Prostatitis: how to recognize the disease

Inflammation of the prostate gland is one of the main urological problems in men under 50 years of age. Ten to twelve percent of all representatives of the stronger sex have experienced symptoms of prostatitis at least once in their lives. The disease can appear in an acute and chronic form, on which its signs and symptoms directly depend.

What is prostatitis

Prostatitis is a term meaning inflammation of the prostate gland.The prostate gland or prostate gland is an organ of the male reproductive system. Its normal size does not exceed the size of a walnut. The gland is located below the bladder, in front of the rectum. The prostate surrounds the urethra, the tube through which urine and sperm leave the body. Its main function is the production of a secretion (prostatic juice) that maintains the vital activity of the sperm after ejaculation.

The inflammatory process in the prostate gland can be caused by infection, as well as by various other reasons.

Types and first signs of the disease

The first signs and further symptoms will depend on the type of prostatitis. In total, clinicians distinguish 4 varieties.

1. Acute bacterial prostatitis: Caused by a bacterial infection, it usually has a sudden onset that can resemble flu-like symptoms. This is the least common of the four types of prostatitis.
2. Chronic bacterial prostatitis: Characterized by recurrent bacterial infections of the prostate gland. There may be few or no symptoms between attacks, so it can be difficult to treat successfully.
3. Chronic prostatitis/chronic pelvic pain syndrome: Most cases of prostatitis fall into this category, but at the same time, this type is the least understood. It can be characterized as inflammatory or non-inflammatory, depending on the presence or absence of infection-fighting cells—antibodies in urine, semen, and prostate secretions. It is often impossible to pinpoint a specific cause. Symptoms may come and go or be intermittent.
4. Asymptomatic inflammatory prostatitis: This disease is often diagnosed incidentally during treatment for infertility or prostate cancer. People with this form of prostatitis do not complain of symptoms or discomfort, but tests show the presence of infectious cells in the prostate secretion.

Main symptoms

Symptoms associated with prostatitis can vary depending on the underlying cause of the disease.Common, gradually increasing symptoms include:

• pain or burning when urinating (dysuria);
• difficulty urinating, such as a thin stream of urine or slow, intermittent urination;
• frequent urination, especially at night (nocturia - going to the toilet more than 2 times a night);
• urgent urge to urinate.

An important symptom is pain that may occur or radiate to different areas of the lower body. She can be:

• in the rectum (rectally), sometimes combined with constipation;
• in the abdomen and/or lower back;
• in the perineum - between the scrotum and the rectum.

Patients often report discomfort in the penis and testicles. Painful ejaculation is characteristic, and in addition, prostatitis can be accompanied by sexual dysfunction.

A rapid and severe onset is usually characteristic of the acute bacterial form, which is distinguished by an additional complex of symptoms similar to that which occurs during the influenza virus.This:

• fever and chills;
• general malaise and body aches;
• enlarged lymph nodes;
• sore throat.

If the patient ignores the first signs of the disease and does not seek help from a urologist-andrologist, then there are dangerous cases of purulent complications. Acute infectious prostatitis can develop into a severe form of pathology when the prostate tissue becomes covered with pustules or abscesses. Symptoms include the following:

• cloudy urine or blood in the urine;
• discharge from the urethra;
• bad smelling urine and discharge.

If he finds initial signs of inflammation, the man should immediately consult a doctor for further diagnosis.

Diagnostic methods

Prostatitis is usually diagnosed by laboratory testing of a urine sample and examination of the prostate gland by a urologist.This test involves palpating the prostate through the rectum to check for any abnormalities. Sometimes the doctor takes and examines a sample of prostate secretion. To obtain it, the urologist massages the gland during a rectal examination. Because there is concern that the procedure may release bacteria into the bloodstream, this test is contraindicated in cases of acute bacterial prostatitis.

The urologist also measures body temperature in the armpit and rectally, then compares the results. During acute prostatitis, the temperature in the anus will differ upwards by about 0. 5 degrees.

Laboratory researches

Laboratory tests that may be ordered include:

• clinical analysis of blood and urine;
• bacterioscopy and culture of urine sediment and prostate secretion - examination of samples under a microscope for the presence of bacteria;
• spots of discharge from the urethra (if there is discharge);
• determining the level of prostate specific antigen (PSA).

If the clinical blood test shows an increased level of leukocytes (from 10-12 per visual field), this will indicate the presence of inflammation. Acute infectious prostatitis is characterized by an increase in neutrophils, a type of white blood cell whose main function is to destroy pathogenic bacteria. There is also a decrease in the level of eosinophils (below 1% of all leukocytes), another group of leukocytes that is responsible for protecting the body from proteins of foreign origin. The sedimentation reaction of erythrocytes or red blood cells is another indicator of a general clinical blood test and also indicates the presence of a pathological process in the body if its value exceeds 10 mm / h. The rate of sedimentation of these blood cells increases with an increase in the concentration in the blood plasma of markers of the inflammatory process: fibrinogen proteins and immunoglobulins, as well as C-reactive protein.

Bacterioscopy of urine sediment and prostate secretion will show the presence and number of pathological microorganisms in these biological fluids, and thanks to the antibiotic sensitivity culture, the type of bacteria will be established for further treatment selection. The causative microorganism can be determined, among other things, by taking a swab of discharge from the urethra for microscopic examination.

The prostate-specific antigen test is a screening test in the form of an intravenous blood test for a protein that is produced exclusively by prostate cells. The norm of the protein depends on the age of the man and ranges from 2. 5 ng/ml for ages 41–50 years to 6. 5 ng/ml for men over 70 years. An increase in the level of this protein above the age norm means the need for a biopsy - tissue analysis for oncology. However, excess protein content can also be observed due to inflammation of the prostate gland.

