Prostatitis: A Review

Abstract

Although prostatitis is a common affliction of man, correct therapy depends upon the physician's recognition of the specific type of prostatitis with which he is dealing. Acute bacterial prostatitis, with its characteristic symptom complex, is generally easy to recognize and demands organism-specific antibacterial therapy. Chronic bacterial prostatitis, however, is variable in clinical manifestation and is now recognized as perhaps the most common cause of relapsing urinary tract infection in men. Techniques of bacteriologic localization cultures are presented for the accurate diagnosis of chronic bacterial prostatitis. The cure of chronic bacterial prostatitis is difficult to achieve with most antibacterial agents because most of these agents do not diffuse from plasma across relatively uninflamed prostatic epithelium to enter into the prostatic fluid where the bacteria reside. Until recently therapy for patients who have chronic bacterial prostatitis has been limited to either attempts to remove all infected foci of tissue by surgical means or maintenance of the patient on continuous, low dose suppressive antibacterial therapy. A new antibacterial agent, trimethoprim, meets all of the theoretical requirements for diffusion into prostatic fluid and has been shown to actually concentrate in the prostatic fluid of dogs. Because combining trimethoprim with sulfonamides results in synergistic antibacterial activity, for clinical use in this country trimethoprim has been combined with sulfamethoxazole, a sulfonamide that has a similar half-life in plasma. Research protocols to date have shown that this drug combination can cure chronic bacterial prostatitis in some patients. Abacterial prostatitis (“prostatosis”) is characterized by increased numbers of leukocytes and oval fat bodies in the expressed prostatic secretions and symptoms that often simulate those of chronic bacterial prostatitis; however, an infectious agent cannot be demonstrated. Therapy must be directed towards reassurance and symptomatic relief and antibacterial agents should not be used. Although recent years have produced speculation regarding a viral etiology to cases of prostatitis, studies to date have failed to confirm viral prostatitis. Prostatitis due to Trichomonas vaginalis organisms may occur, but is difficult to prove. Rare cases of prostatitis due to specific fungi have been reported but are generally secondary to a generalized mycosis. Nonspecific granulomatous prostatitis is occasionally seen and must be differentiated clinically from carcinoma of the prostate. The discovery of an antibacterial factor in both canine and human prostatic fluid that is highly bactericidal against most urinary pathogens is exciting and suggests that this factor may play a role as a natural defense mechanism against the development of urinary tract infections and prostatitis in men. Preliminary work has shown either total absence or markedly reduced amounts of this factor in patients who have chronic prostatitis.