Chronic Bacterial Prostatitis

by Julie Chacko, M.D.

• Definition: Recurrent or persistent bacterial infection of the prostate gland.

• Overview:
· This is the most common source for recurrent urinary track infection (UTIs) in men.
· The most common organism being E. Coli.

• Causes:
· Incomplete treatment of an episode of acute bacterial prostatitis can contribute to the onset of chronic bacterial prostatitis.
· Often there are calcifications within the prostate that harbor the organism and prevent complete clearance with antibiotics.

• Symptoms:
· The typical symptoms include burning with urination, frequency of urination and pain in any number of areas including the low back, perineum (between the anus and scrotum), low abdomen and increased pain with ejaculation.
· Patients with chronic bacterial prostatitis tend not to be as acutely ill as those with acute prostatitis and fever, lethargy and fatigue are usually not present.

• Complications:
· The recurring infections can lead to fertility issues and occasionally to prostatic abscess formation.

• Clinical Findings/signs:
· The prostate is tender on examination.
· Prostatic massage may be performed to try to obtain a specimen from the prostate itself.
· If a drop of fluid is obtained from the prostate (EPS) or the urine immediately after massage is collected, it usually demonstrates elevated numbers of white cells and will be positive for an organism when cultured.
· PSA (prostate specific antigen) blood test will usually be elevated as well.

• Treatment:
· Lifestyle: There are no lifestyle modifications to treat chronic bacterial prostatitis.

· Medication: The primary treatment is antibiotic therapy for a prolonged course, often 3-6 months, in an effort to eradicate infection. During the treatment course anti-inflammatory medications may be useful in controlling pain related symptoms. If burning on urination is present, bladder analgesics such as Prosed* or Pyridium* may be prescribed.

· Surgery: Surgical management is rarely indicated for chronic bacterial infection. Transurethral resection of the prostate can be performed in an effort to remove prostatic calculi but may not be successful in eradicating infection.

• Prognosis:
· Clearance of the infection can be difficult.
· The prognosis depends on whether clearance of infection is attainable.
· If not, persistent symptomatology is the norm and frequency and control of symptoms is variable.

Posted on April 16, 2009

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