Prostatitis: how to recognize the disease

Inflammation of the prostate gland is one of the main urological problems in men under the age of 50. 10-12 percent of all representatives of the stronger sex have encountered symptoms of prostatitis at least once in their lives. The disease can occur in acute and chronic form, 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 the size of a walnut. The gland is located below the bladder, in front of the rectum. The prostate gland surrounds the urethra, the tube through which urine and sperm leave the body. Its main function is the production of secretion (prostate juice) that supports the vital activity of sperm after ejaculation.

In addition to infection, the inflammatory process in the prostate gland can be caused by various reasons.

Types of the disease and the first symptoms

The first signs and subsequent symptoms will depend on the type of prostatitis. In general, clinicians distinguish 4 types.

1. Acute bacterial prostatitis: Caused by a bacterial infection, usually with a sudden onset of 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, so it can be difficult to treat successfully.
3. Chronic prostatitis/chronic pelvic pain syndrome: Most cases of prostatitis fall into this category, but this type is also the least understood. It can be characterized as inflammatory or non-inflammatory depending on the presence of antibodies in the urine, semen, and prostate secretions that fight infection. Often it is not possible to identify a single specific cause. Symptoms may come and go or be intermittent.
4. Asymptomatic inflammatory prostatitis: This disease is often diagnosed incidentally during treatment for infertility or prostate cancer. People with this form of prostatitis have no symptoms or complaints of discomfort, but tests show the presence of infectious cells in prostate secretions.

Main symptoms

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

• pain or burning during urination (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);
• an urgent urge to urinate.

An important symptom is pain that can occur or spread to different parts of the lower body. It can be:

• in the rectum (rectal), sometimes combined with constipation;
• 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 a complex of additional symptoms similar to those occurring during the influenza virus.This:

• 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 consult a urologist-andrologist, then there are dangerous cases of purulent complications. Acute infectious prostatitis can become a severe form of pathology when the prostate tissue is covered with pustules or abscesses. Symptoms include:

• cloudy urine or blood in the urine;
• discharge from the urethra;
• foul smelling urine and discharge.

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

Diagnostic methods

Prostatitis is usually diagnosed as a result of a laboratory examination of a urine sample and an examination of the prostate gland by a urologist.This examination involves palpating the prostate through the rectum to check for any abnormalities. Sometimes the doctor collects and tests a sample of prostate secretions. To obtain it, the urologist massages the gland during a rectal examination. This test is contraindicated in cases of acute bacterial prostatitis because of concern that the procedure may release bacteria into the blood.

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

Laboratory tests

Laboratory tests that may be ordered include:

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

If the clinical blood test shows an increased level of leukocytes (from 10-12 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 (below 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 the general clinical blood test, and when its value exceeds 10 mm / h, it indicates the presence of a pathological process in the body. The rate of deposition of these blood cells increases with the increased 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 will show the presence and number of pathological microorganisms in these biological fluids, and thanks to the culture for sensitivity to antibiotics, the type of bacteria will be determined for the subsequent selection of treatment. The causative organism can be identified, among other things, by taking a smear of discharge from the urethra for microscopic examination.

The prostate-specific antigen test is a screening test in the form of an intravenous blood test for a protein produced only by prostate cells. The protein norm depends on a man's age and ranges from 2. 5 ng/ml for men 41-50 years old 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 biopsy - tissue analysis for oncology. However, excess protein content may also be observed due to inflammation of the prostate gland.

PSA levels may also be slightly elevated due to benign enlargement of the prostate (adenoma) and urinary tract infections.

Age-related PSA norms - table

Age category	PSA norm
Under 40 years old	2. Less than 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 provide a complete guarantee of the correct diagnosis, other methods - instrumental methods - can be used as part of a comprehensive diagnosis. These include:

1. Urodynamic examination of the bladder- a complex instrumental method using special equipment allows to determine whether the bladder is completely emptied, the speed of urine flow, pressure in the bladder and urethra, as well as to evaluate the effect of prostatitis on normal urine. This study is recommended for people with chronic urinary problems: intermittent or thin flow, urinary incontinence, frequent urination, etc. It is also indicated for patients with long-term inflammation of the prostate gland, especially when standard therapy has failed. Before the examination, a special catheter-sensor is inserted into the patient's urethra in a horizontal position, which is connected to the measuring equipment. After that, he is asked to drink a certain amount of clean water, and at the same time, the feeling of fullness of the bladder, the desire to urinate for the first time, the presence of leakage of urine, etc. it must relax itself while still being monitored by sensors and equipment making the necessary measurements. The procedure consists of several stages, each of which takes about half an hour. The results of the urodynamic study are given to the patient immediately after completion.

2. Ultrasound examination (USA)- the method is used as a diagnosis of existing disorders and is also shown to men after the age of 45 every year as a prevention of prostatitis and other glandular diseases. The study is carried out in the morning on an empty stomach with the help of an ultrasound machine through a bladder filled with clean water through the front wall of the abdominal cavity, as well as 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 you to determine the contour, size and condition of individual areas of the prostate gland. The volume of a healthy prostate is about 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 to study the structure, density, condition and even blood flow of the prostate in detail, sometimes an additional contrast agent is injected intravenously for a better view. The examination is also performed to differentiate prostatitis from oncology. The MRI machine is a large cylinder surrounded by a magnet, into which the medical table with the patient slides like a tunnel. 10-12 hours before the procedure, the person should wear loose clothes without metal fittings and avoid heavy meals. Before the examination, it is necessary to remove watches, jewelry and any other metal objects. The MRI diagnostic method is contraindicated if the patient has metal-containing implants or heart devices. To carry out the procedure, a transrectal sensor is used, having previously cleaned the rectum with an enema (although it is possible without it). The nurse inserts the sensor and secures it with a special disposable cuff. During the entire duration of the examination, which is about 30 minutes, the patient should lie as still as possible. The procedure is painless.

4. Cystoscopy- examination of the urethra and the mucous membrane of the 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 about 15 minutes. The method allows you to evaluate the state of the urinary tract, excluding other possible diseases that cause problems with urination.
5. Biopsy of the prostate gland- it is a necessary procedure if, after a thorough examination, the doctor suspects a malignant process in the prostate gland. It must be excluded or confirmed to choose a 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 gland tissue. Local anesthesia is injected into the anus, then, if effective, an ultrasound probe with a needle attachment is inserted into the intestine. Under ultrasound guidance, the surgeon determines the places where it is necessary to "pinch" the material for analysis. Typically there are up to 18 different points on the body. Biopsy does not cause pain, only mild discomfort is possible after the anesthesia wears off.

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

Differential diagnosis

Symptoms of acute prostatitis are similar to inflammation of the bladder or urethra. In all cases, the symptoms are painful and frequent urination. But acute prostatitis is distinguished by bright symptoms of general intoxication and a mixture of pus in urine and excreta. Palpation of the prostate will be painful and will reveal an increase in the size of the gland, which will not occur with cystitis or urethritis.

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

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

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