Hello, I am Prof. Dr. Volkan İzol.

One of the most common complaints I see at the clinic is prostatitis. My patients come to me with the following questions:

•“Doctor, I have pain in my lower abdomen. Could it be prostatitis?”

•“I always feel like I have to urinate—what should I do?”

•“I took antibiotics, but my symptoms didn’t go away. Why are they coming back?”

To answer these questions, I’d like to share everything I know about prostatitis with you. In this article, you’ll find detailed information on what prostatitis is, what causes it, what its symptoms are, how it’s diagnosed, what treatments are available, and what life is like after treatment.

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The prostate is a walnut-sized organ located just below the bladder and surrounding the urethra. Its function is to produce prostatic fluid, which helps maintain the viability of sperm and facilitates their transport. This fluid makes up approximately 25–30% of the ejaculate.

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Prostatitis is an inflammation of the prostate gland. This inflammation can be acute (onset) or chronic (long-lasting). There are bacterial and nonbacterial forms of the condition.

There are four main types:

1. Acute Bacterial Prostatitis – A serious infection that begins suddenly and is accompanied by fever and difficulty urinating.

2. Chronic Bacterial Prostatitis – A more insidious form characterized by recurrent urinary tract infections.

3. Chronic Pelvic Pain Syndrome (Chronic Prostatitis) – The most common type. No bacteria are detected, but the pain and discomfort persist.

4. Asymptomatic Prostatitis – Inflammation of the prostate that causes no symptoms and is detected incidentally during testing.

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Symptoms vary depending on the type of prostatitis.

•High fever, chills

•Severe groin and perineal pain

•Burning sensation and difficulty when urinating

•Inability to urinate (may indicate complete obstruction)

•Fatigue

•Mild to moderate pelvic pain

•Recurrent urinary tract infections

•A burning sensation after urination

•Pain after ejaculation

•Constant or intermittent pelvic pain

•Increased frequency of urination

•Discomfort during an erection or ejaculation

•Lower back and tailbone pain

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•Bacterial Causes: Urinary tract bacteria, such as E. coli, reach the prostate duct.

• Immunological and Neurological Factors: In the chronic form, the immune system and nerve sensitivity play a role.

•Lifestyle Factors: Prolonged sitting, cycling, and an irregular sex life may increase the risk of prostatitis.

• Stress: It can trigger chronic pelvic pain syndrome.

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Diagnosis requires the patient's medical history, a physical examination, and certain tests:

•Digital Rectal Exam: The prostate’s tenderness is assessed.

•Urine and Prostate Fluid Culture: This test checks for the presence of bacteria.

•Complete Urinalysis: To check for signs of infection.

•Blood Tests (CRP, White Blood Cells): These tests indicate the presence of an infection.

•Ultrasound: Bladder emptying and prostate size are assessed.

At the clinic, I prefer to take a culture after a prostate massage, especially in cases of recurrent infection. This increases our chances of selecting the right antibiotic.

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Treatment varies depending on the type of prostatitis.

Treatment of Acute Bacterial Prostatitis

•Intensive Antibiotic Therapy: It is usually started intravenously.

•Fever and pain management: Anti-inflammatory medications.

•Catheter placement: This may be necessary for patients who are unable to urinate.

These patients are usually monitored in the hospital.

•Long courses of antibiotics lasting 4–6 weeks

•Alpha-blocker medications (relieve urinary flow)

•Anti-inflammatory medications

•Antibiotics are generally not effective.

•A combination of alpha-blockers and anti-inflammatory medications

•Pelvic floor relaxation exercises

•Stress management and psychological support

•Physical therapy or neuromodulation treatments, if necessary

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•Drink plenty of fluids

•Regular ejaculation (to release prostate fluid)

•Avoid sitting for long periods of time

•Use an ergonomic saddle when cycling

•Avoid spicy foods and alcohol

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Many patients ask this question:

“Doctor, does prostatitis affect my sex life?”

Yes, erectile dysfunction, premature ejaculation, and loss of sexual desire can occur, particularly in chronic pelvic pain syndrome. With treatment, most of these symptoms improve.

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Untreated acute prostatitis:

•Prostate abscess

•Sepsis (life-threatening)

•Chronicity

For this reason, early diagnosis and proper treatment are very important.

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In my approach, making the correct diagnosis first is essential. Preventing the unnecessary use of antibiotics, educating the patient about lifestyle changes, and seeking multidisciplinary support (physical therapy, psychology) when necessary all contribute to long-term success.

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•Does prostatitis ever go away completely?

Yes, with the right treatment, most patients make a full recovery. However, chronic cases require patience.

•Does prostatitis cause cancer?

No, prostatitis is not cancer and does not increase the risk of cancer. However, it can cause a temporary increase in PSA levels.

•Does it repeat?

Yes, there is a risk of recurrence in chronic prostatitis. Regular follow-up is necessary.

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Prostatitis is one of the most common urological conditions in men. With an accurate diagnosis, long-term and patient treatment, and lifestyle changes, it can be fully managed.

As Prof. Dr. Volkan İzol, my goal is to both alleviate the symptoms of every patient who comes to me with prostatitis and improve their quality of life.