The Role Of Antibiotics In The Treatment Of Chronic Prostatitis: A Consensus Statement
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Natural Ways To Relieve Prostatitis Symptoms
1. Take Quercetin
Quercetin is a type of flavonoid antioxidant that helps to reduce inflammation and pain associated with nonbacterial prostatitis. Research suggests that quercetin can be helpful for men with bladder or prostate symptoms and pelvic floor pain or spasms.
In one study, 500 milligrams of quercetin was administered twice a day for four weeks. Patients with chronic prostatitis showed significant improvement and reduced inflammation over the placebo group.
2. Try Bee Pollen
Studies show that bee pollen may be effective in prostatic conditions because of its anti-inflammatory, analgesic and anti-androgen effects. In fact, the efficacy of bee pollen has been compared to anti-inflammatory drugs like naproxen and indomethacin. According to research published in Evidence-Based Complementary and Alternative Medicine, clinicians confirm that, in nonbacterial prostate inflammations, pollen improves the condition of patients by effectively removing the pain.
The most common way to use bee pollen is to mix ground pollen with foods, like cottage cheese, yogurt, juices or smoothies. To reduce inflammation and boost your prostate health, I suggest taking 1 teaspoon of ground pollen three times a day.
3. Take Saw Palmetto
You can find saw palmetto capsules in most health food stores. Make sure the product label indicates that the contents are standardized and contain 85 to 95 percent fatty acids and sterols.
4. Avoid Inflammatory Foods
5. Eat Healing Foods
Recommendations For A General Approach
Although evidence to support them is scarce, the following recommendations are offered. If the history and physical examination suggest prostatitis, physicians may consider a diagnostic test, such as the four-glass test or the PPMT. In most cases, empiric antibiotic therapy is reasonable whether or not the diagnostic test proves a bacterial cause. Common choices include TMP-SMX, doxycycline or one of the fluoroquinolones. Treatment is often recommended for four weeks, although some clinicians use shorter courses. Physicians should encourage hydration, treat pain appropriately and consider the use of NSAIDs, an alpha-blocking agent, or both. If symptoms persist, a more thorough evaluation for CNP/CPPS should be pursued. Some patients may need several trials of different therapies to find one that alleviates their symptoms.
The term prostatitis describes a wide spectrum of conditions with variable etiologies, prognoses and treatments. Unfortunately, these conditions have not been well studied, and most recommendations for treatment, including those given here, are based primarily on case series and anecdotal experience. For these reasons, many men and their physicians find prostatitis to be a challenging condition to treat.
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Chronic Prostatitis/chronic Pelvic Pain Syndrome
Chronic prostatitis/chronic pelvic pain syndrome produces similar symptoms to the bacterial form of the condition, but its causes are unknown. It was previously called chronic nonbacterial prostatitis.
CP/CPPS is the more common type of chronic prostatitis. According to a 2016 study, CP/CPPS cases make up at least 90 percent of chronic prostatitis cases.
The symptoms of both the bacterial form of chronic prostatitis and CP/CPPS are very similar. They usually start out mild and build in intensity over time.
Musculoskeletal pain and constipation are also possible.
Seek medical attention if you have any of these symptoms. Your doctor can rule out serious conditions or help you get started on an appropriate therapy, if necessary.
Both types of chronic prostatitis have multiple possible causes.
How Common Is Prostatitis
Prostatitis is the most common urinary tract problem for men younger than age 50 and the third most common urinary tract problem for men older than age 50.1 Prostatitis accounts for about two million visits to health care providers in the United States each year.2
Chronic prostatitis or chronic pelvic pain syndrome is
- the most common and least understood form of prostatitis.
- can occur in men of any age group.
- affects 10 to 15 percent of the U.S. male population.3
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Modulation Of Inflammatory Process
Since the early 2000s, the immunological mechanisms responsible for chronic inflammation in CP/CPPS have been exhaustively explored. Not surprisingly, many different factors seem to be involved. In vivo and in vitro CP/CPPS studies24,25 showed a sort of autoimmunity against prostate cells inducted by the inflammation, with the recruiting leukocytes including Th1 cells and mast cells, which enhance and trigger the development of CPPS,26 in a similar way to that described for rheumatoid arthritis, multiple sclerosis, and inflammatory bowel diseases.27,28
Thus, medications able to interrupt this molecular mechanism can have a primary therapeutic role.
