Prostatitis: how to recognize the disease?

Inflammation of the prostate is one of the most common urological problems in men under 50 years of age. Ten to twelve percent of all representatives of the stronger sex have experienced symptoms of prostatitis at least once in their lives. The disease can occur in acute and chronic forms, from which its signs and symptoms directly depend.

What is Prostatitis?

Prostatitis is an inflammation of the prostate.The prostate or prostate is an organ of the male reproductive system. Its normal size does not exceed the size of a walnut. The gland is located under 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 (prostate juice), which supports the vital activity of sperm after ejaculation.

The inflammatory process in the prostate can be caused by an infection or various other causes.

Types and first signs of the disease

The first signs and further symptoms depend on the type of prostatitis. In total, clinicians differentiate between 4 variants.

1. Acute bacterial prostatitis: Caused by a bacterial infection and usually comes on suddenly, which may resemble flu-like symptoms. This is the least common of the four types of prostatitis.
2. Chronic bacterial prostatitis: Characterized by recurrent bacterial infections of the prostate. There may be little or no symptoms between attacks, so successful treatment can be difficult.
3. Chronic prostatitis/chronic pelvic pain syndrome: Most cases of prostatitis fall into this category, but at the same time this type is the least understood. It can be characterized as inflammatory or non-inflammatory depending on the presence or absence of infection-fighting cells - antibodies in urine, semen and prostatic secretions. It is often impossible to determine 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 form of prostatitis do not experience any discomfort or discomfort, but tests show the presence of infectious cells in the prostatic secretion.

Main symptoms

The symptoms associated with prostatitis can vary depending on the underlying cause of the disease.Common, gradually increasing symptoms include:

• pain or burning when urinating (dysuria);
• Difficulty urinating, e. g. B. a thin stream of urine or sluggish, intermittent urination;
• frequent urination, especially at night (nocturia – going to the toilet more than twice a night);
• urgent need to urinate.

An important symptom is pain that can occur or radiate to various areas of the lower body. She could be:

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

Patients often report discomfort in the penis and testicles. Painful ejaculation is characteristic, and prostatitis can also be associated with sexual dysfunction.

The acute bacterial form is usually characterized by a rapid and severe course, which is characterized by an additional symptom complex that is similar to that which occurs with the influenza virus.The:

• 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, dangerous cases of purulent complications arise. Acute infectious prostatitis can develop into a severe form of pathology if the prostate tissue is covered with pustules or abscesses. Symptoms include:

• cloudy urine or blood in the urine;
• discharge from the urethra;
• bad smell of urine and discharge.

If he notices the first signs of inflammation, a man should immediately consult a doctor for further diagnostics.

Diagnostic methods

Prostatitis is usually diagnosed through a laboratory examination of a urine sample and an examination of the prostate by a urologist.This exam involves palpating the prostate through the rectum to check for any abnormalities. Sometimes the doctor takes and tests a sample of the prostate secretions. To do this, the urologist massages the gland during a rectal examination. Because there are concerns that the procedure could introduce bacteria into the bloodstream, this test is contraindicated in acute bacterial prostatitis.

The urologist also measures the body temperature in the armpit and rectum and then compares the results. In acute prostatitis, the temperature in the anus fluctuates by about 0. 5 degrees.

Laboratory tests

The following laboratory tests can be ordered:

• clinical blood and urine analysis;
• Bacterioscopy and culture of urine sediment and prostatic secretions – examination of samples under a microscope for the presence of bacteria;
• a smear of discharge from the urethra (if there is discharge);
• Determination of prostate specific antigen (PSA) levels.

If a clinical blood test shows an increased level of leukocytes (of 10-12 per field of view), this indicates the presence of inflammation. Acute infectious prostatitis is characterized by an increase in neutrophils, a type of white blood cell whose main function is to destroy pathogenic bacteria. There is also a decrease in the level of eosinophils (less than 1% of all leukocytes), another group of leukocytes responsible for protecting the body from proteins of foreign origin. The sedimentation reaction of erythrocytes or red blood cells is another indicator of a general clinical blood test and also indicates the presence of a pathological process in the body if its value exceeds 10 mm / h. The sedimentation rate of these blood cells increases with an 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 secretion indicates the presence and number of pathological microorganisms in these biological fluids and thanks to culture for sensitivity to antibiotics, the type of bacteria can be determined for further selection of treatment. The causative microorganism can be determined, among other things, by microscopic examination of a swab of discharge from the urethra.

The prostate-specific antigen test is a screening test in the form of an intravenous blood test for a protein produced exclusively by prostate cells. The protein norm depends on the age of the man and ranges from 2. 5 ng/ml for the age group 41–50 years to 6. 5 ng/ml for men over 70 years old. An increase in the level of this protein above the age norm means the need for a biopsy - a tissue analysis for oncology. However, increased protein levels can also occur due to inflammation of the prostate.

