Disease Description (Causes and Symptoms)
- Definition summary: A condition involving chronic inflammation of the prostate (chronic bacterial prostatitis generally corresponds to type II in the NIH classification).
- Main causes: Ascending urinary tract infection (penetration into the prostate through the urethra), urinary reflux into the prostate, persistent infection/biofilm caused by prostatic stones or calcification, sexually transmitted pathogens (such as Chlamydia and gonococci), intestinal bacteria, etc. Viruses, protozoa, autoimmune factors, and psychological factors (stress) may also be involved. A decrease in antibacterial factors in prostatic fluid (e.g., zinc) is associated with recurrence.
- Pathophysiology summary: Chronicity develops because persistent retention of pathogens and inflammatory responses, fibrosis and secretory dysfunction of prostatic tissue, urinary reflux, and biofilm formation make it difficult for antimicrobial agents to reach the site.
- Main symptoms: Pain or discomfort in the perineum, pelvis, scrotum, or tip of the urethra; urinary frequency·urinary frequency·urgency·nocturia·difficulty urinating·sensation of incomplete emptying; pain during ejaculation or abnormal discharge; sexual dysfunction (such as erectile dysfunction and premature ejaculation); and general malaise. Symptoms may worsen with excessive alcohol consumption, overwork, long-distance driving, or prolonged sitting.
Treatment Methods
- Antibiotics
- The principle is to use targeted antibiotics according to the causative organism. Select an agent with good penetration into the prostate (mainly fluoroquinolones (ciprofloxacin, levofloxacin) or trimethoprim-sulfamethoxazole, etc.).
- In cases of chronic bacterial prostatitis, administer for a relatively long period (generally at least 4–6 weeks, and 6–12 weeks if necessary). Extend or change treatment according to the treatment course and culture results.
- Fluoroquinolones may cause side effects such as tendinitis·tendon rupture, central nervous system effects (insomnia·mood changes), and QT prolongation — caution is required in patients with risk factors.
- Adjunctive medications and nonpharmacological treatment
- Alpha-blockers (reduce urethral·bladder outlet pressure and improve urinary symptoms) — may help relieve symptoms and reduce recurrence.
- NSAIDs or other analgesics (pain control).
- Pelvic floor physical therapy, biofeedback, and electrical stimulation therapy (relaxation of pelvic muscle tension and pain relief).
- Sitz baths (half-body baths), regular rest, adjustment of sexual activity, and lifestyle improvements such as avoiding excessive alcohol consumption, caffeine, and spicy foods.
- Rarely, if persistent mechanical obstruction or periprostatic lesions (such as an abscess) are present, surgical treatment (such as drainage or prostatectomy) may be considered.
- Special situations
- If specific pathogens such as Trichomonas or fungi are suspected, metronidazole or an antifungal agent may be considered.
- In cases of repeated recurrence or negative cultures, a multidisciplinary approach (anti-inflammatory treatment·analgesia·physical therapy·psychotherapy) is needed.
- Precautions / risk of complications / self-management
- Follow antibiotic prescription instructions and do not stop them arbitrarily (risk of resistance and recurrence).
- Report antibiotic side effects (gastrointestinal symptoms, skin reactions, tendon symptoms, etc.) immediately. In particular, when taking fluoroquinolones, stop taking the medication and consult a healthcare professional if tendon pain or sudden muscle weakness occurs.
- Because prolonged pain and sexual problems may be accompanied by psychological stress and depression, mental health support is recommended when necessary.
- Complications: Prostatic abscess, recurrent urinary tract infections, reduced quality of life due to chronic pelvic pain syndrome, and, rarely, urinary retention and sexual dysfunction.
Checklist Before an Outpatient Visit (Including Items to Bring and Example Questions)
- Items to bring (take to the appointment)
- A list of currently used medications (including prescription drugs·OTC medications·supplements) (medication name, dosage, and duration of use).
- Copies of previous urination·prostate test results, if available (urine culture, prostatic fluid tests, blood tests, and previous imaging findings).
- A symptom diary (symptom onset date·location and severity of pain (pain scale)·urination pattern·painful ejaculation·fever, etc.), including aggravating and relieving factors.
- Sexual history (including sexually transmitted infection risk factors), bowel habits (whether constipation is present), and any recent catheter use or history of urethral procedures.
- Tests that may be performed in the outpatient setting
- Urinalysis and urine culture, prostatic fluid (EPS) after prostate massage and pre- and post-massage urine tests (4-glass test or simplified culture test), blood tests (such as inflammatory markers), and pelvic ultrasound/CT if necessary.
- Items to self-check before the appointment (mark if present)
- Fever·chills·whether there has been acute worsening (urgent evaluation is required if acute symptoms occur).
- Recent history of antibiotic use and whether it was effective.
Examples of General Questions to Ask the Doctor
- What are the main side effects of this medication (the prescribed antibiotic), and what should I be careful about?
- How long is the expected treatment period, and when can I expect symptoms to improve?
- What lifestyle changes or preventive measures can reduce recurrence?
- If my symptoms do not improve or worsen, what are the next tests or treatments?
Examples of Condition-Specific Questions
- Is antibiotic treatment necessary even though no organism was detected on the culture test? (Ask about treatment criteria and expected benefits when the culture is negative.)
- If pain during ejaculation or sexual problems persist, could this affect fertility or long-term sexual function? (Consult about the risk of infertility and preservation of sexual function.)