An RCT by Zhao et al29 demonstrated the efficacy of celecoxib over placebo for pain modulation however, symptoms suddenly re-presented after treatment discontinuation. Another trial failed to demonstrate a benefit from oral prednisolone administration over 4 weeks.30 Similarly, studies involving monoclonal antibodies did not show significant clinical CPPS improvement.31 Common anti-inflammatory drugs seem to give rapid relief of symptoms but only for a short period . This limits the application of these drugs to acute phases of the disease, without the possibility for long-term administration. Moreover, their well-known side effects further limit their applicability for pain reduction in CP/CPPS.
Treating Prostatitis Effectively: A Challenge For Clinicians
Nhuan Nguyen, PharmD, MBA, CHEClinical PharmacistGR Health, Georgia Regents Medical CenterAugusta, GeorgiaCharlie Norwood VA Medical CenterAugusta, GeorgiaUniversity of Georgia College of PharmacyAthens, Georgia
US Pharm. 2014 39:35-40.
ABSTRACT: Prostatitis, which affects 5% to 9% of males and occurs mostly in middle age, is classified based on signs and symptoms, with urinary urgency, frequency, and pain typical in nearly all categories. Most physicians are not familiar with prostatitis, particularly chronic prostatitis associated with chronic pelvic pain syndrome . Accordingly, patients are often misdiagnosed and receive ineffective treatment, resulting in poor quality of life. CP/CPPS is challenging to treat, as its causes are not clearly defined and the antibiotics used for therapy have low effective rates. Clinical pharmacists can contribute significantly to patient care by advising physicians and other medical professionals regarding drug efficacy, adverse drug reactions, and drug interactions, and by assisting in the selection of optimal antibiotics and/or treatment regimens for prostatitis.
Prostatitis , which occurs in 5% to 9% of males aged 18 years and older, most often develops in middle age.1 In the early 1990s, prostatitis accounted for about 1% and 8% of office visits to family practitioners and urologists, respectively.1
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What Are The Risk Factors For Chronic Nonbacterial Prostatitis
The cause of chronic nonbacterial prostatitis is unknown. This makes it difficult to predict who is at risk for this condition. However, research into the cause is ongoing. Once a cause is discovered, doctors will be able to identify risk factors and target treatment.
request a urine sample to look for infection.
During a prostate exam, your doctor will insert a lubricated, gloved finger into your rectum. They do this so they can feel for a tender, soft, or swollen prostate, which indicates inflammation or infection. Depending on the results of your exam, your doctor may perform the following:
- prostate ultrasound
- tests to rule out a sexually transmitted infection
- studies to evaluate urine flow
- further evaluation of the urinary tract
What Is Chronic Nonbacterial Prostatitis
Chronic nonbacterial prostatitis, also known as chronic pelvic pain syndrome, is a common condition that affects men. It causes pain and inflammation in the prostate, pelvis, and the lower urinary tract. The prostate gland is located right below the bladder in men. It produces fluid that helps transport sperm. In the United States, chronic nonbacterial prostatitis affects around
- sexual dysfunction
- genital pain after urination
Dont ignore any of the symptoms of chronic nonbacterial prostatitis. Instead, make an appointment with your doctor. There are a variety of treatments that may help.
National Institutes of Health describes four categories of prostatitis:
- Acute bacterial prostatitis happens when bacteria, like sexually transmitted organisms, cause an infection in the prostate. Symptoms typically develop suddenly, and usually respond well to antibiotics.
- Chronic bacterial prostatitis is an ongoing problem. Its also more difficult to treat. Its often associated with ongoing urinary tract infections.
- Asymptomatic inflammatory prostatitis has no symptoms. Its usually discovered while undergoing other tests. It appears to be more common in men who smoke and drink regularly .
