From the Guidelines
Prostatitis should be diagnosed and treated based on its type, with acute bacterial prostatitis typically requiring a 2-4 week course of antibiotics, chronic bacterial prostatitis requiring a longer 4-12 week course, and chronic pelvic pain syndrome focusing on symptom relief with alpha-blockers, anti-inflammatories, and pelvic floor physical therapy, as recommended by the European Association of Urology guidelines 1.
Diagnosis of Prostatitis
The diagnosis of prostatitis involves a thorough medical history and physical examination, with the European Association of Urology guidelines emphasizing the importance of antimicrobial stewardship to combat the rising threat of antimicrobial resistance 1. The guidelines also provide recommendations for antibiotic selection, dosing, and duration based on the latest evidence.
- For acute bacterial prostatitis (ABP), diagnosis relies on clinical presentation and laboratory tests, with a midstream urine culture recommended to guide diagnosis and tailor antibiotic treatment 1.
- For chronic bacterial prostatitis (CBP), diagnosis involves comparing bacteria levels in prostatic fluid and urinary cultures, with the Meares and Stamey 2- or 4-glass test recommended 1.
Treatment of Prostatitis
Treatment of prostatitis depends on the type, with the following recommendations:
- For ABP, a 2-4 week course of antibiotics like ciprofloxacin 500mg twice daily or trimethoprim-sulfamethoxazole 160/800mg twice daily is recommended 1.
- For CBP, a longer 4-12 week course of the same antibiotics may be necessary 1.
- For chronic pelvic pain syndrome (non-bacterial prostatitis), treatment focuses on symptom relief with alpha-blockers like tamsulosin 0.4mg daily, anti-inflammatories like ibuprofen 400-600mg three times daily, and pelvic floor physical therapy 1.
Supportive Measures
Supportive measures for all types of prostatitis include:
- Increased fluid intake
- Warm sitz baths
- Avoiding irritants like alcohol and caffeine
- Over-the-counter pain relievers Prompt treatment is important to prevent complications like abscess formation or chronic pain, as emphasized by the European Association of Urology guidelines 1 and the Wikiguidelines group consensus statement 1.
From the Research
Diagnosis of Prostatitis
- Prostatitis is a collection of signs and symptoms that occur as a result of inflammation or swelling of the prostate gland 2
- The diagnosis of prostatitis is based on history, physical exam findings, and analysis of expressed prostatic secretions 3
- Differential diagnosis of prostatitis is based on history, physical exam findings, and, frequently, analysis of expressed prostatic secretions 3
- The National Institutes of Health Classification System for prostatitis categorizes the condition into four categories: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis 4
Treatment of Prostatitis
- Effective treatment of prostatitis often depends on identification of the cause, but a microbiologic organism is not always detectable, especially in cases of chronic prostatitis 2
- Bacterial prostatitis can be acute or chronic and always requires some degree of antimicrobial therapy 2
- Fluoroquinolones are the preferred agents for treating bacterial causes of prostatitis and have demonstrated efficacy in some cases of chronic prostatitis when an organism has not been identified 2, 5
- Treatment responses to α-blockers appear to be greater with longer durations of therapy in α-blocker-naïve patients 2
- Combination therapy with an α-blocker, an anti-inflammatory, and a muscle relaxant does not appear to offer significant advantages over monotherapy 2
- Patients who have had multiple unsuccessful treatment regimens may benefit from direct stimulation of the pelvic muscles through electromagnetic or electroacupuncture therapy 2
- A therapeutic trial of antibiotics is often in order even when patients do not appear to have bacterial prostatitis, and if the patient responds to therapy, antibiotics are continued for at least three to four weeks 6