How much does prostatitis treatment cost?

A survey of residents of different countries showed that 2-10% of adult men experience symptoms suggesting prostate problems during their lifetime.

Any urinary disorder is a warning signal and self-medication in this case should be excluded.However, the problems are not always specifically associated with prostatitis.

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Our articles are written with love for evidence-based medicine.We cite reputable sources and solicit comments from reputable physicians.But remember: responsibility for your health lies with you and your doctor.We don't write prescriptions, we give recommendations.Whether or not you trust our point of view is up to you.

How does the prostate work?

The prostate, or prostate gland, is a walnut-shaped organ located just below the bladder.Between the halves of the “nut” runs the urethra, a tube through which urine is drained from the bladder and sperm from the testicles.

Key task of the prostateconsists of producing a secretion which is part of the seminal fluid.Thanks to this secretion, the sperm are able to move.The second task of the prostate is to contract, ensuring ejaculation, i.e. ejaculation.

Next to the prostate are the seminal vesicles, which are connected to the vas deferens, through which sperm leave the genitals.The seminal vesicles produce the liquid part of sperm and store prostate secretions.

Prostate secretion is a mixture of citric acid and enzymes.This fluid liquefies the spermatozoa which enter the urethra through the vas deferens from the testicles.

Prostate problems don't always lead to erection problems

In the vast majority of cases, sexual dysfunction is not associated with prostate problems, because there is no physical connection between the prostate and the erection mechanism.

But disturbances in urination, discomfort due to incomplete emptying of the bladder, pain or discomfort associated with inflammation make the person nervous and embarrassed.Because of this, psychological problems arise - as a rule, they negatively affect the erection.

What does prostatitis look like?

Prostatitis is inflammation of the prostate associated with pathogenic microbes or other non-infectious causes.Sometimes the inflammation also affects the seminal vesicles – this is called vesiculitis.

At the same time, inflammation of the prostate gland does not always lead to pain and problems with urination, and the presence of unpleasant symptoms is not necessarily associated with inflammation of the gland.

To avoid confusion, urologists around the world use the classification proposed by the American National Institute of Diabetes and Digestive and Kidney Diseases, or NIDDK.

To simplify a little, the classification divides prostatitis into bacterial and abacterial, that is, not associated with bacteria.This approach helps doctors make the important decision whether or not to prescribe additional antibiotics and medications.It is incorrect to give antibiotics to all patients with suspected prostatitis, because nonmicrobial forms of prostatitis are more common than bacterial forms.Taking unnecessary antibiotics is harmful to your health.

The NIDDK classification identifies five forms of prostatitis.

Acute bacterial prostatitis.A disease that is most often caused by pathogens typical of urinary tract infections: for example E. coli, Klebsiella and Enterobacter.

As a rule, the disease begins unexpectedly and is accompanied by a general deterioration in health.The temperature rises to 38-39°C, with some people feeling weakness, severe pain or burning in the perineum, scrotum or anus, lower abdomen and sometimes muscles.Some people experience pain during ejaculation.Sometimes with bacterial prostatitis, frequent, difficult and painful urination occurs.

Chronic bacterial prostatitis.This disease can also be caused by microbes typical of acute prostatitis.The disease is considered chronic if symptoms last at least three months.

The symptoms of chronic bacterial prostatitis are similar to those of acute prostatitis, but may not be as severe or less severe.There is usually no fever or weakness, the pain in the lower abdomen is more aching than sharp, but it is difficult to start urinating and completely empty the bladder.In addition, unpleasant symptoms may disappear temporarily and reappear after a while.

Any man can get acute and chronic bacterial prostatitis.But those most at risk are those at higher risk of exposure to germs: those who have sex, especially anal sex, without a condom, patients with urinary tract infections, and people who have recently had prostate surgery or biopsy.

Chronic abacterial prostatitis associated with inflammation.The symptoms of nonbacterial inflammatory prostatitis are very similar to those of acute and chronic bacterial prostatitis.In this case, there are no pathogenic bacteria in semen, prostate and urine, but the concentration of leukocytes will be high - this indicates inflammation of the prostate.

Chronic abacterial prostatitis, or chronic pelvic pain syndrome, not associated with inflammation.The symptoms also resemble acute and chronic bacterial prostatitis.At the same time, there are no pathogenic bacteria and a high concentration of leukocytes in semen, prostate and urine - this indicates that the prostate is not inflamed.

In the case of non-bacterial forms of prostatitis, it is not always possible to determine which cause leads to the development of the disease.Risk groups are also difficult to determine.

Asymptomatic inflammatory prostatitis.This form of the disease does not cause any discomfort.Most often, inflammation is discovered accidentally when the patient is examined for other problems, such as infertility.

