Prostatitis refers to a condition characterized by inflammation in the prostate gland of men. The prostate is a tissue found exclusively in males and plays a crucial role in producing a portion of semen. Prostatitis is accompanied by various symptoms, prominently including pain, voiding dysfunction, and sexual dysfunction. Patients may experience pain in the suprapubic lower abdomen, perineal pain between the testicles and anus, or pain in the testicles, penis, or pelvis. Urinary symptoms such as frequent urination (pollakiuria), urgent urination (urgency), delayed urination (hesitancy), and nighttime urination (nocturia) are also commonly associated. Furthermore, it is not uncommon for sexual dysfunction, such as erectile dysfunction or premature ejaculation, to occur alongside these symptoms.
According to the classification by the U.S. National Institutes of Health (NIH), prostatitis is broadly divided into five categories. First, there is 'acute bacterial prostatitis,' characterized by acute symptoms such as fever or chills, with causative bacteria identified in bacterial culture tests. Second is 'chronic bacterial prostatitis,' where chronic pain, voiding dysfunction, and sexual dysfunction symptoms persist, and bacteria are detected. Third is 'inflammatory chronic pelvic pain syndrome,' where prostatitis symptoms are present, and inflammation is confirmed in prostatic fluid or semen analysis, or in urine tests after prostate massage. Fourth is 'non-inflammatory chronic pelvic pain syndrome,' where symptoms exist but no signs of inflammation are found. Lastly, there is 'asymptomatic inflammatory prostatitis,' where no symptoms are present, but inflammation is discovered upon examination.
Given the diverse classifications of prostatitis, its treatment is also not straightforward. In cases of acute bacterial prostatitis, the causative bacteria are accurately identified, followed by appropriate antibiotic and injection therapies. For chronic bacterial prostatitis, medication is also the primary treatment, but due to the low drug permeability of prostate tissue, a sufficient treatment period of at least 4 to 6 weeks or more is required.
In cases of non-bacterial prostatitis, an even more complex approach is necessary. While many often consider antibiotic treatment to be the sole therapy for prostatitis, in reality, antibiotics are not the entirety of prostatitis treatment. Anti-inflammatory analgesics are used, as are medications to control urinary symptoms, drugs for neuropathic pain management, and in some cases, even pain clinic interventions or psychiatric pharmacotherapy may be combined. In essence, the core of prostatitis treatment is not 'whether to use medication or not,' but rather 'how accurately and appropriately medication is utilized.'
Prostate massage is also one of the treatment methods. This technique involves directly stimulating the prostate area through the anus to relieve congestion, and performing it 2-3 times a week often helps alleviate symptoms. In addition to this, various non-pharmacological treatments can be combined, such as magnetic field therapy, biofeedback, behavioral therapy, physical therapy, and thermotherapy.
Furthermore, it is not uncommon for patients suspected of having prostatitis to visit a hospital, only for the diagnosis to change to urethral stricture or interstitial cystitis after precise examination. Due to similar symptoms, differentiation is difficult with simple anamnesis alone, making accurate examinations and experience crucial. In fact, there are frequent cases where individuals visit an internal medicine clinic believing they have body aches or cold symptoms, only to be later diagnosed with prostatitis through urological consultation. This highlights how challenging the diagnosis of prostatitis itself can be.
As such, prostatitis is categorized as a disease where both diagnosis and treatment are challenging and complex. If treatment is inadequate or misdiagnosis recurs, relapses become frequent, and there is a possibility that the condition may become chronic, leading to a poor prognosis. Therefore, if symptoms persist or recur, it is crucial to seek medical professionals with extensive experience in treating prostatitis to receive an accurate diagnosis and systematic treatment.
Dr. Lee Min-jong, director of Goldman Urology Clinic Gangnam Branch, advised, "Alongside medication, lifestyle improvements play a significant role in preventing recurrence. Alcohol consumption can markedly worsen prostatitis symptoms and must be avoided, and spicy foods can also irritate the bladder lining, exacerbating symptoms, thus requiring moderation." He added, "Exercise is also important; consistent aerobic exercises like jogging, swimming, and walking positively impact the alleviation of prostatitis symptoms by improving blood circulation. However, activities that put severe pressure on the perineum, such as cycling or horseback riding, should preferably be avoided."