Chronic prostatitis: a common pathology

What is chronic prostatitis?

The chronic prostatitis, also referred to as chronic pelvic pain syndrome (CPPS), is one of the most common forms of prostatitis. Unlike acute bacterial prostatitis, caused by an identifiable infection, it most often occurs in the absence of an obvious infectious agent. Diagnosis and management are consequently much more complex.

CPPS is currently a major issue in urology: it affects up to 10 % for men during their lifetime. The impact on quality of life is often significant, with symptoms that permanently interfere with patients' daily activities and emotional health.

A frequent wandering

Many patients consult several practitioners before a name is given to their symptoms. The pain is real, but the tests come back normal, which fuels doubt.

Recognizing the SDPC as a distinct entity in its own right is already a therapeutic step.

Etiology and risk factors of chronic prostatitis

The exact cause of chronic prostatitis remains uncertain. Research suggests that it is a condition multifactorial, involving a combination of infectious, inflammatory, neurological, and psychological factors. Four main hypotheses emerge.

• Immune system dysfunction — an autoimmune reaction could cause persistent inflammation of the prostate, even in the absence of infection.
• Neurological factors — hypersensitivity or pelvic nerve neuropathy can perpetuate the pain. The pain circuits in the pelvic region are believed to be dysregulated, leading to an amplified perception.
• Urethral reflux — urine reflux into the prostatic ducts could cause prolonged inflammation and pain.
• Stress and psychological factors — chronic stress and anxiety are often associated with symptom exacerbation, suggesting an interaction between the central nervous system and the inflammatory response.

Let's clarify a point that matters to patients: acknowledging the role of stress does not mean saying the pain is imaginary. It is very real, and its mechanism involves identified neurological pathways.

Symptomatology of chronic prostatitis

Symptoms are often varied and persistent, which complicates management. Four main categories are encountered.

1. Pelvic painLocated in the perineal region, it can radiate to the lower back, testicles, or pubic region. Continuous or intermittent, it is generally exacerbated by stress or certain physical activities.
2. Urinary symptomsPatients frequently report urgent needs to urinate, a sensation of incomplete emptying, burning during urination, and sometimes a decreased urinary flow.
3. Pain during ejaculationFrequently reported, they affect the quality of sexual and emotional life. They can lead to a decrease in libido and secondary erectile dysfunction.
4. Psychological impactProlonged discomfort and the lack of immediate curative treatment lead to significant emotional distress, which exacerbates anxiety in many patients.

These symptoms partly overlap with those of the adenoma. This is why the medical evaluation systematically seeks to distinguish between them. View the complete prostate symptom assessment

Diagnosis: a multidisciplinary approach

The diagnosis of chronic prostatitis is based primarily on'elimination other possible causes of pelvic pain and urinary symptoms. There is no direct test to confirm it.

• Clinical assessment and medical history — special attention is paid to the symptoms, how long they have been present, and how they evolve over time.
• Laboratory analysis — although infection is not the primary cause, urinalysis and prostate cultures are performed to rule out any underlying bacterial infection.
• Physical examination and pelvic ultrasound — they make it possible to visualize the structure of the prostate and evaluate any anatomical anomaly that may contribute to the symptoms.
• PSA test — useful, keeping in mind that prostatitis itself causes a temporary increase in PSA.

What treatments are available for SDPC?

No single treatment is suitable for all patients. In practice, management combines several approaches, adjusted according to the dominant symptoms and their response.

1. AntibioticsInitially used to eliminate any potential bacterial infection, although chronic prostatitis is most often non-bacterial.
2. Nonsteroidal anti-inflammatory drugsThey help reduce inflammation and pain for limited durations.
3. Alpha-blockersThese medications relax the muscles of the prostate and bladder neck, improving urinary flow and reducing pain.
4. Pelvic physiotherapyTherapies targeting the pelvic floor muscles reduce muscle tension and spasms, which are often associated with chronic pelvic pain.
5. Stress management and psychological therapiesCognitive behavioral therapies and relaxation techniques help manage anxiety and stress, which worsen the symptoms.
6. Complementary therapiesAcupuncture, meditation, heat therapy: they can help relieve pain and reduce muscle tension.
7. Lifestyle changesReducing alcohol and caffeine, regular exercise, and a balanced diet: these simple measures contribute to the reduction of symptoms.
8. Prostatic artery embolizationMinimally invasive technique consisting of reducing prostate vascularization. It is being evaluated in forms refractory to conventional treatments.
9. Supplements and phytotherapyCertain plants, such as saw palmetto or rye pollen extracts, are sometimes used. Evidence of effectiveness remains variable.
10. SurgeryRarely used. A transurethral resection of the prostate may be considered in specific situations where other treatments have failed.

Note that this list is not traversed in order. The treatment is built with you, depending on what dominates your clinical picture — pain, urinary discomfort, or sexual impact.

Embolization in refractory forms

When conventional treatments are no longer enough,'prostatic artery embolization can be discussed. The principle is the same as in benign hypertrophy: reducing the blood supply to the gland, via the arterial route, without incision or general anesthesia.

The objective differs, however. It is no longer a matter of removing an obstruction, but of acting on the inflammatory and congestive component that sustains the pain.

In detail: embolization in chronic prostatitis

Frequently asked questions

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Send your medical reports, your test results, and the list of treatments already tried. We will let you know what is missing from your evaluation and which options are still feasible.

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