Prostatitis: Types, Symptoms, and Treatment

Prostatitis, or inflammation of the prostate, accounts for roughly two million doctor visits each year. Symptoms can include burning or painful urination, an urgent need to go (especially at night), painful ejaculations, and pain in the lower back or perineum (the area between scrotum and anus).

Types of Prostatitis

  1. Acute Bacterial Prostatitis
    Sudden onset often due to bacteria like Escherichia coli. Symptoms include muscle aches, fever, blood in semen or urine, and urogenital pain. Swelling may block urinary outflow—complete blockage is a medical emergency and may require hospitalization.
  2. Chronic Bacterial Prostatitis
    Milder infections that linger for months, more common in older men. Symptoms wax and wane and can become barely noticeable.
  3. Chronic Nonbacterial Prostatitis (Chronic Pelvic Pain Syndrome, CPPS)
    The most common form, triggered by stress, urinary tract infections, or pelvic trauma causing inflammation or nerve damage. It can affect the entire pelvic floor—muscles, nerves, and tissues supporting bowel, bladder, and sexual function.
  4. Asymptomatic Inflammatory Prostatitis
    Detected when white blood cells appear in prostate tissue or secretions during evaluation for other conditions. Generally requires no treatment.

PSA Considerations

Both acute and chronic bacterial prostatitis can cause prostate-specific antigen (PSA) levels to spike, potentially mimicking prostate cancer. After treating bacterial prostatitis, PSA should be retested—if levels remain elevated or are abnormal in nonbacterial cases, standard cancer diagnostic approaches apply.

Treatment Options

  • Bacterial Prostatitis: Fluoroquinolone antibiotics for 4–6 weeks; growing resistance may require alternative drugs like fosfomycin. PSA levels typically decline over 3–6 months.
  • CPPS (Nonbacterial):
    • NSAIDs (e.g., ibuprofen) for inflammation
    • Alpha blockers (e.g., tamsulosin/Flomax) to relax prostate and bladder neck muscles
    • PDE5 inhibitors (e.g., tadalafil/Cialis) to improve prostate blood flow
    • Physical therapy:
      • Trigger point therapy to release muscle spasms
      • Myofascial release to reduce connective tissue tension
    • Avoid Kegel exercises, which can worsen pelvic floor tension
    • Acupuncture—clinical trials show symptom improvements lasting up to six months

Holistic and Psychological Approaches for CPPS

Men with CPPS often experience depression, anxiety, or other mental health issues that heighten pain perception. Holistic strategies—mindfulness and cognitive behavioral therapy—can help develop effective coping skills and improve quality of life.

“An accurate diagnosis is important given differences in how each of the four categories of prostatitis is treated,” says Dr. Boris Gershman of Harvard Medical School and Beth Israel Deaconess Medical Center. Proper evaluation and follow-up testing ensure the right treatment path and help rule out more serious conditions like prostate cancer.