How much does it cost to treat prostatitis?

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

Any urological disease is a wake-up call, and self-medication should be excluded in this case.However, the problem is not always related to prostatitis.

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Our articles are written out of a love for evidence-based medicine.We cite reputable sources and seek reviews from reputable doctors.But remember: You and your doctor are responsible for your health.We don’t prescribe, we give advice.It's up to you whether you believe our point of view.

How does the prostate work?

The prostate, or prostate, is a walnut-shaped organ located just below the bladder.Between the two halves of the "nut" is the urethra, a tube through which urine is drained from the bladder and sperm is drained from the testicles.

Key tasks of the prostateIncluding the production of secretions that are part of semen.Due to this secretion, sperm are able to move.The second job of the prostate is to contract to ensure ejaculation, or ejaculation.

Next to the prostate are the seminal vesicles, which are connected to the vas deferens, through which sperm leave the genitals.The seminal vesicles produce the fluid portion of sperm and store prostate secretions.

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

Prostate problems don't always cause erection problems

In the vast majority of cases, sexual dysfunction is not related to prostate problems because there is no physical connection between the prostate and the erectile mechanism.

But urinary disturbances, discomfort from incomplete emptying of the bladder, pain or discomfort related to inflammation can cause a person to become tense and embarrassed.As a result, psychological problems can arise - often negatively affecting erections.

What does prostatitis look like?

Prostatitis is inflammation of the prostate associated with pathogenic microorganisms or other non-infectious causes.Sometimes inflammation also affects the seminal vesicles – this is called seminal vesiculitis.

At the same time, prostate inflammation does not always cause pain and urinary problems, and the presence of unpleasant symptoms is not necessarily related to inflammation of the gland.

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

To keep it simple, classification divides prostatitis into bacterial and non-bacterial, that is, not related to bacteria.This approach can help doctors make important decisions about whether to prescribe antibiotics and other medications.It would be incorrect to give antibiotics to all patients with suspected prostatitis because nonmicrobial forms of prostatitis are more common than bacterial forms of prostatitis.Taking unnecessary antibiotics is harmful to your health.

The NIDDK classification identifies five forms of prostatitis.

Acute bacterial prostatitis.A disease most commonly caused by pathogens typical of urinary tract infections: such as E. coli, Klebsiella, and Enterobacteriaceae.

Generally, the disease begins suddenly and is accompanied by a general deterioration in health.When the body temperature rises to 38-39°C, some people will feel weakness, severe pain or burning sensation in the perineum, scrotum or anus, lower abdomen, and sometimes muscles.Some people experience pain during ejaculation.Sometimes with bacterial prostatitis, you will experience frequent urination, difficulty urinating, and painful urination.

Chronic bacterial prostatitis.The disease may also be caused by microorganisms typical of acute prostatitis.The disease is considered chronic if symptoms persist for at least three months.

The symptoms of chronic bacterial prostatitis are similar to acute prostatitis but may be less severe or less severe.There is usually no fever or weakness, and the pain in the lower abdomen is more stabbing than sharp, but it is difficult to start urinating and completely emptying the bladder.In addition, unpleasant symptoms may disappear temporarily and reappear after a while.

Any man can suffer from acute and chronic bacterial prostatitis.But those most at risk are those who are at higher risk for exposure to the bacteria: people who have sex without a condom (especially anal sex), people with urinary tract infections, and people who have recently had surgery or a prostate biopsy.

Chronic nonbacterial prostatitis associated with inflammation.The symptoms of inflammatory nonbacterial prostatitis are very similar to acute and chronic bacterial prostatitis.In this case, the semen, prostate, and urine will be free of pathogenic bacteria, but the concentration of white blood cells will be high - indicating inflammation of the prostate.

Chronic nonbacterial prostatitis, or chronic pelvic pain syndrome, is not associated with inflammation.Symptoms are also similar to acute and chronic bacterial prostatitis.At the same time, the semen, prostate, and urine were free of pathogenic bacteria and had a high concentration of white blood cells—a sign that the prostate was not inflamed.

