Acute bacterial prostatitis is typically treated with a 14 day course of antibiotics. Almost all acute infections are cured with this treatment though sometimes hospital admission is required or antibiotics are continued for a longer period.
Chronic bacterial prostatitis
In the case of chronic bacterial prostatitis, patients may require antibiotics for up to twelve weeks. About 75 percent of all cases of chronic bacterial prostatitis clear up with this treatment. Sometimes the symptoms recur and antibiotic therapy is needed again. For cases that do not respond to this treatment, long-term, low-dose antibiotic therapy is used to relieve the symptoms. Other medications (such as those used for nonbacterial prostatitis) or other treatments (e.g., prostate massage therapy) may also be used in difficult cases.
In some rare cases, surgery on either the urethra or prostate may be recommended. There must be a specific anatomic problem, such as scar tissue in the urethra, for any surgery aimed at improving prostatitis to be effective.
Non Bacterial Prostatitis
Non Bacterial Prostatitis can be very difficult to treat and there is no gold standard. It is often a relapsing and remitting condition, with relatively asymptomatic periods followed by exacerbations. Like all pain conditions, it is best approached with a multi-disciplinary team including a Urologist, Physiotherapist, Pain Physician, and Counsellor or Psychologist. Having Non Bacterial Prostatitis can cause significant stress, and stress itself exacerbates the condition, hence the need for psychological support.
Among the treatment that can be tried are
- Non-steroidal anti-inflammatory drugs (NSAID)
- Alpha-blockers may be of value but the evidence is inconclusive
- Alpha-blockers in combination with antibiotics may help
- Stress management, although there are no trial data on the effectiveness
- Physiotherapy and relaxation techniques: new research in this area suggests that muscle tension may be the cause of pain in the pelvic floor
Other treatments that have been investigated include thermotherapy (transurethral microwave hyperthermia or transurethral microwave thermotherapy), bioflavonoids (quercetin), and allopurinol.
Newer drug prostatitis treatments in the UK include finasteride and quercetin in combination