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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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The prostate gland is a part of a man's reproductive system, secreting fluids that help transport sperm. The gland lies just below the bladder and surrounds the urethra (the tube that drains the bladder).

Prostate infections may irritate the prostate and cause inflammation and swelling of the gland. Prostate infections occur most often in men aged 30-50 years but can occur in older men. Statistics vary; some researchers suggest that about 30%–50% of males get prostatitis, while others suggest about 5%–10% are affected. Unfortunately, many people equate the terms prostate infection and prostatitis, but prostate infections comprise only two of the four major classifications of the term "prostatitis," and infectious types comprise only 5%-10% of the total number of prostatitis diagnosed patients.

The National Institutes of Health consensus panel has designated four types of prostatitis classifications.

1. Acute bacterial prostatitis
2. Chronic bacterial prostatitis
3. Chronic (nonbacterial) prostatitis/chronic pelvic pain syndrome (CPPS; sometimes termed prostatodynia) with subtypes of CPPS termed inflammatory and noninflammatory
4. Asymptomatic inflammatory prostatitis

Chronic nonbacterial prostatitis may also be occasionally caused by infection; the infectious agent may be at a low level and not found on culture of prostatic secretions. Needle biopsy has also found some patients with difficult to cultivate anaerobic organisms likely causing the infection and may explain why long term-term antibiotic therapy may help some patients with this diagnosis. If an infectious agent is identified by needle biopsy or other tests, the diagnosis should be changed to acute or chronic prostatitis. Chronic nonbacterial prostatitis/CPPS has not been scientifically demonstrated to be primarily either a disease of the prostate or the result of an inflammatory process.

The NIH has established extensive criteria for chronic pelvic pain syndrome that excludes infection and other problems and is as follows:

Inclusion Criteria

• male, at least age 18
• pain or discomfort in the pelvic area (penis, scrotum, perineum, or thereabouts) for at least 3 months

Exclusion Criteria

• the presence of cancer of the genitourinary tract
• active urinary stone disease
• herpes of the genitourinary system
• bacteriuria (100,000 colonies in a midstream urine) within the past 3 months
• antibiotic therapy within the past 3 months
• perirectal inflammatory disorders
• inflammatory bowel disease
• history of pelvic radiation or systemic chemotherapy
• history of intravesical chemotherapy
• documented gonorrhea, chlamydia, mycoplasma, or trichomonas infection of the urinary tract within the past 3 months
• clinical epididymitis within the past 3 months
• urethral stricture of 12 French or smaller
• neurological disease or disorder affecting the bladder
• prostate surgery (not including cystoscopy) within the past 3 months

This classification system is important to understand because about 90% of men with prostatitis symptoms are diagnosed with chronic pelvic pain syndrome and, by definition, do not have infectious prostatitis.

The fourth category, asymptomatic inflammatory prostatitis, by definition, does not have an identified infectious cause, nor do the affected men have pain like chronic pelvic pain syndrome diagnosed patients. These patients are discovered when the prostate is biopsied for other situations such as a reason (possible cancer) for elevated PSA (prostate specific antigen) tests, or infertility. However, if the biopsy shows only inflammatory tissue changes and no cancer or other likely cause (infectious agents) for the asymptomatic inflammatory changes, then the patient is diagnosed with asymptomatic inflammatory prostatitis. Chronic pelvic pain syndrome and asymptomatic inflammatory prostatitis are undergoing research to better define their causes and treatments.

Consequently, a diagnosis of prostatitis should be further defined by describing the classification that fits the patient. Clearly, infectious prostatitis fits only the acute or chronic classifications. The aim of this article is to describe prostate infections and not all four prostatitis classifications.

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