What is the treatment for prostatitis?
The prostatitis treatment is based on the cause. Your doctor may do a rectal exam and test urine samples to find out the cause. Once your doctor determines the kind of prostatitis you have, the two of you can work together on a plan for treating this condition.
Your treatment plan may include medications as well as physical therapy and in rare cases, surgery.
If acute bacterial prostatitis is diagnosed, the patient will need to take antibiotics for a minimum of 14 days. Sometimes, this means being admitted to the hospital and being given intravenous antibiotics. A catheter is sometimes required if the patient has difficulty urinating. Almost all acute infections can be cured with this treatment. Frequently, the antibiotics will be continued for as long as four weeks.
If chronic bacterial prostatitis is diagnosed, the patient will require antibiotics for a longer period of time, usually four to 12 weeks. About 75 percent of all cases of chronic bacterial prostatitis clear up with this treatment. Sometimes the symptoms recur and antibiotic therapy is again required. For cases that do not respond to this treatment, long-term antibiotic therapy may be recommended to relieve the symptoms. Other medications (such as those used for nonbacterial prostatitis) or other treatments (e.g., prostate massage therapy) may also be used in difficult cases. In some rare cases, surgery on either the urethra or prostate may be recommended. Surgery for chronic bacterial prostatitis should not be taken lightly and a second opinion is advisable.
The patient may not need antibiotics, if they are diagnosed with chronic non-bacterial prostatitis/chronic pelvic pain syndrome. Frequently, physicians have difficulty trying to decide whether a patient has bacterial or nonbacterial prostatitis. This is because of the difficulties in obtaining a specimen and, sometimes, previous antibiotic therapy obscures the diagnosis. An organism that responds to antibiotics, but is difficult to diagnose may also cause nonbacterial prostatitis. For these reasons, antibiotics may be prescribed, at least initially, even when a definitive diagnosis of bacterial prostatitis has not been made with the appropriate tests. Your response to the antibiotic therapy will decide whether or not it should be continued. Depending on your symptoms you may receive one of a variety of other treatments. These may consist of alpha-blockers, anti-inflammatory drugs, muscle relaxants, plant extracts (or vitamins) and repetitive prostatic massage (to drain the prostate ducts).
Various heat therapies, biofeedback and relaxation exercises may alleviate some of the symptoms. You may be advised to discontinue some foods (e.g. spicy) and drinks (e.g. caffeinated, acidic) and avoid circumstances (e.g. bicycle riding) that exacerbate the problem. Once a correct diagnosis has been made, one of the best therapies may be that of reassurance that the patient does not have a serious condition.
Treatment for aysmptomatic prostatatic inflammation is usually not required.
Treatment options for early-stage prostate cancer include:
Radical prostatectomy - surgery to remove the prostate gland and surrounding tissue and structures
Radiation therapy - use of high-energy, external x-ray beams or internal radiation seeds to destroy cancerous tissue
Watchful waiting: observation and monitoring of PSA levels with no immediate active treatment.
Treatment options for advanced prostate cancer include:
Hormone therapy - use of drugs to inhibit the action or block the production of male hormones that cause prostate cancer to grow. Hormone therapy may include surgical removal of the testicles, which produce the male hormone testosterone.
Radiation therapy - use of high-energy, external x-ray beams to destroy cancerous tissue
A combination of hormone and radiation therapies
Chemotherapy - use of toxic drugs to destroy cancer cells.
Depending on the type of prostatitis you have, certain medications may help rid or control your symptoms. These medications include antibiotics, alpha blockers, and pain relievers.
Antibiotics - In general, antibiotics are the first line of treatment for all forms of bacterial prostatitis. Your doctor will likely start you with a drug that fights a broad spectrum of bacteria but may switch to a different medication once he or she has determined the type of bacteria causing your infection. How long you take antibiotics depends on how well you respond to the drug. If you have acute prostatitis, you may need medication for only a few weeks. Chronic bacterial prostatitis, on the other hand, is more resistant to antibiotics and takes longer to treat. You may need to continue taking medication for as long as six to 12 weeks. In some cases the infection may never be eliminated, and in others you may have a relapse as soon as the drug is withdrawn. If this happens, you may need to take a low-dose antibiotic indefinitely to combat the infection or try other measures. Although the cause of nonbacterial prostatitis is not an infection, some doctors may prescribe an antibiotic for a few weeks to see if symptoms improve. For unknown reasons, some men with nonbacterial prostatitis seem to benefit from a continuous low dose of an antibiotic.
Alpha blockers - If you're having difficulty urinating, your doctor may prescribe an alpha blocker — an oral medication that helps relax the bladder neck and the muscle fibers where your prostate joins your bladder. This may help you urinate more easily and empty your bladder more completely.
Pain relievers - Sometimes an over-the-counter pain reliever, such as aspirin or ibuprofen (Motrin, Advil, others), can make you more comfortable. Keep in mind, however, that taking too much of any of these medications can cause serious side effects including abdominal pain, intestinal bleeding or ulcers.
Special exercises and relaxation techniques can improve symptoms of prostatitis in some men, perhaps because tight or irritated muscles can contribute to the condition. Commonly used techniques include:
Exercise - Stretching and relaxing the lower pelvic muscles — sometimes with the addition of heat to make the muscles more limber — may help relieve your symptoms. A physical therapist can show you which exercises will benefit you the most and how to perform them. You can then do the exercises yourself at home.
Biofeedback - This technique teaches you how to control certain body responses, including relaxing your muscles. During a biofeedback session, a trained therapist applies electrodes and other sensors to various parts of your body. The electrodes are attached to a monitor that displays your heart rate, blood pressure and degree of muscle tension. You'll see changes on the monitor and learn to control these changes on your own.
Sitz baths - From the German word sitzen, which means "to sit," this type of bath simply involves soaking the lower half of your body in a tub of warm water. Warm baths can relieve pain and relax the lower abdominal muscles. Few treatments are easier or as relaxing.
Prostate massage - Some men have found that massaging the prostate helps relieve congestion by unplugging the tiny ducts blocked by inflammation. The massage is performed using a gloved finger, similar to what is done during a digital rectal exam. This procedure is performed less often today than it once was, however.
Most doctors prefer not to treat prostatitis surgically. But your doctor may recommend surgery to open blocked ducts if you have a bacterial form of the disease and antibiotics don't improve your symptoms or your fertility is severely affected. Surgery is not a treatment for nonbacterial prostatitis.
Finasteride (Propecia, Proscar), a drug that lowers hormone levels in the prostate, and microwave thermotherapy have been successful in treating some men, but scientific evidence to endorse these treatments is lacking.