This document provides an overview of benign and malignant prostate diseases, including BPH, prostate cancer, and prostatitis. It discusses the anatomy, epidemiology, etiology, pathogenesis, clinical findings, diagnosis and treatment options for each condition. For BPH, it describes the incidence, risk factors, symptoms, signs, evaluation, medical therapies including alpha blockers and 5-alpha reductase inhibitors, and surgical treatments such as TURP, TUIP and stents. For prostate cancer, it covers grading, staging, pattern of progression, tumor markers like PSA, biopsy for diagnosis, and imaging with ultrasound and CT.

1. Benign & Malignant
Diseases Of The
Prostate
By: Dr. Saud Al-Subaie
Moderator: Dr.E.O.Kehinde

2. Outline
Introduction
BPH
Prostate cancer
Prostatitis
1. Acute bacterial prostatitis
2. Chronic bacterial prostatitis
3. Chronic pelvic pain (CPP) syndrome (inflammatory/non-inflammatory)

3. Introduction
BPH & prostate adenocarcinoma are the 2 major
neoplasms affecting the human prostate.
The prostate is a complex organ consisting of epithelial,
stromal, & muscular element.
Anatomically the prostate gland is the shape of a
compressed inverted cone, residing in the true pelvis.
Arterial blood supply: inferior vesical+ middle rectal a.
Venous drainage: Dorsal venous plexes

5. The normal prostate measures between 3-4cm at its
widest portion; it is 4-6cm in length & 2-3cm in thickness.
Weight 17-25 gm
In the early 1970’s McNeal proposed a concept of zonal
anatomy.
According to this concept, the glandular portion of the
prostate is composed of a large peripheral & a small
central zone, which together constitute about 95% of the
gland.

6. The other 5% is formed by the transition zone which is
located just outside the urethra & is composed of the
periurethral glands, which presumably are responsible
for all of the BPH.
60-70% of prostatic CA occurs in the peripheral zone,
10-20% in the transition zone, & 5-10% in the central
zone.

7. Benign Prostatic
(hypertrohy (BPH

8. Incidence & Epidemiology
The term BPH is a misnomer because the actual
change is a hyperplasia & not hypertrophy.
The initiation of BPH may not be environmental
or genetically influenced.
It is also suggested that the prevalence of BPH
increases with age in all male populations.

9. Etiology
The etiology of BPH is unclear.
Two factors necessary for BPH to occur are:
(1) endocrine control (DHT)
(2) aging
The relative roles of androgen & estrogen in inducing
BPH, however , are complex & not completely
understood.

11. Pathogenesis
Stromal – epithelial interaction
normal 2:1, BPH 3 or 4:1
major change is connective tissue
The differential representation of the histologic
components of BPH explains the potential
responseviness to medical therapy

12. Pathophysiology Of Symptoms
Symptoms of BPH:
1( obstructive
decrease in force & caliber of the stream: due to urethral
compression is one of the early & constant features of BPH.
Hesitancy: occurs because the detrusor takes a longer time to
generate the initial increased pressure to overcome the urethral
resistance.
Intermittency: occurs because the detrusor is unable to sustain
the increased pressure until the end of voiding.
Terminal dribbling of urine & incomplete sense of bladder
emptying

13. Pathophysiology Of Symptoms
2( Irritative symptoms:
Frequency:
- Incomplete emptying during each void results in shorter
intervals between voids.
- The presence of enlarged prostate provokes the bladder to
trigger a voiding response more frequently than in normal
individuals, especially if the prostate is growing intravesically.
Nocturia: normal cortical inhibitors are lessened and also because
the normal urethral and sphincteric tone is reduced during sleep.
urgency & dysuria: uncommon.

14. Pathophysiology Of Symptoms
Obstructive symptoms are common with
enlarged prostates. Predominance of
irritative should suggest voiding
dysfunction.

15. Pathophysiology Of Symptoms
Systemic symptoms related to the UT:
- Vesicoureteral reflux
- Dilatation & hydronephrosis
- Renal failure & symptoms of uremia
Symptoms unrelated to the UT:
- hernias, hemorrhoids and vesical calculus
- change in the caliber of bowl movements
Symptoms related to complications:
- cystitis
- pyelonephritis
- bladder calculi
- micro or gross hematuria.

17. Signs of BPH
If the disease is advanced & has resulted in renal failure.
Signs of renal failure include elevated BP, rapid pulse &
respiration, uremic fetor, pericarditis & pallor of nail beds.
Abdominal examination may reveal palpable kidney or
flank tenderness if there is hydronephrosis or
pyelonephritis.
A distended bladder may be noted on palpation or
percussion.