How is prostatitis different from prostate adenoma?

In about 8% of men after the age of 40, the prostate begins to enlarge – this is called prostatic adenoma or benign prostatic hyperplasia.An enlarged prostate compresses the urethra, which can lead to problems with urination: frequent urges to go to the toilet or leaking urine.Faced with symptoms of an adenoma, some patients may think they are suffering from prostatitis.

While some symptoms of prostatic hyperplasia may indeed resemble prostatitis, they are not the same thing.Prostatitis is an inflammation of the prostate.And an adenoma is an age-related uncontrolled proliferation of prostate cells that is not associated with inflammation.

An adenoma can cause significant discomfort, so if you have problems urinating, it is important to see a urologist as soon as possible.However, adenoma is still not as dangerous as prostatitis, since it does not increase the risk of developing cancer.

How often is chronic bacterial prostatitis diagnosed?

According to data from the generalized literature, worldwide, acute bacterial prostatitis occurs in 5-10% of cases, and chronic bacterial prostatitis - in 6-10% of cases.In addition, both variants of chronic abacterial prostatitis account for 80-90% of all cases of the disease.

If we carry out a massive microscopic examination of the prostate, we will find certain signs of inflammation in all men over 40 without exception.But this has nothing to do with the diagnosis of “chronic bacterial prostatitis”.

There are many urological diseases that can hide behind the mask of chronic prostatitis, and some of them are quite serious and require immediate treatment.Therefore, I recommend that all patients with symptoms reminiscent of prostatitis undergo a more detailed examination, which will clarify the diagnosis.

How is prostatitis diagnosed?

From the patient's perspective, the symptoms of bacterial and nonbacterial prostatitis are very similar.Without consulting a urologist and without special tests, it is impossible to distinguish one form of prostatitis from another and to benefit from quality treatment.As part of your compulsory health insurance, you can get an appointment with a urologist free of charge or make an appointment with a doctor in a private clinic. 

The main task of a urologist seeing a patient with suspected prostatitis is to rule out other prostate diseases, such as cancer, and to determine what form of the disease the person has.It is very important to distinguish chronic pelvic pain syndrome from confirmed or suspected bacterial prostatitis.Here's what a doctor should do to figure it out.

Ask the patient about their symptoms and health status.To gather more information, your doctor may suggest you answer questions on a questionnaire called the Chronic Prostatitis Symptom Index.In some cases, in order not to waste time during the appointment, it makes sense to print the questionnaire and fill it out in advance.

Perform a physical exam.The doctor will examine the patient, paying particular attention to the groin area.If there are swollen and painful lymph nodes in the groin, this increases the risk that there is actually an inflammatory process in the body.Typically, the exam includes a digital rectal exam, which allows the doctor to assess the size, shape and condition of the prostate.The study helps to understand if the prostate is enlarged.If touching the gland is painful, it is likely that it is inflamed.

Is it possible to do without a rectal exam?

Rectal examination and prostate massage are not the most pleasant procedures.In case of acute inflammation, this can cause pain.Some patients are so eager to avoid these procedures that they refuse to make an appointment with a urologist altogether.

Digital rectal examination is a diagnostic method, but prostate massage through the rectum is carried out to obtain material for laboratory analysis - prostate secretion.If secretion cannot be obtained, the doctor may replace the analysis of prostate secretion with either an analysis of the first portion of urine or a two- and three-glass urine analysis.These tests can determine approximately where the problem area is located in the urinary tract.

Sometimes, instead of this examination, a spermogram analysis is prescribed for the same purpose.It helps to understand whether prostatitis is part of infections of the male reproductive glands and provides information on the quality of the ejaculate.In addition, counting leukocytes in the ejaculate makes it possible to differentiate between inflammatory and non-inflammatory forms of chronic pelvic pain syndrome.

If a patient is concerned about an upcoming digital exam or prostate massage, I suggest they discuss it with their healthcare provider.Perhaps the analysis of prostate secretions, which requires massage, can be replaced by a urine or semen analysis.

Prescribe blood, urine and prostate secretion tests.The diagnostic standard includes a microscopic examination of prostate secretion, a general blood test, a general urine test with sediment microscopy, as well as a microbiological examination of urine and prostate secretions.

During microbiological studies, the patient's biological material is placed on a nutrient medium and it is observed which bacteria grow there - this helps to clarify the diagnosis.You can get tested in a private clinic for a fee or free of charge under compulsory health insurance.

Other tests and examinations - for example, a test for the concentration of total prostate-specific antigen (PSA) in the blood and a transrectal ultrasound of the prostate (TRUS) - are usually not carried out if prostatitis is suspected.In some cases, TRUS of the prostate can reveal fibrosis, that is, a scar, or foci similar to a malignant tumor, but such studies are not indicated for all patients without exception.

