The prostate is part of the male genitourinary system. Its role is to produce seminal fluid that is released during ejaculation into the prostatic urethra, thereby aiding the vitality and motility of sperm.
Throughout life, the prostate can be affected by various pathological conditions, such as prostatitis. Prostatitis is an inflammation of the prostate, which should not be confused with prostate cancer, as it is not related to tumor processes, nor with benign prostatic hyperplasia, which represents an abnormal enlargement of the gland. Prostatitis can affect any man, and it is estimated that 50% of the male population will experience it at least once in their lifetime, with a higher incidence between the ages of 30 and 50.

There are different forms of prostatitis:

–  Acute bacterial prostatitis: It manifests suddenly, with classical symptoms associated with genitourinary infections, including chills, fever, perineal pain, premature ejaculation, urinary urgency, and burning sensations in the glans.

–  Chronic bacterial prostatitis: Symptoms develop much more slowly and tend to be intermittent, alternating between periods of relative well-being and phases where symptoms become more pronounced.

–  Chronic non-bacterial prostatitis/chronic pelvic pain syndrome: Clinically, this condition is very similar to chronic bacterial prostatitis, differing only in the absence of bacteria in urine, semen, and fever.

– Asymptomatic prostatitis: Despite evident signs of inflammation, such as an increase in white blood cells in semen, it does not cause pain or discomfort.

Diagnosis and Treatment

The symptoms of prostatitis provide useful indications for diagnosis but are not exhaustive. Confirmation of any infections in the seminal pathways is mainly done through semen culture (semen analysis), and to some extent, through urine analysis. Generally, these examinations are sufficient; however, in cases of non-bacterial prostatitis, additional tests such as uroflowmetry and prostate ultrasound may be necessary.

The management of prostatitis varies depending on its causes and can require an extended period of time. For bacterial prostatitis, the first-line treatment is antibiotics. The urologist selects the type of antibiotic, dosage, and method of administration based on the severity of the condition, the patient’s overall health, and the patient’s response to treatment.
For non-bacterial forms, it is useful to adopt multimodal approaches that include medications (anti-inflammatory and alpha-blockers) and lifestyle changes (such as reducing coffee and alcohol consumption). Physical therapies, such as shockwave therapy, have proven to be very effective. This technique uses low-intensity waves that are painless and non-invasive, emitted through a device placed on the skin; they can be delivered to specific areas without affecting surrounding tissues. Various studies have shown that shockwaves are effective in treating chronic prostatitis as they promote increased vascularization, stimulate anti-inflammatory signals, disrupt nerve impulses responsible for pain, and reduce passive muscle tone.
Prostatitis, particularly in its chronic forms, represents a complex condition requiring adequate management and can have significant effects not only on physical health but also on mental well-being. Urinary and sexual disorders, and especially the fear of a persistent condition, can lead to feelings of anxiety and embarrassment, interfere with sexual activity, and create discomfort in personal relationships. For this reason, it is essential for men experiencing these symptoms to consult a specialist who can not only manage the condition appropriately but also provide psychological support or recommend strategies for managing stress and reducing the risk of recurrences.