18. Signs of BPH
Rectal examination may reveal an enlarged prostate.
The distinction between right & left lobes of the prostate
is usually lost in BPH.
Median sulcus always present.

19. Laboratory Findings
Urinalysis & microscopic examination: to R/O infection
or the presence of hematuria.
serum U/E & creatinine: to provide baseline information
on renal function & metabolic status.
Uroflowmetry: At a volume of 125-150ml, normal
individuals have average flow rates of 12ml/sec & peak
flow close to 20ml/sec.
Mild 11-15 ml/sec
Moderate > 7 and < 10 ml/sec
Severe < 7ml/sec
Residual Urine: estimated by U/S or catheterizations.
Volumes >150 ml are considered significant since they
constitute approximately one-third of normal bladder
volume.

20. Imaging
Ultrasonography:
In BPH, it is most useful for measuring bladder &
prostate volume as well as residual urine.
Estimation of prostatic size is important because most
urologists prefer to perform TURP for glands under
100g.
TRUS must be used as it is more accurate.
IVP:
For UTI & complications of BPH

21. Treatment
Because BPH is not invariably progressive, the timing of
intervention for each patient is variable.
Absolute indications for treatment include severe
obstructive symptoms & renal insufficiency.
Relative indications include moderate symptoms of
prostatism, recurrent UTI and hematuria.
Until recently, surgery was the mainstay of therapy for
BPH. In the last decade or so , there has been a
tremendous resurgence of interest in non surgical
therapies.

22. Medical Treatment
Obstruction secondary to BPH occurs because
of 2 factors:
a. Dynamic component: a result of
contraction of smooth muscles of the prostate
& prostatic urethra mediated mostly by
adrenergic receptors.
b. Mechanical component: related to the
presence of a mass which compresses &
narrows the urethral lumen.

23. Alpha-1 adrenergic antagonists
Ideally suited for the treatment of the dynamic component of
BOO because they can selectively reduce resistance along the
bladder outlet without impairing detrusor contractility.
Example:
- Tamsulosin 0.4mg OD
- Alfuzosin XL 10mg OD
- Doxazosin 4mg TID
Indication: Prostate size < 40 gm
S/E are related to their antihypertensive effects and include
dizziness and lightheadedness, Tachycardia, palpitation,
tiredness, weakness & nasal congestion.
Retrograde ejaculation may occur due to relaxation of the
bladder neck.
Alpha blockers also have beneficial S/E including lowering of
serum cholesterol & triglycerides.

24. alpha- reductase inhibitor 5
Agents that selectively blockade androgens at the
prostate cellular level are termed anti-androgens.
the prostate normally requires conversion of
testosterone to dihydrotestosterone by the enzyme 5
alpha-reductase.
Proscar is an anti-androgen that blocks this enzyme.
In long term clinical trials, proscar has been shown to
decrease prostatic size & improve urine flow rates &
symptoms of BPH.

25. alpha- reductase inhibitor 5
Another approach to blocking androgen uptake by
prostatic cells is to prevent androgen binding to nuclear
androgen receptors ( e.g. Flutamide).
There are also anti-androgens that block both LH and
nuclear androgen uptake.
In BPH patients, this has been demonstrated to improve
flow rates & voiding symptoms.
Indication: Prostate size > 40 gm
S/E include impotence, decreased libido & lowers serum
PSA by approximately 50% within 6 months of use.

26. Conventional Surgical Therapy
1) TURP
The principles of TURP are to remove the obstructing
adenomatous portion of the prostate via the urethra.
Overall morbidity: 18%.
Current mortality: 0.2%.
One preventable complication is TUR syndrome
Immediate complications: failure to void, post op.
haemorrhage, clot retention, & UTI.
Late complications: impotence, incontinence,
uretheral stricture and retrograde ejaculation.

27. Conventional Surgical Therapy
TUR syndrome
Because irrigating fluid under pressure is used during
resection, there is a certain amount of absorption via the
venous sinuses.
It results in hypervolemia & hyponatremia which leads to
cerebral oedema & seizures.
Other S/E include visual disturbance &
hyperammonemia or hemolysis.
The incidence is approximately 2%.
Preventive measures include suprapubic drainage during
TURP, continuous flow resectoscopes & diuretics.

