Prostatitis describes a wide number of symptoms.  Prostatitis can be as varied as the individuals who have it and can be a challenging condition to treat.

In a survey of the National Guard 39% were found to have experienced symptoms of prostatitis.

Patients with a previous episode of prostatitis were much more likely to experience subsequent episodes. In a nationwide review of data from outpatient physician visits, it was noted that 15 percent of men who saw a physician for genitourinary complaints were diagnosed with prostatitis. Every year, approximately 2 million physician visits include the diagnosis of prostatitis. Despite its widespread prevalence, prostatitis remains a poorly studied and little understood condition.

Prostatitis is not easily diagnosed or classified. Patients often present with varied and nonspecific symptoms. The physical examination is frequently not useful.

The two most commonly forms of treated prostatitis are acute and chronic bacterial.

Acute prostatitis can have rapid onset of symptoms. This usually responds very well to therapy. However, many physician treatments are only for 2 weeks and many treatment failures occur. Treatments are generally for 3-4 weeks or longer and can result in few recurrences.  Patients respond well to most antibiotics primarily because the prostate is inflamed. Antibiotics that are usually used include: tetracycline, trimethoprim-sulfamethoxazole, or a quinolone.

Chronic bacterial prostatitis can have an onset of symptoms that takes longer; weeks to months. Antibiotic treatment is limited by the lack of inflammation in the prostate. Many treatment failures occur and it is most likely due to lack of penetration of the antibiotic into the prostate. With treatment failures sometimes result in recurrent urinary tract infections. Long course antibiotics oftentimes are needed. The cure rate with antibiotics ranges from 33 to 71 percent depending of the study and the antibiotics used. Initially treatment with trimethoprim-sulfamethoxazole should be considered for at least 3-4 weeks. Treatment failures can be treated with Norfloxacin for 28 days with a cure rate in one study of 64 percent.

The less common forms of prostatitis are chronic nonbacterial prostatitis, also known as chronic pelvic pain syndrome and asymptomatic prostatitis.

Treatment for chronic nonbacterial prostatitis can be challenging and very difficult. Failures are commonplace. Treatment is the same as with bacterial and can include sitz baths, nonsteroidal anti-inflammatory drugs (NSAIDs), avoiding intake of alcohol or spicy foods.   Symptoms may be helped with anticholinergic drugs or alpha-blocking agents.  Reassurance that their condition is neither infectious nor contagious and it is not known to cause prostatic cancer or other serious disorders can help with a patient’s mental attitude and sometimes counseling is prescribed or advised.

Treatment for asymptomatic prostatitis can include a 14-day treatment with antibiotics.  Treatment is only recommended in patients with chronic asymptomatic prostatitis known to elevate PSA.