Prostatitis: how to recognize the disease

Prostatitis is one of the main urological problems of men under the age of 50. Ten to twelve percent of the representatives of the stronger sex have experienced the symptoms of prostatitis at least once in their lives. The disease can occur in an acute or chronic form, on which its signs and symptoms directly depend.

What is prostatitis

Prostatitis is a term that means inflammation of the prostate gland.The prostate gland or prostate gland is an organ of the male reproductive system. Its normal size does not exceed the size of a walnut. The gland is located below the bladder, in front of the rectum. The prostate surrounds the urethra, the tube through which urine and sperm leave the body. Its main function is the production of secretion (prostatic juice), which supports the vital activity of spermatozoa after ejaculation.

The inflammatory process of the prostate can be caused by infection as well as many other reasons.

Types of the disease and first signs

The first signs and further symptoms depend on the type of prostatitis. Overall, clinicians distinguish 4 types.

1. Acute bacterial prostatitis: Caused by a bacterial infection, it usually comes on suddenly and can resemble flu-like symptoms. It is the least common of the four types of prostatitis.
2. Chronic bacterial prostatitis: It is characterized by recurrent bacterial infections of the prostate. There may be little or no symptoms between attacks, so it can be difficult to treat successfully.
3. Chronic prostatitis/chronic pelvic pain syndrome: Most prostatitis falls into this category, but this type is the least known. It can be characterized as inflammatory or non-inflammatory, depending on the presence or absence of infection-fighting cells - antibodies found in urine, semen and prostate secretions. It is often impossible to pinpoint a single specific cause. Symptoms may come and go or remain intermittent.
4. Asymptomatic inflammatory prostatitis: This disease is often diagnosed accidentally during treatment for infertility or prostate cancer. People with this type of prostatitis do not complain of symptoms or discomfort, but tests show the presence of infectious cells in the secretions of the prostate.

Main symptoms

Symptoms related to prostatitis can vary depending on the underlying cause of the disease.Common, gradually increasing symptoms are:

• pain or burning when urinating (dysuria);
• difficulty urinating, such as a thin stream of urine or slow, intermittent urination;
• frequent urination, especially at night (nocturia - going to the toilet more than twice at night);
• urge to urinate.

An important symptom is pain, which may occur or radiate to different areas of the lower body. He can be:

• in the rectum (rectal), sometimes combined with constipation;
• in the abdomen and/or lower back;
• in the perineum - between the scrotum and the rectum.

Patients often report discomfort in the penis and testicles. Painful ejaculation is typical, and prostatitis can also be accompanied by sexual dysfunction.

The acute bacterial form is usually characterized by a rapid and severe onset, distinguished by an additional set of symptoms similar to those occurring during the influenza virus.This:

• fever and chills;
• general malaise and body aches;
• enlarged lymph nodes;
• sore throat.

If the patient ignores the first signs of the disease and does not seek help from a urologist-andrologist, there are dangerous cases of purulent complications. Acute infectious prostatitis can become a serious pathological form when the prostate tissue is covered with pustules or abscesses. Symptoms include:

• cloudy urine or blood in the urine;
• discharge from the urethra;
• bad smelling urine and secretions.

If the man notices the initial signs of inflammation, immediately consult a doctor for further diagnosis.

Diagnostic methods

Prostatitis is usually diagnosed by laboratory testing of a urine sample and examination of the prostate gland by a urologist.This test involves palpating the prostate through the rectum to check for any abnormalities. Sometimes the doctor collects and tests a sample of the discharge from the prostate. To obtain it, the urologist massages the gland during a rectal examination. Because of concern that the procedure may release bacteria into the bloodstream, this test is contraindicated in acute bacterial prostatitis.

The urologist measures the body temperature in the armpit and the rectum, and then compares the results. During acute prostatitis, the temperature of the anus increases by about 0. 5 degrees.

Laboratory tests

The laboratory tests that can be ordered are the following:

• clinical blood and urine analysis;
• bacterioscopy and culture of urine sediment and prostate secretion - microscopic examination of samples for the presence of bacteria;
• discharge from the urethra smears (if there is discharge);
• determination of the prostate specific antigen (PSA) level.

If the clinical blood test shows an increased level of leukocytes (10-12 per field of view), this indicates the presence of inflammation. Acute infectious prostatitis is characterized by an increase in the number of neutrophils, a type of white blood cell whose main task is to destroy pathogenic bacteria. The level of eosinophils also decreases (below 1% of all leukocytes), another group of leukocytes responsible for protecting the body against proteins of foreign origin. The erythrocyte sedimentation reaction, or red blood cells, is another indicator of the general clinical blood test, and also indicates the presence of a pathological process in the body if its value exceeds 10 mm/hour. The sedimentation rate of these blood cells increases with the increase in the concentration of markers of the inflammatory process in the blood plasma: fibrinogen proteins and immunoglobulins, as well as C-reactive protein.

Bacterioscopy of urine sediment and prostatic secretions reveals the presence and number of pathological microorganisms in these biological fluids, and thanks to the cultivation of antibiotic sensitivity, the type of bacteria is determined for the further selection of treatment. The causative microorganism can be determined, among other things, by taking a smear from the urethra for microscopic examination.

The prostate-specific antigen test is a screening test in the form of an intravenous blood test to detect a protein produced exclusively by prostate cells. The protein norm depends on a man's age and ranges from 2. 5 ng/ml for men aged 41-50 to 6. 5 ng/ml for men over 70. An increase in the level of this protein above the age norm means that a biopsy - oncological tissue analysis - is required. However, excessive protein content can also be observed due to inflammation of the prostate.

