Prostatitis in Men: Symptoms, Diagnosis, and Effective Treatment

What is prostatitis and how common is it?

Prostatitis is a complex condition describing inflammatory processes in the prostate gland. It can manifest in various forms, including infectious diseases (acute and chronic bacterial prostatitis), chronic pelvic pain syndrome (CPPS), and asymptomatic inflammation [1]. As the largest male reproductive gland, the prostate plays a key role in seminal fluid quality and sperm function, influencing overall male fertility [2].

According to studies, symptoms of prostatitis affect a significant portion of the male population. An analysis of data from 10,617 men showed that the overall prevalence of prostatitis symptoms is approximately 8.2%, ranging from 2.2% to 9.7% across different groups [1]. The annual incidence of physician-diagnosed prostatitis is estimated at 4.9 cases per 1,000 person-years [1]. Risk factors include a history of sexually transmitted infections [1]. Men who have had prostatitis are also more likely to experience benign prostatic hyperplasia, lower urinary tract symptoms, and prostate cancer [1].

Types of prostatitis: from acute to chronic

Prostatitis is not a single disease, but rather a spectrum of conditions classified by causes and clinical course [5, 6]. There are several main types:

• Acute bacterial prostatitis: Caused by uropathogens, often Gram-negative bacteria. It presents with acute symptoms, including fever, chills, pelvic pain, and tenderness of the prostate upon palpation. It generally responds well to antibiotic therapy [6].
• Chronic bacterial prostatitis: Characterized by recurrent urinary tract infections caused by bacteria persisting in the prostate gland. Symptoms may be less severe but prolonged and varied, including pelvic pain and voiding dysfunctions [6]. Treatment is often difficult and requires long-term antibiotic administration [6].
• Chronic prostatitis / Chronic pelvic pain syndrome (CPPS): This is the most common type, which can be inflammatory (with signs of inflammation in expressed prostatic secretions) or non-inflammatory (without signs of inflammation) [5]. Its cause often remains unknown, and antimicrobial agents are ineffective in this case [5]. CPPS is frequently misdiagnosed as prostatitis, but may involve pelvic floor muscle dysfunction, myofascial pain syndromes, functional somatic syndromes, and psychosocial stress [4].
• Asymptomatic inflammatory prostatitis: This type shows signs of inflammation in the prostate (e.g., detected on biopsy or in seminal fluid analysis) in the absence of any symptoms [1, 5]. Treatment is generally not required unless other indications are present.

Symptoms of prostatitis: how to recognize the problem?

Symptoms of prostatitis can be extremely diverse and affect various aspects of a man's life. The primary manifestation is often pain, which may be localized not only in the pelvic region but also radiate beyond it [3].

Among the most common symptoms are:

• Pain syndrome: Pain may be felt in the perineum, scrotum, lower abdomen, lower back, groin, penis, or rectum. The nature of the pain ranges from dull and aching to sharp and burning [3, 4].
• Lower urinary tract symptoms (LUTS): Include urinary problems such as frequent urges, hesitancy, intermittent stream, feeling of incomplete bladder emptying, and waking up at night to urinate (nocturia) [7]. These symptoms may be related not only to the prostate but also to bladder function [7].
• Sexual dysfunctions: Prostatitis can affect libido, cause erectile dysfunction, or painful ejaculation [7].
• Recurrent urinary tract infections: Particularly characteristic of chronic bacterial prostatitis [6].
• Psychosocial distress: Chronic pain and discomfort can lead to anxiety, depression, and a reduced quality of life [4].

It is important to note that the presence of prostatic calculi (stones) can exacerbate symptom severity and reduce the efficacy of antibiotic therapy in chronic prostatitis [8].

Diagnosis of prostatitis: a comprehensive approach

Because prostatitis has many forms and manifestations, its diagnosis requires a thorough and comprehensive approach. It is important not only to identify the presence of inflammation but also to determine its type in order to prescribe appropriate treatment [3].

The main diagnostic steps include:

• Detailed medical history and physical examination: The physician asks in detail about symptoms, their duration, comorbid conditions, and lifestyle. A methodical physical examination, including a digital rectal examination of the prostate, allows assessment of its size, consistency, and tenderness [4, 6].
• Laboratory tests:
  • Urinalysis and expressed prostatic secretion analysis: Help detect the presence of bacteria and inflammatory cells, which is critical for differentiating bacterial from non-bacterial prostatitis [5]. In non-bacterial prostatitis and prostatodynia, cultures are typically sterile [5].
  • Complete blood count and blood chemistry: May indicate an inflammatory process in the body.
  • Prostate-specific antigen (PSA) test: May be elevated during inflammation, but also requires differential diagnosis with other prostate conditions.
• Instrumental methods:
  • Prostate ultrasound: Allows assessment of gland size, structure, presence of cysts, or prostatic calculi that can worsen symptoms [8].
  • Urodynamic studies: May be useful for identifying urinary disturbances, especially in prostatodynia, where acquired voiding dysfunction is often found [5].
• Ruling out other conditions: It is important to exclude serious urological, neurological, or colorectal conditions that can mimic the symptoms of prostatitis [4].

