Prostatitis is considered a condition that confuses both patients and medical staff due to its vague and broad symptoms. Voiding abnormalities, pelvic pain, and a heavy discomfort in the lower abdomen often recur, yet clear abnormalities are sometimes not found in various tests. In such situations, it is pointed out that repeatedly prescribing antibiotics based on assumed simple inflammation makes it difficult to expect treatment effects and may even cause patients to miss the optimal window for proper treatment.
In particular, acute prostatitis requires special attention. While it begins with symptoms similar to a cold in the early stages, if accompanied by sudden high fever and chills, the possibility that inflammation has already spread throughout the body cannot be ruled out. Overlooking this can lead to severe infections, as medical experts explain that accurate judgment in the early stages determines the success or failure of treatment.
Anatomically, the prostate has a structure protected by the 'blood-prostate barrier.' Because of this, it is difficult for oral antibiotics or anti-inflammatory drugs to reach inflammatory tissues inside the prostate at sufficient concentrations. This structural characteristic also plays a role in why chronic prostatitis does not heal easily and repeats recurrence.
The problem arises in cases of chronic non-bacterial prostatitis, also known as Chronic Pelvic Pain Syndrome (CP/CPPS). Since bacterial infection is not confirmed in this disease, it is effectively difficult to treat by repeatedly prescribing only antibiotics. In fact, major societies such as the American Urological Association (AUA), National Institutes of Health (NIH), and European Association of Urology (EAU) are known to recommend a multi-modal treatment approach including medication, physical therapy, and pain control for chronic prostatitis.
Intraprostatic Injection (IPI) therapy is mentioned as one of the methods to supplement these limitations. It is a treatment method where, after confirming the inside of the prostate with transrectal ultrasound, antibiotics or anti-inflammatory drugs are directly injected into the lesion site so that the medicine reaches the inflamed tissue at high concentrations.
Prostate massage therapy to improve circulation of the prostate may also be considered in some patients. However, it is not applicable to all patients. If massage is performed on patients with acute bacterial prostatitis, there is a risk of bacteria entering the bloodstream and causing sepsis; a cautious approach is also needed for patients suspected of or diagnosed with hemorrhoids, anal fissures, or prostate cancer. Therefore, experts share the consensus that it should be performed under a specialist's judgment at a medical institution where accurate diagnosis can precede.
Drug treatment also requires a customized approach tailored to the patient's condition. Anti-inflammatory analgesics, medication for voiding symptom control, and neurogenic pain control medication should be combined according to the situation, and in some cases, treatment from pain medicine or psychiatric drug therapy is also combined.
According to papers published by several researchers including Abdel-Meguid in the international academic journal 'The Canadian Journal of Urology (CJU),' direct injection of drugs into the prostate has shown improvement effects in chronic and refractory prostatitis. Furthermore, a paper published by several researchers including Duclos A.J. in the international journal 'Therapeutics and Clinical Risk Management' also proved that combine therapy of prostate circulation/drainage treatment (prostate massage) with drug treatment leads to excellent treatment effects. As such, prostatitis can be called a disease where a multi-faceted approach is most important.
Director Min-jong Lee of Goldman Urology (Gangnam branch) emphasized, "Prostatitis is a disease where it is crucial to accurately judge when to start and stop treatment. A recurrence-proof system—combining diagnostic capabilities to distinguish between acute and chronic, the clinical experience to differentiate concomitant diseases, and the system to combine drugs, physical therapy, and injection therapy according to the patient's condition—is essential to prevent recurrence." He added, "Receiving an accurate diagnosis and appropriate treatment from the very beginning is more important than anything else."