PSA levels may be slightly elevated due to benign enlargement of the prostate (adenoma) and urinary tract infections.

Age-related PSA norms - table

Age category	PSA norm
They are under 40 years old	less than 2. 5 ng/ml
They are 40-49 years old	2. 5 ng/ml
They are 50-59 years old	3. 5 ng/ml
They are 60-69 years old	4. 5 ng/ml
Over 70 years old	6. 5 ng/ml

Instrumental studies

Since none of the individual tests or analyzes provide a complete guarantee of the correct diagnosis, other – instrumental – methods can also be used as part of the overall diagnosis. These include:

1. Urodynamic examination of the bladder- a complex instrumental method performed with special equipment makes it possible to determine whether the bladder is completely emptied, the rate of urine flow, the pressure inside the bladder and urethra, as well as the assessment of the effect of prostatitis on normal urination. This test is recommended for people with chronic urinary tract problems: intermittent or thin urination, incontinence, frequent urination, etc. It is also indicated for patients with long-standing prostatitis, especially when the usual therapy is ineffective. Before the examination, a special catheter sensor is inserted into the patient's urethra in a horizontal position, which is also connected to a measuring device. Then they ask you to drink a certain amount of clean water, simultaneously recording the feeling of a full bladder, the first urge to urinate, the presence of urine leakage, etc. Then the patient is transferred to a specially equipped chair, on which he must relieve himself, while still under the control of sensors and equipment that performs the necessary measurements. The procedure consists of several stages, each of which takes about half an hour. The patient receives the results of the urodynamic examination immediately after its completion.

2. Ultrasound Imaging (USA)- the method is used to diagnose existing disorders and is recommended for men over the age of 45 annually to prevent prostatitis and other glandular diseases. The examination is performed in the morning on an empty stomach with an ultrasound machine through the front abdominal wall with a bladder filled with clean water, and by inserting a special sensor 5-7 cm deep into the rectum (rectal method), orthrough the urethra. The procedure is completely safe and allows you to determine the contour, size and condition of certain areas of the prostate gland. The volume of a healthy prostate is about 20-25 cm³. The maximum length, width and thickness are 3. 5 cm, 4 cm and 2 cm.
3. Magnetic resonance imaging (MRI)- the method enables a detailed study of the structure, density, condition and even blood flow of the prostate; sometimes additional contrast material is injected intravenously for a better view. The examination is also carried out to differentiate prostatitis and oncology. The MRI machine is a large cylinder surrounded by a magnet, into which a medical table with a patient slides in like a tunnel. 10-12 hours before the procedure, the person should wear loose clothes without metal fittings and refrain from eating heavy food. Be sure to remove watches, jewelry, and all other metal objects before the test. If the patient has metal-containing implants or cardiac devices in his body, the MRI diagnostic method is contraindicated. To perform the procedure, a transrectal sensor is most often used (although it is possible without it), after the rectum has been cleaned with an enema. The nurse inserts the sensor and secures it with a special disposable cuff. During the entire duration of the examination, which is approximately 30 minutes, the patient must lie as still as possible. The procedure is painless.

4. Cystoscopy- examination of the mucous membrane of the urethra and bladder with a cystoscope - a long, narrow catheter with a light bulb and a camera at the end under local anesthesia. The procedure should be performed after the bladder is full. The cystoscopy takes about 15 minutes. The method makes it possible to assess the condition of the urinary tract, excluding other possible diseases that cause urination problems.
5. Prostate biopsy- a necessary procedure if, after a comprehensive examination, the doctor suspects a malignant process in the prostate. To choose a treatment tactic, it must be excluded or confirmed. The procedure is performed on an outpatient basis, with a needle inserted through the patient's rectum and a sample of prostate tissue is taken. A local anesthetic is injected into the anus, and if it has worked, an ultrasound probe is inserted into the intestine with a needle. In addition to ultrasound guidance, the surgeon determines the places from which the material needed for the analysis should be "plucked". There are usually up to 18 different points on the organ. The biopsy does not cause pain, only mild discomfort is possible after the anesthesia wears off.

If the patient experiences recurrent urinary tract infections and prostatitis, the specialist prescribes a full, comprehensive examination of the urogenital system to identify anatomical abnormalities.

Differential diagnosis

Symptoms of acute prostatitis may resemble inflammation of the bladder or urethra. In all cases, symptoms include painful and frequent urination. However, acute prostatitis is distinguished by the vivid symptoms of general intoxication and the mixture of pus in the urine and secretions. Palpation of the prostate will be painful and will reveal an increase in the size of the gland, which is not the case with cystitis or urethritis.

According to doctors, prostatitis does not increase the risk of prostate cancer.

A distinction must be made between chronic inflammation of the prostate in young men with anogenital syndrome and vegetative urogenital syndrome. These diseases can only be distinguished by analyzing prostate secretions for the presence of bacteria. In men over 45 years of age, oncology and prostate adenoma, which are most often asymptomatic in the initial stage, unlike prostatitis, should be excluded. For a more detailed analysis, the urologist prescribes a PSA test and, if necessary, a biopsy.

Prostatitis can be an acute bacterial disease, which is often easily treated with antibiotics, or a chronic disease that recurs and requires constant medical monitoring and control. In any case, only a urological and andrological specialist can correctly diagnose the disease.