The PSA value can also rise slightly if there is a benign enlargement (adenoma) of the prostate and as a result of urinary tract infections.

Age-related PSA norms - table

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

Instrumental studies

Since none of the tests or analyzes individually provides a complete guarantee of a correct diagnosis, other methods - instrumental - can also be used as part of a comprehensive diagnosis. These include:

1. Urodynamic examination of the bladder- A complex instrumental method using special devices allows you to complete theTo determine the emptying of the bladder, the speed of urine flow, the pressure in the bladder and urethra, and also to assess the effect of prostatitis on normal urination. This study is recommended for people with chronic urinary problems: intermittent or thin stream, incontinence, frequent urination, etc. It is also indicated for patients with long-term inflammation of the prostate gland, especially when standard therapy is ineffective. Before the examination, a special catheter sensor is inserted in a horizontal position into the patient's urethra, which is also connected to measuring devices. Next, he is asked to drink a certain amount of clean water while recording the feeling of a full bladder, the first urge to urinate, the presence of urine leaks, etc. Subsequently, the patient is placed on a specially equipped chair in which he must relieve himself while still under the control of sensors and devices that take the necessary measurements. The procedure consists of several steps, each lasting about half an hour. The results of the urodynamic study are communicated to the patient immediately after completion.

2. Ultrasound Imaging (USA)- The method is used to diagnose existing diseases and is also indicated annually for men over 45 years old to prevent prostatitis and other glandular diseases. The examination is carried out in the morning on an empty stomach using an ultrasound device through the anterior abdominal wall with a bladder filled with clear water and by inserting a special sensor 5-7 cm deep into the rectum (rectal method) or through the urethra. The procedure is completely safe and allows the contour, size and condition of individual areas of the prostate to be determined. The volume of a healthy prostate is approximately 20-25 cm³. The maximum length, width and thickness are 3. 5cm, 4cm and 2cm respectively.
3. Magnetic resonance imaging (MRI)- This method allows you to examine in detail the structure, density, condition and even blood flow of the prostate. For a better overview, a contrast medium is sometimes injected intravenously. The examination is also carried out to differentiate prostatitis from oncology. An MRI machine is a large cylinder surrounded by a magnet into which a medical table with a patient inside slides like a tunnel. The person should wear loose clothing without metal fittings and avoid heavy food for 10-12 hours before the procedure. Watches, jewelry and other metal objects must be removed before the examination. If there are metal-containing implants or cardiac devices in the patient's body, the MRI diagnostic method is contraindicated. To carry out the procedure, a transrectal sensor is most often used (although it is possible without it), having previously cleaned the rectum with an enema. The nurse inserts the sensor and secures it with a special disposable cuff. The patient should lie as still as possible for the entire duration of the examination, which lasts around 30 minutes. The procedure is painless.

4. cystoscopy- Examination of the mucous membranes of the urethra and bladder using a cystoscope - a long narrow catheter with a light bulb and a camera at the end under local anesthesia. The procedure is performed after the bladder is full. The duration of the cystoscopy is approximately 15 minutes. This method allows you to assess the condition of the urinary tract and exclude other possible diseases that cause problems with urination.
5. Prostate biopsy- is a necessary procedure if, after a comprehensive examination, the doctor suspects a malignant process in the prostate. It must be excluded or confirmed to select treatment tactics. The procedure is performed on an outpatient basis by inserting a puncture needle through the patient's rectum and taking a sample of prostate tissue. A local anesthetic is injected into the anus and, once it takes effect, an ultrasound probe with a needle attachment is inserted into the intestine. Under ultrasound control, the surgeon determines the places where material needs to be "clamped" for analysis. Typically, there are up to 18 different points on the organ. The biopsy does not cause any pain; after the anesthesia has worn off, only mild discomfort is possible.

If a patient experiences recurrent episodes of urinary tract infections and prostatitis, the specialist will prescribe a comprehensive examination of the genitourinary system to identify anatomical abnormalities.

Differential diagnosis

The symptoms of acute prostatitis can resemble bladder or urethritis. In all cases, symptoms include painful and frequent urination. However, acute prostatitis is characterized by vivid symptoms of general intoxication and an admixture of pus in the urine and secretion. Palpation examination of the prostate is painful and shows enlargement of the gland, which is not the case with cystitis or urethritis.

Doctors say that inflammation of the prostate does not increase the risk of prostate cancer.

Chronic inflammation of the prostate should be differentiated in young men with anogenital symptom complex and vegetative genitourinary syndrome. These diseases can only be distinguished by analyzing prostate secretions for the presence of bacteria. In men over 45 years of age, it is necessary to exclude oncology and prostate adenoma, which are usually asymptomatic in the initial stages, unlike prostatic inflammation. For a more detailed analysis, the urologist will prescribe a PSA test and, if necessary, a biopsy.

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