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Breaking Myths: How Complicated Is the Diagnosis of Chronic Bacterial Prostatitis?
Chronic bacterial prostatitis (CBP) is a relatively rare condition that is closely related to men's health. This disease is often misunderstood, has different symptoms than other prostate diseases, and can be challenging to diagnose. This article will delve into the diagnostic process of chronic bacterial prostatitis and help readers understand the complexity of this disease.
Symptoms of chronic bacterial prostatitis
Chronic bacterial prostatitis usually presents with intermittent urinary tract infection (UTI)-like symptoms, which is also the main feature of the disease. The study pointed out that "recurrent urinary tract infection is a sign of chronic bacterial prostatitis," which shows that its diagnosis is difficult. Moreover, symptoms of chronic bacterial prostatitis are often subtle in patients with lower urinary tract symptoms (LUTS) associated with prostate-related non-benign prostatic hyperplasia (BPH), and patients may endure ongoing discomfort without obvious symptoms.
Potential causes
Chronic bacterial prostatitis is usually caused by an ascending urinary tract infection and is related to physiological or anatomical abnormalities. Potential risk factors include:
- Urethritis caused by catheterization, prostate biopsy, or sexually transmitted infection
- Unprotected anal sex
- Prostate stones or structural abnormalities
Chronic bacterial prostatitis occurs in less than 5% of patients with prostate-related non-BPH lower urinary tract symptoms.
The complexity of the diagnostic process
In terms of diagnosis, the challenge with chronic bacterial prostatitis is that despite the presence of bacteria in the prostate, patients may have no obvious symptoms. Doctors usually need to conduct cultures of urine and prostate fluid to confirm infection.
Urine culture and prostatic fluid (EPS) testing are important steps in diagnosis. Prostatic fluid obtained through rectal examination can help confirm the source of infection.
In addition, prostate-specific antigen (PSA) levels may be elevated without cancer, making diagnosis more complicated.
Treatment methods
Radical treatment
Antibiotics are the first choice treatment for chronic bacterial prostatitis, but due to the blood-prostate barrier, many antibiotics cannot effectively penetrate prostate tissue. Therefore, certain classes of antibiotics such as fluoroquinolones, trithiouracil, and meclonine are recommended.
Although antibiotics are highly effective in treating chronic bacterial prostatitis, the recurrence rate is still as high as 25% to 50%.
Other treatments
Prostatectomy (removal of the prostate) is sometimes used for highly recurring conditions, but post-operative complications such as erectile dysfunction and urinary incontinence are also real challenges that need to be faced.
Prognosis and future prospects
Research shows that the recurrence rate of patients with chronic bacterial prostatitis exceeds 50%. However, recent studies have shown that combination therapy is significantly more effective than antibiotics alone. As for the specific effect of combined therapy, there is currently lack of sufficient clinical data to support it.
A large-scale review study reported that 80% of patients with chronic bacterial prostatitis achieved significant improvement when using α1-adrenergic antagonists.
In the future, how to improve the diagnosis and treatment of chronic bacterial prostatitis, thereby reducing the recurrence rate of patients and providing long-term relief, is still an important topic worthy of study. We should re-evaluate existing treatment options and future research directions to explore more possibilities. How can we best meet this challenge?