31. Conventional Surgical Therapy
2) TUIP
It is indicated in patients with obstructive symptoms &
normal or small prostates in whom TURP is considered
excessive surgery to obtain relief of symptoms.

32. Conventional Surgical Therapy
3) Open prostatectomy
Open prostatectomy can be done either Tranvesical,
perineal or Retropupic prostatectomy.
In recent years the suprapubic & retropubic approaches
for BPH have been limited to approximately 10% of
patients.
Indications for suprapubic prostatectomy are a gland
size greater than 100g, cystolithotomy or diverticulum
excision.
Most post op complications are similar to TURP,
however, wound infection & thromboembolism are
additional complications.

34. Minimally Invasive Therapy
1) Laser prostatectomy
advantages over TURP: technical simplicity, lack of
complications & shorter hospital stay.
Laser energy works by thermal destruction of tissue.
disadvantages: lack of tissue availability for pathologic
examination, longer postop cathitarization time, more
irritative voiding complain, & high costs

35. Minimally Invasive Therapy
2) Transurethral needle ablation
High frequency radio waves to cause thermal injury to
the prostate.
3) High-intensity focused Ultrasound

36. Minimally Invasive Therapy
4) Prostate stents
In recent years, metallic spirals & stents have been used
as permanent indwelling prostheses .
These stents may be placed endoscopically & under
radiologic guidance.

37. Minimally Invasive Therapy
5) Transurethral balloon dilatation
It involves the use of non compliant balloons to dilate the
prostate under pressure.
This pressure is maintained for 15 min.
The exact mechanism is unclear.
6) Thermotherapy

38. Prostate Cancer

39. Incidence
prostate cancers is the 2nd most common cause of cancer deaths in
USA.
Autopsy studies demonstrate that there is an increasing incidence
starting around 30% in men at 50 increasing to 75% in men at 75
years.
USA (blacks) 137/100,000 per year
Germany 45/100,000 per year
Kuwait 6.5/100,000 per year (1998-2002)
Kuwait 12.8/100,000 per year (2002-2005)
China <1/100,000 per year

40. Etiology
* Genetic predisposition, racial origin.
Autosomal dominant inheritance of
rarely yet highly penetrant gene.
* Hormonal influences.
* Dietary & environmental factors.
* Infectious agents.
* Sexual habits, multiple sexual partner.
* Idiopathic

41. Pathogenesis
Most prostate cancers are adenocarcinomas arising
from prostatic acinar cells.
Prostate normally atrophies between the 5th & 7th decades
of life with some atypical and hyperplastic changes.
Among dysplastic changes, prostatic intraepithelial
neoplasia (PIN) considered premalignant lesion found in
30% of patients with prostate cancers.
70% of prostate cancers arise in the peripheral zone of
the prostate; 15-20% arise in the central zone; 10-15%
arise in the transition zone.
Most prostate cancers are multicentric.

42. Grading of Prostatic Cancer
Gleason grading system is the most
widely used. It’s based on glandular
differentiation:
* Gleason Score 2-4  well differentiated
5-7  moderately differentiated
8-10  poorly differentiated

43. Stages of Prostatic Cancer

44. Pattern of Progression
Local Metastasis:
Cancers arising in close proximity are prone to spread
early to the urethra, periprostatic tissues, bladder and
seminal vesicles.
Spread to seminal vesicles indicates ominous prognosis
with 50% of patients developing distant metastasis.
Rectal invasion is rare, ? Due to the tough Denonvilliers’
fascia in between.
Ureteral invasion by direct extension can occur but late,
usually lymph node and distant metastasis present at
this time.

45. Pattern of Progression
Distant Metastasis
Osseous metastases is most common form of
hematogenous metastases and occur in 85% of patients
dying from prostate cancer
Frequent sites: lumbar spines, pelvis, proximal femur,
thoracic spines, ribs, sternum and skull.
Extension to the axial skeleton vai the Batson’s plexus of
presacral veins which communicate with the pre &
periprostatic venous complex.

