ABSTRACT
Prostatitis is a significant and prevalent male healthcare issue, a fact that is not generally recognized by either physicians or the lay community. As a prostate-related condition, it does not have the respect that is associated with prostate cancer nor the perceived importance of benign prostatic hyperplasia. However, a community-based survey of family physicians ’ offices in Olmsted County (a county in Minnesota serviced by the Mayo Clinic) noted that 11 % of men had a physician diagnosis of prostatitis. 1 In Finland, 14 % of fit men in the Oulu district had a current or previous diagnosis of prostatitis. 2 In the US health professional epidemiological study, 14 % of male health professionals surveyed recollected a diagnosis of prostatitis. 3 It has been estimated from population-based studies in Canada and the USA that 2 – 6 % of men in the community are experiencing at least mild to moderate prostatitis-like symptoms at any particular time. 4-6 In fact, the diagnosis of prostatitis is the most common diagnosis in urology outpatient practice in the USA in men under 50 years of age (and the third most common diagnosis in men over 50 years of age), representing approximately 8 % of a urologist ’ s outpatient visits. In family practice, the diagnosis of prostatitis represents 1 % of outpatient visits. 7
Prostatitis, either acute or chronic, is characterized by a constellation of symptoms, which include pain (genitourinary or pelvic, or both), variable voiding, and sexual dysfunction, which
have significant impacts on patients ’ quality of life. Employing standard quality-of-life assessment tools, patients with prostatitis have a quality of life similar to that of patients who have just had an acute myocardial infarction or suffer from unstable angina, active Crohn ’ s disease, congestive heart failure, or severe diabetes mellitus. 8,9 Patients with prostatitis do not have an enviable quality of life, and many find it impossible to do the mental and physical activities they would like to do or accomplish goals that they have set for themselves. Many of these patients become disabled in the age category that should represent the time of their major contribution to society. Physician visits, diagnostic testing, long-term medical therapy, alternative minimal invasive therapies, and surgery in some instances are expensive. The economic costs of prostatitis have been found to be enormous and based on the estimated number of patients in the USA alone, it could reach hundreds of millions of dollars a year. 10
Prostatitis can present clinically as an acute or chronic syndrome and etiologically as an infectious or non-infectious process. The etiology of acute prostatitis is almost invariably infectious and the agents implicated are usually Enterobacteriaceae spp. (particularly Escherichia coli but also Klebsiella pseudomonas and other Enterobacteriaceae spp.) and
occasionally Gram-positive Enterococci spp. A small percentage (estimated to be between 5 % and 10 % ) of cases of chronic prostatitis appear to have either an etiology or an association with chronic infection of the prostate gland (with similar organisms as acute bacterial prostatitis). Patients with an infectious chronic prostatitis suffer acute exacerbations, which usually resolve with appropriate antibiotic therapy. However, because the bacteria can persist as a nidus in the prostate gland, patients with chronic bacterial prostatitis are characterized by recurrent episodes of infection. Patients may be asymptomatic between these acute infectious episodes while the bacteria lie dormant in the prostate gland. The Enterobacteriaceae ( E. coli , Klebsiella spp., Pseudomonas spp.) and Enterococcus spp. remain the most common organisms isolated but many investigators believe that Chlamydia spp., Mycoplasma spp., and perhaps even anaerobic bacteria such as Corynebacterium spp. and in some specific cases (such as immunocompromised patients) fungi, viruses, and other atypical pathogens may also be involved. 11
Significant controversy exists in the research community in relation to patients who suffer from chronic prostatitis symptoms and who have no history of urinary tract infection (UTI) but in whom bacteria are localized to the prostate gland. The controversy exists because recent studies, employing standard clinical microbiological techniques, 12 have indicated that asymptomatic men who do not suffer from prostatitis have the same prevalence of uropathogenic and non-uropathogenic bacteria localized to the prostate.
