The good news is that treatment with antibiotics is usually successful, and relief is as dramatic as the symtoms were. Important: Antibiotics must be taken for six weeks even after the symptoms have disappeared. The reason is that, if it’s not obliterated right away, acute bacterial prostatitis becomes much more difficult to cure. Eradicating acute bacterial prostatitis the first time around, by relentless treatment with antibiotics, is the best way to avoid developing chronic bacterial prostatitis.

Chronic bacterial prostatitis is also caused by bacteria, and also treated by antibiotics. It can be a recurring illness, coming back periodically for years after an initial episode of acute bacterial prostatitis. Its symptoms are usually milder versions of those in the acute form. Here, too, treatment with antibiotics should continue for six weeks.

Nonbacterial prostatitis is the most common form of prostatitis, and it’s a mystery. Nobody knows what causes it, and antibiotics don’t make it go away. Men with this form of prostatitis may have many of the same symptoms as in chronic bacterial prostatitis, and white blood cells may be present in fluid made by the prostate—but as far as we know, it doesn’t involve bacteria.

Prostatodynia has basically the same symptoms as nonbacterial prostatitis; the difference is made in diagnosis. Prostatodynia can be caused by many things, particularly muscle spasms in the bladder neck, urethra, perineum, or pelvis.

Treatment for nonbacterial prostatitis and prostatodynia is largely sy/mptomatic. Muscle relaxants and other drugs have been helpful in easing the muscle tension in the prostate and making urination easier. Some doctors recommend anti-inflammatory drugs and sitz baths, and many men have found that diet has an effect on nonbacterial prostatitis, and that some foods—particularly, spicy dishes, red wine and caffeine—seem to aggravate their symptoms.

Even if prostatitis is not always curable, it is treatable. Most men can get medical relief from their symptoms. It is not contagious; men can continue a normal sex life without worrying about giving the disease to someone else. And, having prostatitis does not mean you’re at a greater risk of getting BPH or prostate cancer.

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Early randomized trials comparing laser prostatectomy to TUR demonstrate that urinary flow rates and symptom improvement are better in patients who have TUR. In these early laser studies, about 10 percent of men needed to be retreated in the first year. Laser treatment of BPH is too new for anyone to make predictions about its long-term effectiveness.

So, the jury’s still out; the final verdict on laser prostatectomy won’t be given until we know what the true retreatment rates will be. Currently, the results for laser prostatectomy aren’t as immediate or as long-lasting—and improvement is not as dramatic—as in TUR. However, unlike TUR, laser prostatectomy doesn’t involve hospitalization, and it can be done under local anesthesia. Currently, many men would rather have two TURs in ten years than one open prostatectomy. It may be that, in the future, men will prefer to have two or three treatments with a laser than one TUR Another point to keep in mind, as a Stanford urologist noted in a recent journal article, is that “all laser devices available today represent first-generation products … All will most likely become obsolete in the foreseeable future,” as the design of these devices, and the knowledge it takes to use them, continues to improve that surgeons can use them, continuous to improve.

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Your doctor will probably begin with the outside first, checking your abdomen for swelling (to see whether the bladder is emptying completely), and to make sure the kidneys feel normal—and that they’re not palpable. (Normally, kidneys cannot be felt in a physical exam through the abdomen.) Also, your doctor will probably examine your testicles, to make certain that both are present and that they’re normal in size.

Because of the prostate’s location—below the bladder, and just in front of the rectum—it can’t be seen or examined from the outside. So the first step in examining it is usually the digital rectal examination, in which a doctor’s gloved, lubricated finger is inserted into the rectum to feel for lumps, enlargement, or areas of hardness that might indicate the presence of cancer. Because BPH affects only the innermost core of the prostate, your doctor may find nothing out of the ordinary here. It’s important to keep in mind that the size of the prostate often has nothing to do with the degree of symptoms. Some men with major prostate enlargement have no urinary tract trouble, while other men with seemingly minor enlargement suffer many symptoms of obstruction. Again, it depends on the site of enlargement in the prostate (see above). Some men, for example, may have middle lobe growth, but hardly any lateral lobe enlargement. Because the middle lobe can’t be felt by a doctor’s finger, a man may have what feels like a very small prostate, yet have big trouble with urinary retention.

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Drugs for Milder Pain

Listed here are some nonsteroidal anti-inflammatory drugs (NSAIDs) and some of their brand names. (Just because we don’t mention the brand name here doesn’t mean it isn’t a good drug.) Over-the-counter drugs include aspirin; acetaminophen (brand names include Tylenol and Datril); and ibuprofen (brand names include Motrin, Advil and Nuprin). Prescription drugs include diflunisal (Dolobid); choline magnesium trisalicylate (Trisilate); salsalate (Disalcid); naproxen (Naprosyn); naproxen sodium (Anaprox); indo-methacin (Indocin); sulindac (Clinoril); and ketorolac (Toradol).

Drugs for Moderate to Severe Pain

Here are prescription drugs, and some of their brand names. (Again, not all brand names are mentioned here.) They include fenatyl (Duragesic); propoxyphene (Darvon, Darvocet); codeine (Tylenol with codeine); oxycodone (Tylox, Percocet, Percodan); meperidine (Demerol); methadone (Dol-ophine); hydromorphone (Dilaudid); and morphine (Roxanol).

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How does an X-ray machine work? The simplest way to think of it is to imagine yourself getting a suntan. The difference here is that you can’t feel or see the X-ray energy hitting your body, and the “tan” occurs internally, as the radiation particles destroy DNA, causing targeted cells to die. The best way to get a good, even tan is in increments, not all at once. Therefore, radiation doses are spread out over several weeks’, with each treatment lasting only minutes at a time. The goal here, besides killing the cancer, is to do as little harm as possible to the surrounding tissue—the rectum, bowel, bladder, bone and skin.

External-beam radiation therapy’s effects may not be as durable in the long run as those of radical prostatectomy; it is often associated with positive biopsies and, over time, with increases in PSA. This is why external-beam radiation therapy is an ideal option for older patients. However, within the last few years, an exciting new technique called 3-D conformal radiation therapy has come on the scene. It increases external-beam therapy’s potential by maximizing the dose of radiation to the prostate tumor, while keeping the risk of damaging nearby tissue to a minimum—and it may improve long-term results.

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