Patient's question:
Prostate diseaseDoctor's answer:
Chronic prostatitis is generally not difficult to diagnose based on medical history, symptoms, digital rectal examination, and prostatic fluid tests. However, for patients with complex symptoms or atypical signs, differentiation from the following conditions is necessary.1. Prostatodynia: These patients present with persistent urinary frequency, dysuria, and difficulty urinating, along with pain and discomfort in the perineum, lower abdomen, and lumbosacral region, which worsen after prolonged sitting or cycling. Digital rectal examination reveals significant tenderness in both levator ani muscles, while prostatic palpation is normal without tenderness. Previously known as piriformis levator ani syndrome, this condition shows normal findings in prostatic fluid microscopy and no bacterial growth in culture.
2. Prostatic abscess: Most cases are complications of acute bacterial prostatitis, occurring primarily in individuals aged 50–60. Half of the patients experience acute urinary retention, urinary frequency, difficulty urinating, rectal discomfort, purulent urethral discharge, and sometimes orchitis. Digital rectal examination reveals enlargement of the affected prostate, which feels soft and fluctuant. Occasionally, a prostatic abscess may rupture naturally into the urethra or rectum, mistakenly being diagnosed as a periurethral abscess.
3. Prostatic calculi: These are stones formed within the prostatic acini and ducts, associated with chronic prostatitis, prostatic fluid retention, ductal stenosis, and metabolic disorders. Inorganic salts such as calcium oxalate, calcium phosphate, and magnesium phosphate deposit on amyloid bodies, epithelial cells, and inflammatory exudates within the prostatic acini, forming stones. Patients may exhibit symptoms similar to chronic prostatitis, but digital rectal examination can detect a grinding sensation in the prostate due to stones. Pelvic X-rays may show positive stone shadows in one side of the symphysis pubis, while ultrasound reveals bright bands at the site of prostatic calculi, accompanied by acoustic shadows.
4. Prostatic tuberculosis: The symptoms are similar to chronic prostatitis, but patients often have a history of urinary tuberculosis or other tuberculous lesions. Digital rectal examination reveals an irregular nodular prostate, swollen and hardened epididymis, and in the vas deferens. Direct smear or PCR detection of Mycobacterium tuberculosis in prostatic fluid confirms the diagnosis.
5. Prostate cancer: Advanced stages may present with urinary frequency, dysuria, and difficulty urinating, but patients often exhibit significant systemic symptoms such as weight loss, fatigue, anemia, and poor appetite. Digital rectal examination detects a hard, stone-like mass in the prostate with an irregular surface. Elevated serum prostate-specific antigen (PSA) and acid phosphatase levels are observed. Prostate biopsy reveals cancer cells, while ultrasound shows an enlarged gland with irregular or defective boundary echoes and uneven internal echoes, including bright spots or masses in the tumor area. CT imaging reveals asymmetry in prostate morphology, and if the tumor invades beyond the capsule, it may show loss of tissue spacing between the seminal vesicles and posterior bladder wall. CT can determine the extent of prostate cancer invasion.
6. Pubic osteitis: Clinically, it often presents with symptoms similar to chronic prostatitis, but digital rectal examination and prostatic fluid tests are normal. The main feature is significant tenderness at the symphysis pubis. Pelvic X-rays show widening of the symphysis pubis gap (>10 mm) and bilateral asymmetry in the superior pubic rami (>2 mm), as well as irregular edges with erosion and reactive bone sclerosis.