PSA levels can also be slightly elevated with a benign enlargement (adenoma) of the prostate and as a result of urinary tract infections.

Age-related PSA norms - table

Age category	PSA norm
Under 40 years old	less than 2. 5 ng/ml
40-49 years old	2. 5 ng/ml
50-59 years	3. 5 ng/ml
60-69 years	4. 5 ng/ml
Over 70 years	6. 5 ng/ml

Instrumental studies

Since none of the tests or analyzes individually gives a full guarantee of a correct diagnosis, other methods - instrumental - can be used as part of the overall diagnosis. They include:

1. Urodynamic examination of the bladder- a complex instrumental method using special equipment allows you to determine whether the bladder is completely emptied, the rate of urine flow, the pressure inside the bladder and urethra, as well as to assess the effect of prostatitis on normal urination. The test is recommended for people with chronic urinary problems: irregular or thin stream, incontinence, frequent urination, etc. It is also indicated in patients with prolonged inflammation of the prostate gland, especially when standard therapy is ineffective. Before the examination, a special catheter-sensor is inserted into the patient's urethra in a horizontal position, which is also connected to measuring equipment. Then he is asked to drink a certain amount of pure water, simultaneously recording the feeling of a full bladder, the first urge to urinate, the presence of urine leakage, etc. The patient is then transferred to a specially equipped chair, on which he willit must be relieved while still under the control of sensors and equipment making the necessary measurements. The procedure consists of several stages, each of which takes about half an hour. The results of the urodynamic examination are given to the patient immediately after its completion.

2. Ultrasound Imaging (US)- the method is used for the diagnosis of existing diseases, and is also indicated in men after 45 years annually as a prevention of prostatitis and other gland diseases. The examination is carried out in the morning on an empty stomach using an ultrasound machine through the front abdominal wall with a bladder filled with clean water, as well as by introducing a special sensor at a depth of 5–7 cm into the rectum (rectal method) or through the urethra. The procedure is absolutely safe and allows you to determine the contour, size and condition of individual areas of the prostate gland. The volume of a healthy prostate is approximately 20-25 cm³. The maximum length, width and thickness are 3. 5 cm, 4 cm and 2 cm respectively.
3. Magnetic resonance imaging (MRI)- the method allows you to examine in detail the structure, density, condition and even blood flow of the prostate; sometimes, for a better view, an additional contrast agent is injected intravenously. The examination is also carried out to differentiate prostatitis from oncology. The MRI machine is a large cylinder surrounded by a magnet, into which a medical table with a patient slides like a tunnel. The person should wear loose clothes without metal elements and refrain from heavy food 10-12 hours before the procedure. Before the examination, it is mandatory to remove watches, jewelry and any other metal objects. If the patient has metal-containing implants or cardiac devices in the patient's body, the diagnostic method with MRI is contraindicated. To perform the procedure, a transrectal sensor is most often used (although it is also possible without it), and the rectum was previously cleaned with an enema. The nurse places the sensor and secures it with a special disposable cuff. During the entire duration of the examination, which is about 30 minutes, the patient should lie as still as possible. The procedure is painless.

4. Cystoscopy- examination of the mucous membranes of the urethra and bladder using a cystoscope - a long narrow catheter with a bulb and a camera at the end under local anesthesia. The procedure is performed after the bladder is filled. The duration of the cystoscopy is about 15 minutes. The method allows you to assess the condition of the urinary tract, excluding other possible diseases that cause problems with urination.
5. Prostate biopsy- a procedure is necessary if, after a comprehensive examination, the doctor suspects a malignant process in the prostate. It must be excluded or confirmed in order to choose a treatment tactic. The procedure is performed on an outpatient basis by inserting a puncture needle through the patient's rectum and taking a sample of prostate tissue. A local anesthetic is injected into the anus, then when it takes effect, an ultrasound probe with a needle is inserted into the intestine. Under ultrasound monitoring, the surgeon determines the places from which it is necessary to "pinch off" material for analysis. Usually there are up to 18 different points on the organ. The biopsy does not cause pain, after the anesthesia wears off, only slight discomfort is possible.

If the patient experiences repeated episodes of urinary tract infection and prostatitis, the specialist will prescribe a complete comprehensive examination of the genitourinary system to identify anatomical abnormalities.

Differential diagnosis

Symptoms of acute prostatitis can resemble inflammation of the bladder or urethra. In all cases, symptoms include painful and frequent urination. But acute prostatitis is distinguished by vivid symptoms of general intoxication and admixture of pus in urine and secretions. Palpation of the prostate will be painful and will reveal an increase in the size of the gland, which will not occur with cystitis or urethritis.

Doctors say inflammation of the prostate does not increase the risk of prostate cancer.

Chronic inflammation of the prostate gland should be differentiated in young men with anogenital symptom complex and vegetative urogenital syndrome. These diseases can only be distinguished by analyzing prostate secretions for the presence of bacteria. In men over 45 years of age, it is necessary to rule out oncology and adenoma of the prostate, which in the initial stages are most often asymptomatic, unlike inflammation of the prostate. For a more detailed analysis, the urologist will prescribe a PSA test and then, if necessary, a biopsy.

Prostatitis can be an acute bacterial disease that is often easily treated with antibiotics, or a chronic disease that recurs and requires constant medical monitoring and control. In any case, only a specialist in the field of urology and andrology can correctly diagnose the disease.