- Chronic prostatitis/chronic pelvic pain syndrome is the most common type of prostatitis. But the exact cause is unknown. It causes a variety of symptoms that can be difficult to treat. Doctors suspect it may be due to a prior infection or a small injury that causes inflammation.
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Diagnosing Chronic Bacterial Prostatitis
To make a diagnosis, your doctor will review your medical history and perform a physical exam to look for swollen lymph nodes near the groin or fluid discharge from the urethra.
Your doctor will also perform a digital rectal exam to examine the prostate. During this test, they will insert a lubricated and gloved finger into your rectum to look for signs of infection, such as a soft or enlarged prostate.
Your doctor may also use the following tests and techniques:
Antibiotics are the main course of treatment for this condition. Theyre usually taken for 4 to 12 weeks. For many people, treatment will last for 6 weeks.
First-line treatment is typically a fluoroquinolone antibiotic, such as ciprofloxacin , ofloxacin, or levofloxacin.
However, fluoroquinolones can increase your risk for a ruptured Achilles tendon, which is why they are no longer considered a preferred treatment.
Other commonly prescribed antibiotics include:
- sulfamethoxazole/trimethoprim , another first-line treatment
- tetracycline antibiotics, such as doxycycline or azithromycin
Tetracyclines are commonly used in cases where a doctor identifies or suspects chlamydia or mycoplasma genitalium. Like chlamydia, mycoplasma genitalium is an STI.
The antibiotic that youre prescribed will ultimately depend on which bacterium is causing your prostatitis.
What Happens If Antibiotics Don’t Work For Prostatitis
This type of prostatitis is hard to treat, and the infection may come back. If antibiotics don’t work in 4 to 12 weeks, you may need to take a low dose of antibiotics for a while. In rare cases, you may need surgery to remove part or all of the prostate. This may be done if you have trouble emptying your bladder.
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Clinical Presentation And Diagnostic Evaluation
ABP typically presents abruptly with voiding symptoms and distressing but poorly localized pain and is often associated with systemic findings . Clinicians should enquire about urogenital disorders, recent genitourinary instrumentation, and new sexual contacts. Only 5% of men with ABP develop CBP, and 2% develop a prostatic abscess. CBP usually presents with more-prolonged urogenital symptoms. The hallmark is relapsing UTI , but < 50% of patients with CBP have this history . Between symptomatic UTIs, patients may be asymptomatic, despite ongoing prostatic infection.
Physical examination should include obtaining vital signs and examining the lower abdomen , back , genitalia, and rectum. Digital prostate palpation in ABP can cause discomfort and can potentially induce bacteremia but is safe if done gently. In ABP, the gland is typically tender, swollen, and warm, whereas in CBP, there may be some tenderness, softening , firm induration, or nodularity.
When To Get Medical Advice
They’ll ask about the problems you’re having and examine your tummy.
You may also have a rectal examination. This is where a doctor inserts a gloved finger into your bottom to feel for anything unusual. You may have some discomfort during this examination if your prostate is swollen or tender.
Your urine will usually be tested for signs of infection, and you may be referred to a specialist for further tests to rule out other conditions.
See a GP straight away if you get sudden and severe symptoms of prostatitis.
You may have acute prostatitis, which needs to be assessed and treated quickly because it can cause serious problems, such as suddenly being unable to pee.
If you have persistent symptoms , you may be referred to a doctor who specialises in urinary problems .
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Ways To Relieve Prostatitis Symptoms
If youre like many adult men, youve thought about your prostate health at some point in your life. Its an important issue because 90 percent of men experience some kind of problem with their prostate by the time they are 70 years old. And one of these problems is prostatitis.
Prostatitis is a common condition that involves inflammation or an infection of the prostate gland. Its estimated that prostatitis symptoms affect 35 to 50 percent of men during their lifetime. And unlike an enlarged prostate and prostate cancer, which commonly affect older men, prostatitis affects men of all ages, especially those between the ages of 20 and 40.
Can Complementary Therapies Help
Many men find complementary therapies help them deal with their symptoms and the day-to-day impact of their prostatitis, helping them feel more in control. Some men find they feel more relaxed and better about themselves and their treatment.
