Prostatitis is an inflammation or swelling of the prostate gland. It may be caused by an infection, but sometimes no specific cause is found by the usual diagnostic tests. Its main symptoms include:

  • Pain in the pelvic region (genitals or deeper in the groin) or lower back
  • Difficult or painful urination
  • Sexual dysfunction or painful orgasm
  • General health problems (flu-like feelings, fatigue, depression)
  • An elevated or rising PSA

Prostatitis can occur at any age, but men age 50 or younger are most commonly affected. Many cases are caused by a bacterial infection, and should be treated with antibiotics to avoid worsening. It can also be caused by injury to groin area, or nervous condition. There are four prostatitis categories

  1. Acute bacterial prostatitis comes on gradually or suddenly. It is caused by a bacterial infection and needs antibiotic treatment.
  2. Chronic bacterial prostatitis either lingers on or comes and goes in cycles because antibiotics did not get rid of all the bacteria. It may be difficult to treat because of drug-resistant bacterial strains.
  3. Chronic prostatitis with no sign of infection (also called chronic abacterial prostatitis, Chronic Pelvic Pain Syndrome, or CPPS) has the same characteristics as chronic bacterial prostatis but no infection is found. It is the most difficult to diagnose accurately and reliably, and affects 10-15% of men. Antibiotics are not effective in treating it.
  4. Asymptomatic prostatitis does not have any symptoms, but is detected while diagnosing other health issues in the pelvic area. Generally, no treatment is necessary.

Diagnosing prostatitis

Diagnosing Prostatitis at Sperling Prostate Center
Prostatitis often defies precise diagnosis. It overlaps with other prostate conditions, and conventional diagnostic methods such as a prostate biopsy can be hit-or-miss. In fact, conventional urine tests fail to pick up 85% of bacteria strains that can cause prostatitis. This is why advanced diagnostics including multiparametric MRI is so important, especially before a prostate biopsy.

In standard diagnostics, a doctor takes a medical history: start of symptoms, when and how frequently they occur, how bothersome they are, and any other problems going on at the same time. Lab tests include blood, urine and prostate fluid analysis as well as a digital rectal exam. A physical urological exam may also be done. If all tests are negative for infection, or inconclusive, a diagnosis of CPPS is often assigned, especially if pain or urinary symptoms have been present for 3 of the previous 6 months with no evidence of bacterial infection (culture-negative prostatitis). Finally, if PSA is elevated, a biopsy may be ordered to rule out prostate cancer – but don’t miss an important first step!

New hope: A 3T multiparametric MRI before a biopsy helps correct diagnosis.

Today’s multiparametric MRI (mpMRI), has revolutionized the detection and diagnosis of prostate diseases. When mpMRI is performed before biopsy on a powerful 3 Tesla (3T) magnet, it is superior to CT, ultrasound or other radiological modalities in defining abnormal tissue in the prostate and its surroundings. When interpreted by an expert reader, mpMRI reveals prostate abnormalities that distinguish prostatitis from benign prostatic hyperplasia (BPH) or prostate cancer.

The Sperling Prostate Center uses two specific imaging parameters together to identify prostatitis:

  • Diffusion weighted imaging (DWI) detects the telltale cellular signs of prostatitis.
  • Dynamic contrast enhancement (DCE) tells the difference between inflammation-related blood flow vs. cancer tumor blood supply.

During an mpMRI scan for prostatitis, if an area is detected that is suspicious for prostate cancer, an in-bore mpMRI guided biopsy can be done to rule out prostate cancer.

The Sperling Prostate Center’s advanced diagnostics for prostatitis

In addition to a 3T mpMRI, our Center offers a unique advanced urine test. it is the first of its kind because it identifies bacteria, including drug-resistant strains, that other tests miss. This is especially important for culture-negative patients who may be harboring one or more harmful organisms.

  • We submit a “clean catch” urine sample to a special laboratory that performs a molecular diagnostic analysis that can identify over 100,000 different bacteria, parasites, fungi and targeted viruses.
  • If infection is ruled out, further tests can be done to determine if pelvic floor tension is the cause. There are programs that teach conscious relaxation techniques, “trigger point release”, and certain exercises to stretch and relax the pelvic floor.

Managing chronic prostatitis and CPPS the natural way

It is often difficult to reduce or eliminate the symptoms of chronic prostatitis and CPPS. Over the counter (OTC) anti-inflammatories may provide relief, but don’t work for everyone. However, healthy lifestyle changes, including nutrition and exercise, can improve and promote prostate health.

Nutrition DOs and DON’Ts

Discomfort can be linked with bowel problems so if you are susceptible, avoid foods that cause irritation.

DO’s DON’T’s
  • Mediterranean diet is best since it’s noninflammatory
  • Veggies – focus on cruciferous ones like cauliflower, broccoli for reduced inflammation
  • Fruits – avoid acidic fruit if discomfort increases
  • Plant protein preferred over animal protein
  • Foods high in fiber
  • Organic foods and meats to reduce toxicity
Trigger foods can include:

  • Hot peppers/spicy foods
  • Wheat/gluten
  • Acidic foods
  • Caffeine
  • Alcohol
  • Any food allergy that irritates the bowel


NOTE: There is nearly universal agreement on the information below, though research into supplements produces sometimes conflicting results. Always discuss supplements with your doctor before using.

Okay to Consider Should be Avoided
  • Quercetin
  • Graminex pollen extract
  • Phytotherapy (Quercetin + pollen extract)
  • Turmeric/curcumin
  • Stinging nettle
  • Pygeum (help with urinary symptoms)
  • Buy supplements from reputable companies
  • Discuss taking supplements with your doctor before trying any
  • Supplements with a mixture of herbs or active ingredients. It’s best to try a single ingredient at a time to see if it works for you.
  • Don’t fall for advertising claims without checking the credibility of the source

Lifestyle Tips

Exercise Stress Management
  • Strengthen core muscles
  • Stretch frequently to release tension
  • Regular aerobic exercise (decreases inflammation, reduces blood sugar, balances hormones)
  • Yoga or tai chi
  • Breath work (may also help manage discomfort)
  • Relaxation (may need practice)
  • Constructive ways to vent/talk out negative feelings with neutral person
  • Get adequate sleep
  • Massage
  • Join a support group
Mind & Heart Environment
  • Embrace a positive attitude
  • Meditation or mindfulness exercises
  • Do something creative
  • Follow your bliss
  • Deepen intimacy with those you love
  • Replace personal care products that contain chemicals (soap, deodorant, etc.) with natural products
  • Replace toxic household cleaners with natural products
  • Eat organic

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you have personal health concerns or medical questions.

Sah V, Wang L, Min X, Feng Z et al. Multiparametric MR imaging in diagnosis of chronic prostatitis and its differentiation from prostate cancer. Radiol Infectious Diseases. 2015;1(2):70-77.

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