The Abnormal Prostate

Nonbacterial prostatitis is the most common of the prostatitis syndromes. Its mechanism is unknown and is a diagnosis of exclusion. Acute bacterial prostatitis is usually caused by gram-negative pathogens found in other urinary infections and less commonly by gram-positive organisms (e.g., enterococci). Patients are typically acutely ill with fever, chills, dysuria, perineal or suprapubic pain, and cloudy urine. Sexually transmitted pathogens are possible etiologies in sexually active men. Chronic bacterial prostatitis has more variable symptoms, ranging from asymptomatic to acute symptomatology.

Benign prostatic hyperplasia (BPH) is the most common benign tumor in men. The enlargement of tissue results in the obstruction of urine flow, causing urine retention. Symptoms of obstruction include hesitancy, straining to urinate, slow stream, a sensation of incomplete bladder emptying, and postvoid dribbling. There may also be irritative symptoms such as frequency, urgency, and nocturia. Medical therapies include alpha-blocking agents, 5-alpha-reductase inhibitors, and transurethral resection of the prostate (TURP).

Adenocarcinoma of the prostate is the most common noncutaneous cancer in American men greater than 50 years of age. Patients are typically asymptomatic. Digital rectal examination (DRE) may demonstrate an area of induration. There may also be an elevation in the serum prostate specific antigen (PSA). The diagnosis should be confirmed with biopsy.