The uncomfortable symptoms of prostatitis, including those mentioned above, affect up to a quarter of all men at some point. In fact, it’s the most frequently diagnosed urologic problem in men under age 50. But for a condition that’s so common, it’s amazingly misunderstood.
It’s the black sheep of the prostate disease family. ‘It’s one of those diseases men tend to hide,’ says Dr. Curtis Nickel, a Canada Research Chair in urologic pain and inflammation at Queen’s University, who also has ‘a urology clinic at Kingston General Hospital.
Prostatitis isn’t one condition, but a variety of problems that lead to symptoms in the pelvic area. The common denominator is often severe pain in the prostate, pelvis and even the testicles, but the causes can be different: trauma to tissues around the prostate, urinary tract infections or STDs. Prostatitis can also be affected by other systemic conditions such as irritable bowel syndrome, fibromyalgia, stress, anxiety and depression. About 10 percent of cases are thought to be triggered by a bacterial infection of the prostate gland.
Although prostatitis literally means inflammation of the prostate, fewer than 10 percent of diagnosed men have evidence of inflammation when their prostates are biopsied. Experts now refer to the condition as chronic pelvic pain syndrome.
Talking about it is the key
‘Prostatitis is most common between ages 35 and 50, but it can affect teens and men in their geriatric years,’ says Dr. Joel Teichman, a professor of urology at the University of British Columbia.
But only a third of men with pelvic-area symptoms talk about them with their doctors. ‘Men generally minimize their health issues, particularly anything to do with their private parts,’ says Teichman. ‘Plus, they ‘are embarrassed.’
But for those who do seek help, the success rates of standard approaches’including antibiotics, anti-inflammatories, and alpha-blockers, which can relax the muscles around the bladder and improve urination’are between 30 and 40 percent. Minimally invasive treatments are the place to start, as surgery rarely helps and can even make the condition worse.
Letting symptoms go on for months or years can make the condition harder to cure. ‘What happens is the pelvic floor becomes hypersensitive, spastic and painful,’ says Nickel. ‘We might treat the original problem, but the patient still has pain.’ This can have an intensely negative impact on quality of life and affects many activities, including work, he notes. ‘There’s a lot of patient frustration.’ Men should seek help at the first sign of prostate problems.
How treatments are chosen
Nickel treats prostatitis by classifying men according to clinical characteristics and then determining treatment. Does the patient have tender trigger points in his pelvic floor or abdomen? Does he have urinary symptoms? Does he have a history of depression? Does he have sexual dysfunction? Asking these questions helps the doctor choose a range of treatments such as the medications mentioned above, plus others such as cognitive behaviour therapy or physiotherapy.
A urologist may also recommend that the patient avoid food triggers (50 to 60 percent of prostatitis patients are bothered by caffeine, alcohol, or spicy or acidic foods) and control stress.
Prostatitis, Nickel notes, is a chronic pain condition that’s not always curable. Realistically, the goal is to manage symptoms to improve a person’s quality of life.
‘We individualize therapies for each patient,’ says Nickel. ‘More than 80 percent leave the clinic happy.’ Nickel’s work is being studied around the world, and he hopes more clinics like his will be set up across Canada. In the meantime, men with prostate symptoms should talk to their doctor about a referral to a urologist.