Complementary therapies are usually used alongside medical treatments, rather than instead of them. Some complementary therapies have side effects and some may interfere with your prostatitis treatment. So tell your doctor or nurse about any complementary therapies youre using or thinking of trying.
You should also tell your complementary therapist about your prostatitis and any treatments youre having, as this can affect what therapies are safe and suitable for you.
Some GPs and hospitals offer complementary therapies. But if you want to find a therapist yourself, make sure they are properly qualified and belong to a professional body. The Complementary and Natural Healthcare Council have advice about finding a therapist.
The following are examples of complementary therapies that some men use.
Be very careful when buying herbal remedies over the internet. Many are made outside the UK and may not be high-quality. Many companies make claims that arent based on proper research. There may be no real evidence that their products work, and some may even be harmful. Remember that even if a product is natural, this doesnt mean it is safe. For more information about using herbal remedies safely visit the MHRA website.
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The Upoint Clinical Phenotyping System For Cpps
The most widely adopted questionnaire for clinical evaluation of CPPS is the National Institutes of Health Chronic Prostatitis Symptom Index .16 This tool, validated in 1999, is composed of nine different questions investigating pain, urinary symptoms, and QoL related to CPPS. In 2009, Shoskes et al17 proposed a dedicated clinical classification of CPPS, to separately identify the different possible reported symptoms. It considers: Urinary symptoms Psychosocial dysfunction Organ-specific findings Infection Neurological/systemic and Tenderness of muscles .
The understanding of this clinical phenotyping system for CP/CPPS can explain why this disease has a wide multifactorial genesis, potentially different in each patient, therefore generating an individual multifaceted complex of symptoms for every patient diagnosed with CP/CPPS. A review by Magistro et al23 analyzed 28 randomized controlled trials evaluating various treatments for CP/CPPS, and underlined that monotherapy is never enough to achieve symptom relief and that the therapeutic approach should focus on the different symptomatic pattern presented by the patient in a multimodal setting.
Different phenotypes of chronic prostatitis/chronic pelvic pain syndrome according to the UPOINT classification system,17,20 with the most relevant research work cited in the text.
Causative Pathogens In Prostatitis
Aerobic gram-negative bacilli are the predominant pathogens in bacterial prostatitis. E. coli cause 50%80% of cases other pathogens include Enterobacteriaceae , Enterococcus species , and nonfermenting gram-negative bacilli . Some debate the role of gram-positive organisms other than enterococci , but most accept Staphylococcus and Streptococcus species as pathogens . The increasing prevalence of gram-positive pathogens may represent changing disease epidemiology or acceptance of their pathogenicity by health care providers. Limited data suggest that obligate anaerobes may rarely cause chronic prostatitis .
Some cases of prostatitis are caused by atypical pathogens . A large prospective study of men with chronic prostatitis found that 74% had an infectious etiology the most common isolates were Chlamydia trachomatis and Trichomonas vaginalis , whereas 5% of patients had infection due to Ureaplasma urealyticum . Classical bacterial uropathogens were found in 20% of patients, and more patients with these pathogens, compared with patients with nonbacterial pathogens, had prostatic specimens with leukocytes . Other possible prostatitis pathogens include Mycoplasma genitalium, Neisseria gonorrhoeae, Mycobacterium tuberculosis, various fungi, and several viruses .
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How Do You Test For Prostatis
How is prostatitis diagnosed?
Coping With A Chronic Condition
Chronic nonbacterial prostatitis/chronic pelvic pain syndrome can be an ongoing, painful condition. Exercise and pelvic floor physical therapy may improve your symptoms. According to the American Urological Association, having prostatitis does not increase your risk of prostate cancer.
To cope with anxiety or depression triggered by chronic pain and inflammation, talk with your doctor about treatments to improve your mental health. Other treatments may include anxiety medication and antidepressants. Joining a support group, getting private counseling, or participating in behavioral therapy can also help you cope with the condition.
Last medically reviewed on August 25, 2017
- Chronic prostatitis. .
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