Subject: sci.med.prostate.prostatitis FAQ 2/5
Supersedes: <medicine/prostatitis-faq/part2_825706942@rtfm.mit.edu>
Date: 1 Apr 1996 18:14:43 GMT
References: <medicine/prostatitis-faq/part1_828382217@rtfm.mit.edu>
X-Last-Updated: 1996/01/29

Posting-Frequency: monthly


5.  What are the symptoms of prostatitis?

There are a variety of symptoms, but most of them involve urinary
problems and/or pain in the region of the prostate.

Symptoms can include:
     pain in the perineum (the area between the anus and the base
          of the penis), or in the testicles, penis, lower stomach
          or lower back
     pain during or after ejaculation
     pain when urinating
     frequent urination
     a feeling of urgency when the bladder is not full
     difficulty in starting urination
     getting up frequently during the night to urinate
     a narrowed or split urine stream
     blood in the urine
     blood in the semen

Symptoms may be continual or recurrent.  Prostatitis is ill-
defined; any otherwise unexplained urinary or sexual dysfunction
may be related to prostatitis.  
  
6.  How is prostatitis distinguished from BPH and prostate cancer?

Some of the same symptoms may be caused by BPH or prostate cancer. 

To tell the difference, a doctor may perform a digital rectal exam
(putting a rubber-gloved finger up the rectum to feel the outside
of the prostate for lumps and size) and/or order a PSA (prostate-
specific antigen) blood test.  Both prostatitis and prostate cancer
can cause a rise in PSA levels.  In some cases, a biopsy may be
done to rule out prostate cancer.

If cancer is not found and if the prostate is of an appropriate
size, prostatitis can be assumed to be the problem.  A cystoscopy,
in which a tube is inserted (under anesthesia) through the penis to
look at the prostate from the inside is sometimes done to determine
if there is inflammation.  During a digital rectal exam, the doctor
may press on the prostate to force out some of the fluid; the fluid
can be examined for inflammatory cells.  

7.  How common is prostatitis?

It is estimated that at least 40% of men's visits to urologists are
caused by prostatitis.  It can affect young men, while BPH and
prostate cancer are more typical of older men.  Because prostatitis
varies in severity and because it has attracted little attention
from researchers, no one knows how many men suffer from it.  It has
been estimated by the urologist, Thomas Stamey, that fifty percent
of men will experience symptoms of prostatitis during their
lifetimes, and the National Center for Health Statistics reported
that of the visits of men to the doctor for urogenital problems,
twenty-five percent were for prostatitis.  A pathologist, John E.
McNeal, found prostatitis lesions in 40 of 91 men at random
autopsy.  A University of Illinois Professor of Urology, R.
Sharifi, believes that prostatitis is the most common disease of
middle aged men.  In a National Prostate Cancer Education Survey of
500,000 men of all ages, 28% reported at least one bout of
prostatitis in their past--remarkable, since the prostatitis lesion
and prostate cancer occur in the same anatomic location.  When men
that are biopsied for high PSA's and do not have prostate cancer,
over 50% of them have prostatitis lesions.  

8.  Are there different kinds of prostatitis?

Currently it is thought that of all cases of prostatitis 5% are
clearly bacterial and 95% are "non-bacterial" (with the caveat that
"non-bacterial" prostatitis may be due to chlamydia, mycoplasma,
ureaplasma, anaerobic bacteria, or as yet an unidentified
bacteria.)  Basically, 5% of prostatitis is said to be bacterial
and the other 95% is "idiopathic" or unexplained.

Most discussion of prostatitis divides it into four types. 
However, they are often hard to tell apart, and the dividing lines
are often not clear.  

Acute bacterial prostatitis comes on quickly, can cause intense
pain, fever, and chills, and can require hospitalization, but is
usually cured quickly with antibiotics.

Chronic bacterial prostatitis is less intense, but is not cured
quickly.  Examination of the urine and prostatic fluid,
particularly via the Meares and Stamey technique, indicate that
disease-causing bacteria are present in the prostate.  The
condition may clear up after several months of antibiotics, or it
may not.

The symptoms of chronic nonbacterial prostatitis are the same, but
no disease-causing bacteria can be identified.  Signs of
inflammation are seen.

In prostatodynia (which means simply "prostate pain"), there is no
sign of inflammation, even though there is pain in the prostate.

Because of the limits of diagnostic tests (including the Meares and
Stamey technique), it is not clear that the last three categories
are distinct.  Another way of categorizing prostatitis is as being
either "high white blood cell count" or "low blood cell count"
prostatitis, depending on the number of white blood cells--
indicating infection--which show up in the prostatic fluid under a
high powered microscope.  This is called the Drach classification.

9. What causes prostatitis?

A leading research has called prostatitis has been called "a
wastebasket of clinical ignorance."  In most cases, its causes are
not clearly known.

The presence of disease-causing bacteria and response to antibiotic
treatment is strong evidence that many cases of prostatitis are
caused by bacterial infection.  Since antibiotics do not diffuse
readily into the prostate and since some bacteria appear to defend
themselves with slime coatings, lack of consistent success with
antibiotics does not necessarily mean that most cases of the
disease are not caused by bacterial infection.  The basic test for
infective organisms in the prostate is still the Meares and Stamey
technique, in which urine samples are taken before and after
prostate massage.  Since some level of bacteria are always present,
the results of this test are often inconclusive.

Some researchers believe that many cases of prostatitis are caused
by autoimmune reactions, and autoimmune prostatitis has been
demonstrated in laboratory animals.  

Some doctors think that some cases are caused by a backflow of
urine into the prostate, caused by anatomical factors or overly
rushed urination.  Others believe that decreased sexual activity
can lead to prostatitis, as the prostate becomes "clogged up." 
Another theory is that some cases of prostatitis or prostatodynia
are caused by too much tension in the urinary sphincter.   

And it is possible that many cases diagnosed as prostatitis without
a full range of tests are caused by other conditions, such as
interstitial cystitis or ejaculatory duct obstruction.

John Koch  (KOCH@macc.wisc.edu)
Reference Librarian/Documents Coordinator
Steenbock Memorial Library, University of Wisconsin-Madison
550 Babcock Dr.
Madison, WI 53706-1293
Phone: (608)263-4581    Fax: (608) 263-3221


