lumbosacral, abdominal or pelvic areas, and sometimes the patient may have chills or high fever.
2. Chronic Bacterial Prostatitis
The symptoms are similar to those of acute bacterial prostatitis, but are less severe and develop slowly. The symptoms include painful urination, pain in the genitals, lumbosacral area, abdomen and pelvic area, frequent urination, urgent urination and weakness in urination. A small number of patients can have no symptoms, or symptoms can come and go over a long period of time.
3. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)
This type of diagnosis can be made when the patient has symptoms of prostatitis but no evidence of bacterial infection. Sometimes this type of prostatitis can also be referred to as prostatodynia. Symptoms include pain in the genitals, pelvic region, difficulty urinating and or painful urination, and sometimes pain during or after ejaculation.
4. Asymptomatic Infectious Prostatitis
Despite the inflammation of the prostate, patients with this type are usually asymptomatic. It is usually discovered incidentally during examination for other diseases. These patients usually have evidence of infection obtained through prostate biopsy tissue, or in urine, semen and prostate fluid specimens. For example, an elevated prostate-specific antigen (PSA) level usually indicates the possibility of prostate cancer and requires a prostate biopsy to rule out prostate cancer, resulting in a pathology that suggests a prostate gland infection. This type of patient usually does not require special treatment because there are no other uncomfortable symptoms, but when the patient also has other disorders such as infertility, anti-inflammatory treatment is required.
Etiology of prostatitis
The cause of prostatitis is not fully understood, and there are many explanations for the mechanism by which prostatitis occurs. Many patients with prostatitis can find clear evidence of prostate infection through examination, and specific causative organisms can be found through prostate fluid or semen examination. These pathogenic bacteria most likely come from the urine and reflux into the prostate through the prostatic ducts that open in the urethra, leading to prostatitis.
Non-bacterial prostatitis can also be caused by pathogenic microorganisms other than bacteria, such as Chlamydia trachomatis and mycoplasma, which are usually transmitted through sexual contact.
Other etiologies include abnormalities in the patient’s autoimmune system; irritation caused by reflux of urine through the prostatic ducts into the prostate; and nerve and muscle dysfunction or structural abnormalities in the bladder neck. Chronic pelvic pain syndrome may be associated with interstitial cystitis, a specific type of cystitis characterized by unexplained bladder irritation, urinary frequency and lower abdominal pain.
There are specific causes that can increase the risk of developing prostatitis. These include injury to the prostate, bladder infection, insertion of a urinary catheter or other medical device through the urethra.
How do I choose the right doctor?
In developed countries abroad, patients usually first visit a community physician who performs a physical examination to assess the patient’s symptoms and rule out the possibility of a urinary tract infection or other disease. After the initial diagnosis the community physician refers the patient to a urologist or male surgeon for further diagnosis and treatment. Prostatitis is a disorder of the male reproductive system and requires the help of a specialist for consultation and treatment. Based on the current situation in China, it is recommended that patients go to a regular public hospital and choose a urologist or male surgeon to see them.
How is prostatitis treated?
Different types of prostatitis are treated differently. The first line of treatment for bacterial prostatitis is still the application of antibiotics. Patients with acute bacterial prostatitis sometimes need to be hospitalized and treated with antibiotics given strictly through the vein. When a patient responds poorly to antibiotic therapy, the doctor will make prompt adjustments and change to another type of antibiotic.
The duration of antibiotic application depends on the type of prostatitis the patient has and the characteristics of the antibiotic chosen. During the period of antibiotic use, you should strictly follow your doctor’s instructions and never stop antibiotics early on your own when there is relief from symptoms.
In addition to applying antibiotics, your doctor may sometimes recommend that you take a-blockers (such as Cordovan, Halo, etc.). This medication can relax the muscles around the prostate and bladder outlet, relieving the muscle spasm and tension that occurs during urination, and can effectively reduce dyspareunia and painful urination.
Some people have found that symptoms can be reduced by prostate massage. The doctor will insert his index finger into the patient’s rectum and after clearly touching the prostate, he will apply his finger to gently massage the prostate. When the prostate fluid flows out of the urethra, the patient will feel relief from the symptoms as the pressure in the prostate is relieved. The actual fact is that you will be able to get a lot more than just a couple of hours of work.
There are several other options that are recommended for discomfort caused by prostatitis. The non-steroidal anti-inflammatory drugs (such as anti-inflammatory pain, aspirin, celecoxib, etc.) help reduce inflammation and relieve pain and are available in pharmacies and hospitals; hot water sitz baths and other heat therapy methods can also reduce discomfort; if the patient feels uncomfortable sitting, add a pillow or expandable air cushion to the seat; bicyclists can make the necessary adjustments to the angle of the seat or replace it with a suitable seat.
Stress reduction is also helpful in relieving symptoms, including relaxation training and biofeedback therapy. Preliminary research suggests that acupuncture treatment may also reduce symptoms.
In addition, some patients find that they feel more comfortable when they discontinue caffeine, alcohol, and spicy/acidic stimulating foods.