With nonbacterial prostatitis, it is not always possible to identify the cause of the disease.Risk groups are also difficult to identify.

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

How is prostatitis different from prostate adenoma?

In about 8 percent of men, after age 40, the prostate begins to enlarge, which is called a prostatic adenoma or benign prostatic hyperplasia.An enlarged prostate can put pressure on the urethra, which may cause urinary problems: going to the bathroom too often or leaking urine.Faced with the symptoms of adenoma, some patients may think they have prostatitis.

While some symptoms of prostatic hyperplasia may indeed resemble prostatitis, they are not the same thing.Prostatitis is inflammation of the prostate.Adenoma is an age-related, uncontrolled proliferation of prostate cells that is not associated with inflammation.

Adenomas can cause severe discomfort, so it's important to consult a urologist as soon as possible if you have urinary problems.However, adenoma is still not as dangerous as prostatitis because it does not increase the risk of cancer.

How often is chronic bacterial prostatitis diagnosed?

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

If we perform a large-scale microscopic examination of the prostate, we will find that all men over the age of 40, without exception, have some signs of inflammation.But this has nothing to do with the diagnosis of "chronic bacterial prostatitis."

There are many urinary tract conditions that may hide behind the mask of chronic prostatitis, some of which are very serious and require immediate treatment.Therefore, I recommend that all patients with symptoms of prostatitis undergo a more detailed examination, which will confirm the diagnosis.

How is prostatitis diagnosed?

From a patient's perspective, the symptoms of bacterial and nonbacterial prostatitis are very similar.It is impossible to distinguish one type of prostatitis from another and receive quality treatment without consulting a urologist and performing special tests.You can make a free appointment with a urologist under the compulsory health insurance policy, or with a doctor in a private clinic. 

The urologist's main task when seeing a patient with suspected prostatitis is to rule out other prostate diseases, such as cancer, and to determine which disease the person has.It is important to differentiate between chronic pelvic pain syndrome and bacterial prostatitis with confirmed or suspected causative agents.Here's what doctors should do to find out.

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

Get a physical exam.The doctor will examine the patient, paying special attention to the groin area.If you have swollen, painful lymph nodes in your groin, this increases the likelihood that an inflammatory process does exist in your body.Typically, the exam includes a digital rectal exam, which allows your doctor to evaluate the size, shape, and condition of your prostate.This study helps understand whether the prostate is increasing in size.If the glands are painful to touch, they are most likely inflamed.

Is it possible to skip a digital rectal examination?

Digital rectal exams and prostate massages 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 altogether.

A digital rectal examination is a diagnostic method in which the prostate is massaged through the rectum to obtain material for laboratory analysis - prostate secretions.If the secretions cannot be obtained, the doctor may substitute analysis of the prostate secretions with an analysis of the first part of the urine or a two- and three-cup urine test.These tests can roughly determine where the problem area is in the urinary tract.

Sometimes, a spermogram analysis is performed instead of this test for the same purpose.It helps to understand whether prostatitis is part of a male reproductive gland infection and provides information about the quality of ejaculation.Additionally, counting white blood cells in ejaculate can differentiate between inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.

If patients are concerned about an upcoming digital exam or prostate massage, I recommend discussing it with their healthcare provider.Perhaps prostate secretion analysis, which requires massage, could be replaced by urine or semen analysis.

Blood, urine, and prostate secretion tests are done.Diagnostic criteria include microscopic examination of prostate secretions, general blood tests, general urine tests with microscopic examination of sediments, and microbiological examination of urine and prostate secretions.

During microbiological studies, the patient's biological material is placed on a nutrient medium and the bacteria growing on it are observed - this can clarify the diagnosis.You can have a test at a private clinic for a fee or for free under compulsory health insurance.

If prostatitis is suspected, other tests and examinations, such as a total prostate-specific antigen (PSA) concentration test in the blood and a transrectal prostate ultrasound (TRUS), are usually not performed.In some cases, TRUS of the prostate can reveal fibrosis, that is, scarring or lesions that resemble malignancy, but such studies are not suitable for all patients without exception.

How is prostatitis treated?

