Diagnostic and Therapeutic Problems in Prostatitis

Summary

Lower tract localisation studies have been the gold standard in diagnosing various kinds of prostatitis. Four clinical categories are recognised: acute and chronic bacterial prostatitis, nonbacterial prostatitis, and prostatodynia. In acute bacterial prostatitis Gram-negative bacteria are the most common pathogens isolated. The roles of Gram-positive bacteria in chronic bacterial prostatitis and of Chlamydia trachomatis in nonbacterial prostatitis are contentious. Treatment of these various forms of prostatitis has been a challenge to the clinician. The lack of penetration of various drugs into the prostatic tissue, because of poor lipid solubility, ionisation, protein binding, and unfavourable pH gradients from the plasma to the prostatic fluid, may be the main reasons for poor results. The minimum inhibitory concentration (MIC) of antibacterial drugs used, and the concentration of drugs actually obtained in the prostate, combined with the influence of pH and inoculum size, and the effect of prostatic fluid and prostatic extracts on MIC are important factors in determining at least the theoretical efficacy of various drugs in the treatment of prostatitis. The new fluoroquinolone ofloxacin, the first quinolone to be approved for the treatment of chronic bacterial prostatis, has excellent penetration into human prostate and high in vitro activity in human urine and prostatic tissue. From a theoretical standpoint, ofloxacin should be ideal in the treatment of chronic bacterial prostatis. Comparative studies have shown its superiority to carbenicillin. Several noncomparative studies have also been reported. The initial results are promising, but further investigations are needed.