47. Clinical Findings
Symptoms
Most prostate cancers are discovered because of
elevated PSA or with incidental finding on rectal
examination.
prostate cancers rarely cause symptoms but may
present with bladder outlet obstruction, acute urinary
retention, hematuria or incontinence
Signs
irregular firm or hard prostatic nodule during rectal
examination.
Median sulcus is absent

48. Tumor Markers
Prostate Specific Antigen (PSA)
– Glycoprotein secreted in the cytoplasm of the prostatic
cells and function normally in liquefaction of the
semen, normal value in young adult 0-4 ng/dL.
– PSA elevation is proportional to the size of the
transitional zone. 1g of prostate cancer will ↑PSA by
0.3 ng/dL.
– PSA production by the malignant cell depends on the
degree of differentiation, well diff. gland will give more
– Prostate cancer with poor differentiation have normal
PSA

49. (Tumor Markers (PSA
– PSA rises by 0.04 per year in individual without
cancer upper limit of PSA for
- 40-49 yrs is 2.5 ng/dL
- 50-59 yrs is 3.5 ng/dL
- 60-69 yrs is 4.5 ng/dL
- 70-79 yrs is 6.5 ng/dL.
– PSA density (PSA level/prostate volume( level
between 0.1-0.15 associated with 15% incidence
of cancer, level above 0.15 associated with 60%.
– New studies showed two types of PSA,
a. complex PSA associated with cancer
b. free PSA goes with BPH.

50. Tumor Markers
Other Tumor Markers
– DNA ploidy recently reported to be useful in predicting
prognosis in prostate cancer.
– Low grade tumors associated with diploidy and high
grade tumors with aneuploidy.
– Patients with deploid tumors do well with expectant
therapy while those with aneuploidy do poorly.

51. Prostate Biopsy
Diagnosis of prostate cancers is confirmed by
needle and core biopsy.
Ultrasound guided systematic sampling of the
prostate in 4 quadrants provides the most
accurate information for staging and grading the
cancer.

52. Imaging
1) Trans-rectal U/S
– Can identify 60% of cancers even if non-palpable.
– By allowing precise placement of biopsy needle in
various quadrants, adequate sampling achieved.
– More accurate than DRE at detecting extra-capsular
extension.
– Allow biopsy of seminal vesicles which improve
staging accuracy.
– Disadvantage of TRUS include the inability to look
at the pelvic lymph nodes.

54. Imaging
2) CT:
used only when extensive L.N. disease is suspected
and it is based only on the size of the nodes thus false
+ve and –ve are common.
3) MRI:
not useful because of the cost and the overlap in the
appearance of benign & malignant processes, but its
more accurate than TRUS for staging extracapsular
extension and seminal vesicle involvement.
4) Bone scanning:
– most common way to assess systemic metastasis.
– False +ve rate is less than 2%.
– Diagnosis is confirmed by plain radiographs, thin section CT or
MRI and bone biopsy

56. Management of Localized Disease
The current therapy of patients with low stage disease
(stage T1 and T2( is radical prostatectomy &
radiotherapy to the prostate.
Treatment mortality is under 1%.
For patients > 75 years of age, treatment is “watchful
waiting”

58. Radical Prostatectomy
Retropubic approach allow simultaneous access to
the prostate and the pelvic LN, but it is often associated
with a greater amount of blood loss from the dorsal vein
complex.
Perineal approach requires separate incision for
pelvic LN, associated with minimal blood loss and it is
preferred for obese individuals.
5 yrs disease free survival for Stage T1 is 92% and for
stage T2 is 86%

60. Complication of Surgical Therapy
Intra-operatively:
– bleeding and injury to the obturator nerve,
ureter or rectum
Post-operatively:
– DVT & PE.
– Symptomatic pelvic lymphadenocele.
– Wound infections & UTI
The long term :
– Incontinence and impotence.

61. Radiation Therapy
All modern techniques use CT scans for accurate localization
of the prostate.
Generally, prostate is subjected to 6800-7000 rads and the
pelvic LNs are subjected to 4500-5000 rads.
Total treatment duration is 6-7 weeks.
5 yrs disease free survival rate for Stage T1 is 83% and for
Stage T2 is 72%.
PSA level is useful for assessing the response to RT
Rising PSA or PSA level persistently more than 30 ng/dL
indicate poor response to RT.

63. Complication of Radiation Therapy
Intestinal sequelae:
– Rectal bleeding, tenesmus, mucous discharge,
diarrhea, fecal incontinence, intestinal obstruction and
rectal strictures.
Urological sequelae:
– Frequency, dysurea, cystitis, hematuria and urethral
stricture
Edema of the extremities and impotence
Majority of these complications are minor and persist
less than 6 months

64. Neoadjuvant Hormonal Therapy
LHRH agonists and antiandrogens
Studies showed that hormonal therapy will not down-
stage the cancer in patient with stage T3, however, in
patient with stage T2 the hormonal therapy will reduce
the size and the incidence of positive margins

65. Manegment of patients with Margin-Positive
Disease / Extracapsular Extension
60% of positive margins are at postlateral areas,
30% are posterior
In stage T1 cancers, 40% of positive margins
are anterior.
Adjuvant radiation in these patients controls
local recurrence but whether it reduces systemic
recurrences is unclear.
Adjuvant hormones & more recently intermittent
adjuvant hormones appears to reduce PSA.

