From the Guidelines
Prostatitis is primarily caused by bacterial infections, with Enterobacterales being the primary pathogens in acute bacterial prostatitis (ABP), while chronic bacterial prostatitis (CBP) encompasses a broader spectrum of species. The causes of prostatitis can be broken down into several types, including:
- Bacterial prostatitis, which is caused by bacterial infections, commonly Enterobacterales, as stated in the European Association of Urology guidelines 1
- Nonbacterial prostatitis, which may result from pelvic floor muscle dysfunction, urinary reflux into prostate ducts, autoimmune responses, or chemical irritation
- Chronic prostatitis/chronic pelvic pain syndrome, which has unclear causes but may involve neurological factors, psychological stress, or prior infections triggering ongoing inflammation
- Asymptomatic inflammatory prostatitis, which is typically discovered incidentally during evaluation for other conditions and doesn't require treatment unless symptoms develop
The diagnosis and treatment of prostatitis depend on the type, with bacterial forms requiring antibiotics, while non-bacterial forms may benefit from alpha-blockers, anti-inflammatories, muscle relaxants, and lifestyle modifications to reduce inflammation and relieve symptoms. According to the guidelines for the prevention, diagnosis, and management of urinary tract infections in pediatrics and adults, there is insufficient quality of evidence to enable a clear recommendation for the duration of treatment for either ABP or CBP 1. However, the optimal treatment approach should prioritize reducing morbidity, mortality, and improving quality of life, and therefore, treatment decisions should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances.
From the Research
Causes of Prostatitis
- Bacterial prostatitis is usually caused by an ascending infection, but bacteria can also be introduced during transrectal prostate biopsy 2
- The most common organisms associated with chronic bacterial prostatitis (CBP) are Escherichia coli, Klebsiella, Enterobacter, Proteus, Pseudomonas, and enterococci 3
- Patient populations who are at especially high risk of acute prostatitis include those with diabetes, cirrhosis, and suppressed immune systems 2
- Immunosuppressed patients are at risk of bacterial prostatitis caused by atypical infecting organisms, which may require additional therapies 2
- Multidrug-resistant (MDR) Escherichia coli is a common cause of acute and chronic bacterial prostatitis, and oral fosfomycin has been shown to be effective in treating these infections 4
Risk Factors
- Diabetes
- Cirrhosis
- Suppressed immune systems
- Transrectal prostate biopsy
- Multidrug-resistant (MDR) Escherichia coli
Immune Response
- The immune system fails to mount a protective response to Gram-positive or Gram-negative bacterial prostatitis, leading to chronic disease 5
- Infection induces robust proinflammatory cytokine expression and myeloid cell infiltration, but a protective adaptive response is not developed in the prostate 5