Prostatitis: how to recognize the disease

Inflammation of the prostate gland is one of the main urological problems in men under 50 years old. 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, 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, is an organ of the male reproductive system. Its normal size does not exceed that 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 semen exit the body. Its main function is the production of secretion (prostatic juice), which supports the vital activity of spermatozoa after ejaculation.

The inflammatory process in the prostate gland can be caused by an infection, as well as various other reasons.

Types and first signs of the disease

The first signs and further symptoms will depend on the type of prostatitis. In total, doctors distinguish 4 varieties.

1. Acute bacterial prostatitis: Caused by a bacterial infection, it usually has a sudden onset that 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 gland. There may be few or no symptoms between attacks, which is why it can be difficult to treat successfully.
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 prostate 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 incidentally during treatment for infertility or prostate cancer. People with this form of prostatitis do not complain of symptoms or complaints, however tests show the presence of infectious cells in the prostate secretion.

Main symptoms

Symptoms associated with prostatitis can vary depending on the underlying cause of the disease.Common symptoms, which gradually increase, include:

• 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 2 times a night);
• urgent need to urinate.

An important symptom is pain, which may occur or radiate to various areas of the lower body. She could 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 characteristic, and in addition, prostatitis may be accompanied by sexual dysfunction.

A rapid and severe onset is usually characteristic of the acute bacterial form, which is distinguished by an additional complex of symptoms similar to that which occurs during the influenza virus.This:

• fever and chills;
• general malaise and muscle pain;
• swollen lymph nodes;
• sore throat.

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

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

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

Diagnostic methods

Prostatitis is usually diagnosed through laboratory tests on a urine sample and examination of the prostate gland by a urologist.This test involves palpating the prostate through the rectum to examine for any abnormalities. Sometimes your doctor collects and examines a sample of prostatic secretions. To achieve this, the urologist massages the gland during a rectal exam. Because there is concern that the procedure may release bacteria into the bloodstream, this test is contraindicated in cases of acute bacterial prostatitis.

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

Lab test

Laboratory tests that can be ordered include:

• clinical analyzes of blood and urine;
• bacterioscopy and culture of urinary sediment and prostatic secretion - examination of samples under the microscope for the presence of bacteria;
• a smear of discharge from the urethra (if discharge is present);
• determination of prostate specific antigen (PSA) level.

If a clinical blood test shows an increase in the level of leukocytes (10 to 12 per field of view), this will indicate 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 increasing concentration in the blood plasma of markers of the inflammatory process: fibrinogen proteins and immunoglobulins, as well as C-reactive protein.

Bacterioscopy of urinary sediment and prostatic secretion will indicate the presence and number of pathological microorganisms in these biological fluids, and thanks to culture for sensitivity to antibiotics, the type of bacteria for further treatment selection will be established. The responsible microorganism can be determined, among other things, by taking a smear of secretion from the urethra for examination under a microscope.

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 value depends on the age of the man and varies from 2. 5 ng/ml for subjects aged between 41 and 50 years to 6. 5 ng/ml for men aged over 70 years. An increase in the level of this protein above the age norm means the need for a biopsy - tissue analysis for oncology. However, excessive protein content can also be observed due to inflammation of the prostate gland.

PSA levels may also increase slightly in cases of benign enlargement (adenoma) of the prostate and following 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	2, 5ng/ml
50-59 years	3, 5ng/ml
60-69 years	4, 5ng/ml
Over 70 years	6, 5ng/ml

Instrumental studies

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

1. Urodynamic study of the bladder- a complex instrumental method using special equipment allowsto determine whether the bladder is completely emptied, the speed of urine flow, the pressure inside the bladder and urethra and also to evaluate the effect of prostatitis on normal urination. This study is recommended for people with chronic urinary problems: intermittent or thin flow, incontinence, frequent urination, etc. It is also indicated for patients with prolonged inflammation of the prostate, especially when standard therapy is ineffective. Before the examination, a special sensor catheter is inserted into the patient's urethra in a horizontal position, also connected to the measuring device. Subsequently, he is asked to drink a certain amount of clean water, simultaneously recording the sensation of a full bladder, the first need to urinate, the presence of urine leakage, etc. Then the patient is transferred to a specially equipped chair, on which he will have to relieve himself while still under the control of sensors and equipment that carry out the necessary measurements. The procedure consists of several stages, each of which lasts about half an hour. The results of the urodynamic study are delivered to the patient immediately after its completion.

2. Ultrasound (United States)- The method is used as a diagnosis of existing disorders and is also indicated for men after 45 years of age every year as a prevention of prostatitis and other gland diseases. The study is carried out in the morning on an empty stomach using an ultrasound machine through the anterior abdominal wall with a bladder filled with clean water, as well as inserting a special sensor to a depth of 5-7 cm into the rectum (rectal method) or through the urethra. The procedure is absolutely safe and allows you to determine the contour, size and condition of individual areas of the prostate gland. The volume of a healthy prostate is approximately 20–25 cm³. The maximum length, width and thickness are 3. 5 cm, 4 cm and 2 cm respectively.
3. Magnetic resonance imaging (MRI)- the method allows you to study in detail the structure, density, condition and even blood flow of the prostate; sometimes, for a better overview, an additional contrast medium is injected intravenously. The exam is also carried out to differentiate prostatitis from oncology. An MRI machine is a large cylinder surrounded by a magnet, inside which a medical table with a patient slides, like a tunnel. The person should wear loose clothing without metal accessories and abstain from heavy foods 10-12 hours before the procedure. Before the exam it is imperative to remove watches, jewelery and any other metal objects. If the patient has cardiac implants or devices containing metals in the patient's body, the MRI diagnostic method is contraindicated. To carry out the procedure, a transrectal sensor is often used (although it is possible without it), having previously cleansed the rectum 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 remain as still as possible. 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 bulb and a camera at the end under local anesthesia. The procedure is performed after the bladder is full. The duration of cystoscopy is approximately 15 minutes. The method allows you to evaluate the condition of the urinary tract, excluding other possible diseases that cause problems with urination.
5. Prostate biopsy- is a necessary procedure if, after a thorough examination, the doctor suspects a malignant process in the prostate. It must be ruled out or confirmed to select the treatment tactic. 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, when it has taken effect, an ultrasound probe with a needle is inserted into the intestine. Under ultrasound guidance, the surgeon determines the points from which it is necessary to "pinch" the material for analysis. Typically there are up to 18 different points on the organ. The biopsy does not cause pain; once the effect of the anesthesia wears off, only slight discomfort is possible.

If a patient has recurrent episodes of urinary tract infection and prostatitis, the specialist will prescribe a comprehensive and comprehensive examination of the genitourinary 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. But acute prostatitis is distinguished by vivid symptoms of general intoxication and a mixture of pus in the urine and secretions. The palpation examination of the prostate will be painful and will reveal an increase in the size of the gland, which does not occur with cystitis or urethritis.

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

Chronic inflammation of the prostate gland should be differentiated in young people with the anogenital symptom complex 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 it is necessary to exclude oncology and prostatic adenoma, which in the initial stages are often asymptomatic, unlike inflammation of the prostate. For a more detailed analysis, the urologist will prescribe a PSA test and then, if necessary, a biopsy.

Prostatitis can be an acute bacterial disease, which is often easily treatable with antibiotics, or a chronic disease that relapses and requires constant medical monitoring and supervision. In any case, only a specialist in the field of urology and andrology can correctly diagnose the disease.