Treatment depends on the type of prostatitis.If the inflammation is caused by bacteria, your doctor will prescribe antibiotics.If bacteria are not involved, you will need medication to help deal with the unwanted symptoms of the disease.

acute bacterial prostatitisThey do not need to wait for test results before starting treatment - this is called empiric antimicrobial therapy.In this approach, antibiotics are prescribed based on knowledge of which microbes most commonly cause prostate infections.

Typically, patients are prescribed antibacterial drugs, which 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 are often given antibiotic pills.People with high fevers treated in hospitals more often receive antibiotic injections.With this treatment, most patients with acute prostatitis experience less fever and pain within the second to sixth day after starting the medication.

When the patient's temperature returns to normal and signs of inflammation disappear, doctors can switch the patient from injections to pills.The total duration of antibiotic treatment is usually about 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 that had accumulated in the glands, thereby reducing their swelling.Today, however, most experts have reached consensus that prostate massage should be avoided for bacterial prostatitis.Not only is this painful and useless, but it also worsens the course of the disease because, as a result of the massage, bacteria can enter adjacent uninfected tissue.

chronic bacterial prostatitisAlso used as an antibiotic for the treatment of Gram-negative bacteria.Treatment is usually with fluoroquinolones; these antibiotics are considered fairly safe.But if your doctor suspects that prostatitis is caused by other microorganisms, he may prescribe additional antibacterial drugs without waiting for test results.

Chronic prostatitis requires antibiotics for a longer period of time than acute prostatitis.Their courses last 4-6 weeks, based on the urologist's recommendations.

chronic nonbacterial prostatitisIt is not related to bacteria, so patients with this disease will only take antibiotics if they also have a urinary tract infection in addition to prostatitis.

Because it's unclear exactly what causes nonbacterial prostatitis, treatment is primarily aimed at relieving pain during urination.To accomplish this, doctors will 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.Dosage is chosen individually for each patient.

Some patients with nonbacterial prostatitis benefit from cognitive behavioral therapy, which is the name for a treatment with a psychologist during which a person learns to cope with the pain without taking medications.However, there is no scientific evidence that psychological assistance is effective for non-bacterial prostatitis.

Studies in which researchers have attempted to demonstrate the effectiveness of other interventions such as acupuncture, electromagnetic chair therapy, prostate massage, or transrectal thermotherapy were poorly designed and too short in duration—often less than 12 weeks.So it's impossible to say whether all this helps.

How to avoid prostatitis: Prevention

The main causes of prostate discomfort are a sedentary lifestyle and lack of regular sex life.Doctors believe that men who have the best chance of avoiding prostatitis are:

1. Practice safe sex regularly.
2. Get regular, moderate exercise.
3. Avoid hypothermia.
4. Once they reach the age of 40, they should receive an annual urology exam.

Where is better to treat prostatitis - public clinic or private clinic?

The most important thing is that the diagnosis and treatment of prostatitis should follow the principles of evidence-based medicine.It just depends on the doctor - it doesn't matter where exactly he works.

Unfortunately, doctors in private practice do not always adhere to medical standards of care.This can lead to overdiagnosis and unnecessary treatment, putting patients at risk of paying exorbitant amounts.In public healthcare organizations, the likelihood of meeting all diagnostic and treatment criteria is higher.But patients need to consider that a complete exam will take longer - sometimes much longer than an exam in a private clinic.

remember

1. Male urinary tract problems are common but are not always caused by prostatitis.To understand what is really going on with a person, you need to do a thorough examination.
2. Prostate problems rarely cause erection difficulties.Often, prostatitis is attenuated by psychological problems that arise against the background of unpleasant symptoms.
3. Not all forms of prostatitis are caused by bacteria: 80-90% of prostatitis has nothing to do with bacteria at all.It's bad if a man with suspected prostatitis is prescribed antibiotics without additional testing.Before taking them, it makes sense to consult with another doctor.
4. People with acute or chronic prostatitis may undergo prostate massage to collect glandular secretions for analysis.
5. The best ways to prevent prostatitis are protected sex, a healthy lifestyle, and regular urology exams with your doctor after 40 years.