Prostate infections are extremely difficult to diagnose and treat because many doctors do not order the right tests and even when they make the correct diagnosis, they often fail to treat the condition long enough or they fail to treat infected partners.
SYMPTOMS: Chronic prostatitis is characterized by a feeling of having to urinate all the time, discomfort during urination, terrible discomfort when the bladder is full and having to get up many time each night to urinate. Benign prostatic hypertrophy or large prostate causes difficulty starting stream and dribbling. Prostate cancer rarely causes burning on urination or urgency.
TESTS: Total and free PSA blood test to screen for cancer, check your prostate and sometimes order a sonogram of the prostate. If I am suspicious of a prostate cancer, I will refer you to a urologist for further evaluation. Your doctor can order a urinalysis and urine culture. If abnormal, your doctor will treat a urinary tract infection, but it is usually normal. Then, your doctor may do a special swab for chlamydia and gonorrhea and request a semen culture. No test is available for practicing physicians to diagnose mycoplasma or ureaplasma and the test for chlamydia is not dependable. The only dependable test for prostate infection is for your doctor to massage your prostate to collect secretions and immediately check your secretions for white blood cells. If a) he sees more than 5 white blood cells in your secretions under the microscope, or b) the white blood cells are clumped together; or c) your urine has a positive leukocyte esterase or nitrite test and your urine culture and semen do not grow a germ, the odds are overwhelming that you are infected with chlamydia, mycoplasma or ureaplasma or something else that cannot be diagnosed.
Failure to see white blood cells in your secretions does not rule out a prostate infection. Most urologists do not order semen cultures because they claim that they are always contaminated with germs from the skin. Recent studies from Cornell and Mexico City show that they are wrong (2,3). Most men collect semen cultures from the vagina or mouth which always is contaminated. If the patient is asked to shower and clean himself with soap and water, then collect the specimen with his hands and then let it squirt into the culture jar without touching it, the culture is very dependable (2).
Prostate infections are extraordinarily difficult to cure because antibiotics do not accumulate in high concentrations in the prostate. So most men have to take appropriate antibiotics for many months and their partners have to take the same antibiotics for a much shorter duration. I often prescribe a quinolone antibiotic for several months, or a combination of quinilone and doxycycline. If you do not feel much better by six weeks, you may need to ejaculate frequently or find a kind urologist who will agree to massage your prostate at least once a week while you take the antibiotics. UCLA researchers report that 40 percent were cured, 20 percent were initially cured and then had a recurrence perhaps because the partner was not treated, 21 percent were improved and only 21 percent had no improvement. All the men who had bacteria in their semen cultures produced sterile specimens after treatment (1). However, treatment of prostatitis with long-term antibiotics is controversial and not accepted by many doctors; discuss this with your doctor.
1) DA Shoskes, SI Zeitlin. Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis. Prostate Cancer and Prostatic Diseases, 1999, Vol 2, Iss 3, pp 159-162.
2) FY Kim, , Goldstein. Antibacterial skin preparation decreases the incidence of false-positive semen culture results. Journal of Urology 161: 3 (MAR 1999):819-821.
3) CA VillanuevaDiaz, GA FloresReyes, M BeltranZuniga, M Echavarria Sanchez, JF. International Journal of Fertility and Women's Medicine, 1999, Vol 44, Iss 4, pp 198-203. MEXICO.
4) JJ Stevermer, SK Easley. Treatment of prostatitis. American Family Physician, 2000, Vol 61, Iss 10, pp 3015-3022