In chronic pelvic pain, factors such as pelvic floor muscle dysfunction, myofascial pain syndromes, and psychosocial distress are also taken into account, requiring a multidisciplinary approach [3, 4].

Treatment of prostatitis: modern strategies

Treatment of prostatitis depends on its type and individual patient characteristics. There is no universal approach, and therapy should always be targeted [5, 6].

Treatment of bacterial prostatitis:

• Antibiotic therapy: In acute bacterial prostatitis, antibiotics to which identified uropathogens are sensitive are prescribed. Therapy typically leads to rapid improvement [6]. In chronic bacterial prostatitis, a longer course of antibiotics is required, often using drugs that penetrate prostate tissues well [6]. It is important to consider that prostatic stones can reduce the efficacy of antibacterial therapy and prolong symptoms [8].

Treatment of non-bacterial prostatitis and CPPS:

• Symptomatic therapy: Since there is no infectious cause, antibiotics are ineffective in these cases and not recommended [5]. Treatment is aimed at relieving symptoms.
• Alpha-blockers: Can help relax the muscles of the prostate and bladder neck, improving urine flow and reducing LUTS [7].
• 5-alpha-reductase inhibitors: Used for coexisting benign prostatic hyperplasia [7].
• Anti-inflammatory drugs: Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce pain and inflammation.
• Physical therapy: Includes methods aimed at relaxing pelvic floor muscles, relieving myofascial spasms, and improving pelvic blood circulation [4].
• Psychological support: Acknowledging and validating the patient's physical and psychological distress are cornerstones for building the trust and confidence needed for self-care and chronic pelvic pain management [4].
• Novel approaches: The use of anticholinergics and phosphodiesterase-5 inhibitors for treating LUTS and sexual dysfunctions is being investigated [7].

It is worth noting that approximately one-third of men with prostatitis symptoms experience resolution within a year [1].

Prostatitis and male infertility: is there a link?

Male infertility is a pressing reproductive health issue, with male factors accounting for about 50% of all cases [2]. For a long time, primary attention was focused on the testicles, yet the role of the prostate gland in this process was often underestimated [2].

As the largest male reproductive gland, the prostate plays a vital role in shaping seminal fluid quality. Prostatic secretion is a major component of semen and significantly influences sperm function and overall male fertility [2].

Prostatitis, being one of the most common prostate disorders in men, especially with aging, can seriously impair reproductive health [2]. Inflammatory processes in the prostate can negatively affect the composition of prostatic fluid, which in turn impacts sperm motility, viability, and morphology. Understanding this relationship is crucial for developing effective treatment strategies for prostatitis aimed not only at eliminating symptoms but also at preserving or restoring reproductive function in men [2].

Sources

1. Krieger, J. N., et al. (2008). Epidemiology of prostatitis. International Journal of Antimicrobial Agents, 31 Suppl 1, S15-S20.
2. Wang, Y., et al. (2025). Prostatitis and male infertility. The Aging Male: The Official Journal of the International Society for the Study of the Aging Male, 28(1), 2337626.
3. Nickel, J. C., et al. (2025). Chronic pelvic pain in men: AUA Guideline: Part I. Approach to evaluation and treatment. The Journal of Urology, 213(5), 843-851.
4. Kasturi, S., et al. (2016). Male pelvic pain: Beyond urology and chronic prostatitis. Current Rheumatology Reviews, 12(1), 17-22.
5. Meares, E. M., Jr. (1987). Acute and chronic prostatitis: diagnosis and treatment. Infectious Disease Clinics of North America, 1(4), 855-873.
6. Lipsky, B. A., & Plorde, J. J. (1999). Prostatitis and urinary tract infections in men: what's new; what's true? The American Journal of Medicine, 106(2), 235-242.
7. Chung, E., & Lee, J. (2009). Lower urinary tract symptoms in men: how do symptoms guide our treatment choice? Current Opinion in Urology, 19(1), 12-18.
8. Guo, S., et al. (2018). Prostatic calculi: Do they matter? Sexual Medicine Reviews, 6(1), 101-108.

Disclaimer: The information provided in this article is for informational purposes only and should not be used for self-diagnosis or self-treatment. Always consult a qualified healthcare professional for diagnosis and treatment.