66. Management of locally extensive
disease
Stage T3,T4 or C prostate cancer are advised to
have radiation therapy. Surgery is not
recommended.

68. Management of distant metastatic disease
The standard treatment is androgen ablation therapy to lower
serum testosterone.
Methods of lowering testosterone include:
(1) Bilateral subcapsular orchiectomy
(2) LHRH agonist By downregulating pituitary LH production.
(3) Estrogen e.g. diethylstilbestrol which create negative feedback to
the pituitary.
S/E include impotence, breast tenderness, & hot flushes

69. Prognostic Factors in Ca prostate
Stage 1&2  65 - 98% 5-yrs survival rate
3  60% 5-yrs survival rate
4  30% 5yrs survival rate
Grade
Tumor Volume
– < 0.5 ml → no capsular penetration
– < 4 ml → less SV invasion & LN metastasis

70. Prostatitis

71. NIH Consensus Conference on Prostatitis
((1995
Category I: Acute Bacterial Prostatitis = Acute
infection of the prostate gland
Category II: Chronic Bacterial Prostatitis =
Recurrent infection of the prostate.
Category III: Chronic Abacterial
Prostatitis/CPPS: No demonstrable infection
– Category IIIA: Inflammatory CPPS = WBCs in
semen/EPS/VB3
– Category IIIB: Noninflammatory CPPS = No WBCs in
semen/EPS/VB3
Category IV: Asymptomatic Inflammatory
Prostatitis

72. Acute bacterial prostatitis
Etiology
• Is mainly caused by aerobic gram negative rods.
(E-coli and Pseudomonas aerigenosa(
• Common in people with “uptight personality”
The possible routes of infection include:
1( Ascent from the urethra.
2( Reflux of infected urine into prostatic ducts that empty into the
posterior urethra.
3( Direct extension (lymphatogenous spread(: from the rectum.
Ascending infection and reflux of infected urine into prostatic ducts
are probably the most common routes of prostatic infection.

73. Leukocytic infiltration of stroma and glandular lumina during
acute bacterial prostatitis

74. Acute bacterial prostatitis
Clinical Findings
A. Symptoms
Acute febrile illness characterized by chills, low back and perineal
pain, urinary urgency and frequency, nocturia, dysuria, and
varying degrees of bladder outlet obstruction.
Both myalgia and arthralgia are common.
B. Signs
Moderate or high grade fever.
Rectal palpation: tender, swollen, indurated, boggy and warm to
be touched.
Since acute cystitis often accompanies acute bacterial prostatitis,
the urine may be cloudy.
Initial, terminal, or even total gross hematuria may be observed
occasionally.

75. Acute bacterial prostatitis
C. Laboratory Findings
Voided urine usually shows significant pyuria, microscopic
hematuria, and bacilluria.
The prostatic expressate is purulent and yields the infecting
pathogen in heavy growth on culture plates.
Because massage of an acutely infected prostate is painful for the
patient and can produce bactermia, prostatic massage is generally
contraindicated. Except under anaesthesia and antibiotic cover.
D. Instrumental Examination
Transurethral instrumentation should be avoided during the acute
stage of bacterial prostatitis.

76. Acute bacterial prostatitis
Complications
• Acute urinary retention.
• Acute bacterial cystitis.
• Acute pyelonephritis.
• Unilateral or bilateral acute bacterial epididymitis.
• bactermia with possible septic shock.
1( Rarely meningitis, spread of infection via Batesan’s
veinous plexus
2( Prostate abcess

77. Acute bacterial prostatitis
Prostatic Abscess
More recently, about 70% of prostatic abscesses have been caused
by coliform bacteria, mostly E-coli.
Although the pathogenesis remains unclear, most cases of prostatic
abscesses are probably complications of acute bacterial prostatitis.
The signs and symptoms of prostatic abscess can mimic those of
bacterial prostatitis; Fluctuation is an important diagnostic clue.
Once the diagnosis of prostatic abscess is made preferred
treatment consists of surgical drainage combined with appropriate
antimicrobial therapy.
With proper diagnosis and therapy, the overall prognosis is good.

