Prostatitis
How bacteria reach the prostate and cause acute and chronic bacterial prostatitis, why most prostatitis is pelvic pain without infection, how granulomas form after BCG and other causes, and why an inflamed gland raises PSA.
By the end, you can
- Describe how the glands of the prostate drain into the urethra and what normally keeps them free of infection.
- Explain the routes and usual organisms of acute and chronic bacterial prostatitis, and how a prostatic abscess forms.
- Explain chronic prostatitis/chronic pelvic pain syndrome as pain without infection, and its proposed mechanisms.
- Compare asymptomatic inflammatory and granulomatous prostatitis, including after BCG, and explain why inflammation raises PSA.
- Place each form in the NIH classification, recognise its tissue picture and tests, and explain how the main treatments act on its mechanism.
What it is
Prostatitis is inflammation of the prostate. The NIH classification divides it into four categories: acute bacterial (I), chronic bacterial (II), chronic prostatitis/chronic pelvic pain syndrome (III: pelvic pain without infection, by far the commonest) and asymptomatic inflammatory prostatitis (IV: found by chance). Granulomatous prostatitis is a tissue pattern with several causes, including BCG treatment for bladder cancer.
5 types to tell apart
- Acute bacterial prostatitis (NIH I)
- A sudden infection of the gland, usually by gut Gram-negative bacteria, with fever, pain and painful, obstructed voiding.
- Chronic bacterial prostatitis (NIH II)
- Bacteria persisting in the gland cause recurrent urinary infections with the same organism.
- Chronic prostatitis/chronic pelvic pain syndrome (NIH III)
- Pelvic pain for at least three of the previous six months with no infection; inflammatory (IIIA, white cells in prostatic samples) or non-inflammatory (IIIB).
- Asymptomatic inflammatory prostatitis (NIH IV)
- Inflammation found in a biopsy, prostatic fluid or semen in a man without symptoms.
- Granulomatous prostatitis
- Granulomas in the gland: non-specific (from ruptured ducts), after BCG or tuberculosis, after surgery, or from fungi.
Normal function
Glands that empty into the urethra
The {{prostate}} lies below the , wrapped round the first part of the urethra, the . Its back rests against the rectum, which is why it can be felt, and biopsied, through the rectal wall. It is built of several dozen branched glands set in a stroma of smooth muscle and collagen. Their ducts open into the urethra on either side of a small ridge on its back wall, the , where the also open.
Each gland is lined by secretory (luminal) cells over a layer of basal cells and a basement membrane. They make a thin, milky fluid, a large share of the seminal fluid, rich in citrate, zinc and prostate-specific antigen (PSA), an enzyme that liquefies semen after ejaculation. Almost all PSA leaves through the ducts; only a trace crosses the sealed lining into the blood.
Several defences keep the gland free of bacteria: the length of the male urethra, the flushing of each void, and a zinc-rich prostatic fluid with antibacterial activity. In the usual explanation, the ducts of the peripheral zone, where most inflammation is found, enter the urethra almost at right angles, so urine pressed against them during a forceful or obstructed void can flow back up into the gland. Drugs in the blood reach the glandular fluid only by crossing its lining, the blood–prostate barrier, which matters for treatment.
Underlying change · Step 1 of 5
How bacteria reach the prostate
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 2 of 5
Acute bacterial prostatitis: a swollen, septic gland
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 3 of 5
Chronic bacterial prostatitis: a hidden reservoir
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 4 of 5
Chronic pelvic pain syndrome: pain without infection
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 5 of 5
Inflammation found by chance, granulomas and a rising PSA
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Exam detail
Exam detail
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Treatment
How treatment works
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .