Prostatitis: what it actually is

Emil Aldyrakov — GP, urologist-andrologist

Prostatitis is one of the most myth-laden diagnoses in men’s health. The main thing to know: the word covers several fundamentally different conditions, and they are treated differently.

Four different conditions under one word

The international classification separates:

• Acute bacterial prostatitis — uncommon but dramatic: high fever, chills, pain, difficulty passing urine. Requires immediate antibiotic treatment.
• Chronic bacterial prostatitis — a confirmed bacterial infection with recurrences, also requiring antibiotics, but prolonged.
• Chronic prostatitis / chronic pelvic pain syndrome — by far the commonest form, over 90% of cases. No bacteria are present. Pain in the perineum or lower abdomen, on urination or ejaculation, lasting months.
• Asymptomatic inflammatory prostatitis — found incidentally during investigation for something else, usually needing no treatment.

Why antibiotics often fail

Because in the great majority of cases there are no bacteria to treat. The typical story: a man completes a third consecutive antibiotic course, each time improving briefly through an anti-inflammatory effect, the symptoms return, and his microbiome suffers. Current guidance requires confirming a bacterial cause first, and moving to a different strategy when it is absent.

What works for pelvic pain

In chronic pelvic pain syndrome a multimodal approach has the evidence: treatment is matched to the dominant features — pain, urinary symptoms, pelvic floor muscle tension, and the psychological component. Pelvic floor work, physical activity, lifestyle adjustment and, where indicated, medication genuinely help. It is not a fast route, but it leads somewhere, unlike endless antibiotic courses.

What must be excluded

Similar symptoms come from urinary tract infection, stones, benign prostatic enlargement and, less often, more serious causes. Initial assessment therefore includes urinalysis, an assessment of urinary function, ultrasound and, by age and indication, PSA. Important: PSA is not a test for prostatitis, and inflammation can raise it — interpreting it during an acute episode is misleading.

About confidentiality

Men postpone this appointment for years, and not because of the price. The consultation is one-to-one with the doctor and protected by medical confidentiality. Most of the conditions people present with late are easier to resolve the earlier the conversation happens.

At the clinic

At GMS a urologist-andrologist consultation is AED 600; transabdominal prostate ultrasound AED 1,000, transrectal AED 1,100, urinalysis AED 50 and free PSA AED 150. All in one visit, in English and Russian.

Guidelines referenced

• European Association of Urology. Urological Infections — Prostatitis
• American Urological Association. Clinical Guidelines

FAQ

Is prostatitis always treated with antibiotics?

No. Antibiotics are needed for acute and chronic bacterial prostatitis. In most cases there are no bacteria, so current guidance requires confirming a bacterial cause first.

What does the initial assessment include?

Urinalysis, an assessment of urinary function, ultrasound and, by age and indication, PSA. This excludes urinary tract infection, stones, benign prostatic enlargement and less common causes.

Does PSA show prostatitis?

No, PSA is not a test for prostatitis. Inflammation can raise it, so interpreting it during an acute episode is misleading.

This article is for information only and does not replace a consultation. If you have symptoms, see a doctor.

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