78. Acute bacterial prostatitis
Treatment
• Fluoroquinolone
• Ciprofloxacin
• Trimethoprim-sulfamethoxazole
• Alternatively, initial therapy with Gentamicin or
Amikacin or Tobraminycin, 3-5 mg/kg/d divided into 3
intravenous or intramuscular doses, plus ampicillen,
2 g intravenously every 6 hours, is recommended
until the results of culture and sensitivity tests are
known.
Transurethral instrumentation is contraindicated
during acute infection.

79. Acute bacterial prostatitis
Prognosis
• Unless the patient develops septicemia and septic
shock, the prognosis generally is good with prompt
and appropriate therapy.

80. Chronic Bacterial Prostatitis
Etiology:
Is a non acute infection of the prostate caused by one or
more specific bacteria.
The possible routes of infection are the same
in acute and chronic bacterial prostatitis.

81. Chronic Bacterial Prostatitis
Clinical Findings
A. Symptoms
• Asymptomatic; most have varying degrees of irritative voiding
dysfunction and low back or perineal pain and discomfort.
• Occasionally, myalgia and arthralgia accompany the other
symptoms.
B. Signs
• On rectal examination, the prostate may feel normal (rarely(,
boggy, or very tender focally indurated.
• Crepitation may be felt when large prostatic stones are present or
if infection is due to gas forming organisms commenly seen in
diabetic patients.
• Secondary epididymitis sometimes is associated with chronic
bacterial prostatitis.

82. Chronic Bacterial Prostatitis
C. Laboratory findings
• The Prostatic secretions obtained by prostatic massage typically
show excessive numbers of inflammatory cells.
• The presence of large numbers of lipid laden macrophages in
prostatic fluid correlates particularly well with the presence of
prostatic inflammation.
D. X-Ray findings
• normal unless there are complications (eg, prostatic calculi,
prostatic enlargement, urethral stricture, renal infection(.
E. Instrumental Examination
• Cystoscopy and urethroscopy may reveal normal findings or
erythema and edema of the prostatic urethra, with or without
inflammatory polyps.

83. Chronic Bacterial Prostatitis
Complications
• Relapsing recurrent UTI.
• Ascending bacterial infection of the upper urinary tract
and bacterial epididymitis.
• Bladder outlet obstruction.

84. Chronic Bacterial Prostatitis
Treatment
General Measures
Symptoms can be relieved by the liberal use of hot sits
baths.
Irritative voiding discomfort and pain often respond to the
use of anti-inflammatory agents ( eg, indomethacin,
ibuprofen( and anticholinergic drugs.

85. Chronic Bacterial Prostatitis
Treatment
Surgical Measures
Radical prostatovesiculectomy is curative; unfortunately, the
sequels of this operation ( sexual impotence and possible urinary
incontinence( seldom make this a desirable choice.
Transurethral prostatectomy can be curative provided all infective
stones and tissues are successfully removed; unfortunately, this
may be difficult to achieve, especially since the peripheral zone of
the prostate usually contains the most foci of the infection.

86. Chronic Bacterial Prostatitis
Prognosis
Chronic bacterial prostatitis is difficult to cure
permanently, but its symptoms and tendency to cause
recurrent UTIs generally can be controlled by
suppressive antimicrobial therapy.

87. Chronic Abacterial Prostatitis
Etiology
Is the most common of the prostatitis syndromes; its
cause is unknown.
There has been much speculations but little proof that
chlamydial infection is responsible for many cases of
apparent nonbacterial prostatitis.
Like wise, there is little evidence that infection due to U
urealyticum plays an important role in this prostatitis.
Some researchers believe that non bacterial prostatitis is
an autoimmune disease of the prostate.

88. Chronic Abacterial Prostatitis
Pathogenesis and Pathology
The cause of the pathogenesis of nonbacterial prostatitis
are unknown.
The histopathologic findings are non specific and
resemble those seen in chronic bacterial prostatitis.

89. Chronic Abacterial Prostatitis
Clinical Findings
The signs and symptoms are similar except that
documented UTI almost never occurs in former.
Complications
Non bacterial prostatitis causes no known organic
complications

90. Chronic Abacterial Prostatitis
Treatment
• Antimicrobial therapy should be tried for at least 4 weeks.
• Therapy must be directed toward control of the symptoms.
• Symptomatic flare ups often respond to anti-inflammatory agents.
• Like most patients with prostatodynia, most patients with non
bacterial prostatitis respond favorably to therapy using an alpha
blocking agent.
• Most authorities agree that prostatectomy is not indicated.

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