How is prostatitis treated?

Treatment depends on the type of prostatitis.If the inflammation is caused by bacteria, the doctor will prescribe antibiotics.And if bacteria has nothing to do with it, you will need medication to help you cope with the unpleasant symptoms of the disease.

Acute bacterial prostatitisthey start treatment without waiting for test results - this is called empirical antibacterial therapy.In this approach, antibiotics are prescribed based on knowledge of which microbes most commonly cause prostate infection.

As a rule, patients are prescribed antibacterial drugs that penetrate well into the prostate tissue and act on the most “popular” pathogens of prostatitis and genitourinary infections.

People who feel more or less normal and are treated at home usually receive antibiotic tablets.And patients with high fevers treated in hospitals are more often prescribed antibiotic injections.With this treatment, in most patients with acute prostatitis, fever and pain subside between the second and sixth day after starting treatment.

When the patient's temperature returns to normal and signs of inflammation disappear, the doctor may transition the patient from injections to tablets.The total duration of antibiotic treatment is usually around 2 to 4 weeks.

Sometimes prostate massage is used not only as a diagnostic method, but also as a therapeutic technique.It was once thought that it could help flush out excess secretions accumulated in the gland and thus reduce its swelling.However, today, most experts have reached a consensus that prostate massage should be avoided in cases of bacterial prostatitis.This is not only painful and unnecessary, but can also aggravate the course of the disease, because as a result of massage, bacteria can penetrate into neighboring uninfected tissues.

Chronic bacterial prostatitisalso treated with antibiotics that act on Gram-negative bacteria.Fluoroquinolones are typically used for treatment;these antibiotics are considered quite safe.But if the doctor suspects that prostatitis is caused by other microorganisms, he may prescribe additional antibacterial drugs without waiting for test results.

In case of chronic prostatitis, antibiotics must be taken longer than in case of acute prostatitis.In accordance with the recommendations of urologists, they are prescribed for a course of 4 to 6 weeks.

Chronic abacterial prostatitisis not associated with bacteria, therefore patients with this disease are prescribed antibiotics only if, in addition to prostatitis, they have a urinary tract infection.

Since it is not known exactly what causes abacterial prostatitis, treatment is primarily aimed at relieving pain during urination.To achieve this, doctors prescribe alpha-1 blockers, medications that help relax the prostate muscles that compress the urethra.If the pain persists, the doctor may prescribe nonsteroidal anti-inflammatory drugs.The dosage is selected individually for each patient.

Some patients with abacterial prostatitis benefit from cognitive behavioral therapy, the name given to sessions with a psychologist in which a person learns to cope with pain without medication.However, there is no scientific evidence of the effectiveness of psychological assistance in abacterial prostatitis.

Studies in which researchers have attempted to prove the effectiveness of other interventions, such as acupuncture, electromagnetic chair therapy, prostate massage or transrectal thermotherapy, have been poorly designed and too short in duration – usually less than 12 weeks.So it's impossible to say whether any of this helps or not.

How to avoid prostatitis: prevention

The main cause of prostate discomfort is a sedentary lifestyle and lack of regular sex life.Doctors believe that men who have the greatest chance of avoiding prostatitis:

1. Practice safe sex regularly.
2. Get moderate exercise regularly.
3. Avoid hypothermia.
4. Having reached the age of 40, they undergo an annual urological examination.

Where is it better to treat prostatitis - in a public or private clinic?

The most important thing is that the principles of evidence-based medicine are followed when diagnosing and treating prostatitis.It depends solely on the doctor - and it doesn't matter where exactly he works.

Unfortunately, doctors in private clinics do not always meet standards of medical care.This can lead to overdiagnosis and unnecessary treatment, putting the patient at risk of paying too much.In a public medical organization, the probability of meeting all diagnostic and treatment standards is higher.But patients should take into account that a complete examination will take longer - sometimes much longer than during an examination in a private clinic.

Remember

1. Urinary tract problems in men are common, but they are not always due to prostatitis.To understand what exactly is happening to a person, you need to undergo a thorough examination.
2. Prostate problems rarely cause erection difficulties.Usually, with prostatitis, it weakens due to psychological problems that arise against the background of unpleasant symptoms.
3. Not all forms of prostatitis are caused by bacteria: in 80 to 90% of cases, they have nothing to do with it.If a person with suspected prostatitis is prescribed antibiotics without additional testing, this is bad.Before taking them, it makes sense to consult another doctor.
4. A person with acute or chronic prostatitis may be prescribed a prostate massage to collect glandular secretions for analysis.
5. The best way to prevent prostatitis is to practice protected sex, a healthy lifestyle and, after 40 years of age, regular urological examinations by a doctor.