NURS 5462 Prostatitis/ Prostate CA New Exam 100% Verified
Prostatitis - ANSWER Inflammation and/or painful conditions of the prostate 25% of
office visits by men 50% of men will experience prostatitis in their lifetime
Nonbacterial is the most common—8 times more common than bacterial
epidemiology prostatitis - ANSWER Acute bacterial prostatitis—always associated with
a UTI and comes on abruptly
Chronic bacterial prostatitis is a major cause of recurrent bacteriuria and is associated
with history of recurrent UTI— perhaps from repeated seeding of the urinary tract from
an infected prostate Risk factors—age older than 50 years; history of previously
diagnosed UTI, history of prostate calculi
nonbacterial prostatitis - ANSWER —s/sx are similar to chronic bacterial prostatitis, but
here is no evidence of infection › Long distance runners › Athletes who have vigorous
exercise regimens
Infection may also spread to the prostate ducts from the rectum - ANSWER Gram -
causes—Klebsiella, Pseudomonas, Enterobacter, E. coli, Proteus mirabilis, Neisseria
gonorrhoeae Gram + causes—Streptococcus faecalis, Staphylococcus aureus Rarely,
fungus and Mycobacteria tuberculosis have been seen in chronic prostatitis
Cause of nonbacterial disease is under scrutiny - ANSWER however, Ureaplasma,
Trichomonas vaginalis and Chlamydia trachomatis have been seen as the causative
agents, —thought to be inflammation
Acute Bacterial Prostatitis - ANSWER • Fever • Chills • LBP • Malaise • Arthralgias •
Myalgias • Frequency • Urgency • Dysuria • Nocturia • BOO • Warm, tense boggy, very
tender prostate
Chronic Bacterial Prostatitis - ANSWER • Symptoms often absent • Perineal pain • LBP •
Lower abdominal pain • Scrotal pain • Penile pain • Pain on ejaculation • Dysuria •
, Irritative voiding • Normal, boggy or focally indurated prostate
Nonbacterial Prostatitis - ANSWER • Pelvic pain • Irritative voiding • Abnormal flow •
Similar to chronic bacterial prostatitis, tender on palpation
prostatitis - ANSWER CBC—leukocytosis UA—bacteria, pyuria, +/- hematuria In chronic
prostatitis—must culture expressed prostate secretions—urologist referral needed if
you are not going to do prostatic massage In nonbacterial disease—UA will show WBCs
but the culture will be negative If you suspect abscess or cancer—CT or transrectal US
Mgmt - ANSWER Majority managed outpatient Hospitalize those that are toxic,
immunosuppressed, have proven or suspected abscess and those that have sepsis
Keep the patient hydrated Percutaneous suprapubic cath may be needed if urinary
retention occurs—foley cath is contraindicated in those with acute bacterial prostatitis
[don't want to traumatize the inflamed gland and seed the infection
Acute bacterial disease - ANSWER › Levaquin 750 mg PO for 5 days OR Cipro 750 mg
every 12 hours for 5 days But because quinolones have a BB warning— other options
should be used 1st **TMP/SMX DS 1 tablet BID for 10-14 days—and may be extended for
another 14 days if patient remains symptomatic after 2 weeks
Chronic bacterial disease - ANSWER 75% eradication rate with Levaquin 750 mg orally
per day for 4-6 weeks › Ofloxacin or Moxifloxacin › Like in acute disease—quinolones
have a BB warning so consider other drugs first › **TMP-SMX, Azithromycin, Fosfomycin
for 4-6 weeks, and an additional 4-6 week course can be given if the first course only
gives a partial response
Nonbacterial prostatitis—etiology unclear - ANSWER Treated symptomatically › To
reduce pain and discomfort: ➢Anti-inflammatory agents ➢ Muscle relaxants ➢Sitz
baths ➢Fluid adjustments (avoid caffeine) ➢Anticholinergic agents
A small percentage of cases involve occult infections—empiric antibiotic therapy is
often used - ANSWER Restricted to cases where expressed prostate secretions have
>10 WBCs per hpf › Erythromycin 250 mg QID › TMS-SMX DS 1 tab every 12 hours ›
Nitrofurantoin 100 mg daily › These are used alone or with a quinolone
Prostatitis - ANSWER Inflammation and/or painful conditions of the prostate 25% of
office visits by men 50% of men will experience prostatitis in their lifetime
Nonbacterial is the most common—8 times more common than bacterial
epidemiology prostatitis - ANSWER Acute bacterial prostatitis—always associated with
a UTI and comes on abruptly
Chronic bacterial prostatitis is a major cause of recurrent bacteriuria and is associated
with history of recurrent UTI— perhaps from repeated seeding of the urinary tract from
an infected prostate Risk factors—age older than 50 years; history of previously
diagnosed UTI, history of prostate calculi
nonbacterial prostatitis - ANSWER —s/sx are similar to chronic bacterial prostatitis, but
here is no evidence of infection › Long distance runners › Athletes who have vigorous
exercise regimens
Infection may also spread to the prostate ducts from the rectum - ANSWER Gram -
causes—Klebsiella, Pseudomonas, Enterobacter, E. coli, Proteus mirabilis, Neisseria
gonorrhoeae Gram + causes—Streptococcus faecalis, Staphylococcus aureus Rarely,
fungus and Mycobacteria tuberculosis have been seen in chronic prostatitis
Cause of nonbacterial disease is under scrutiny - ANSWER however, Ureaplasma,
Trichomonas vaginalis and Chlamydia trachomatis have been seen as the causative
agents, —thought to be inflammation
Acute Bacterial Prostatitis - ANSWER • Fever • Chills • LBP • Malaise • Arthralgias •
Myalgias • Frequency • Urgency • Dysuria • Nocturia • BOO • Warm, tense boggy, very
tender prostate
Chronic Bacterial Prostatitis - ANSWER • Symptoms often absent • Perineal pain • LBP •
Lower abdominal pain • Scrotal pain • Penile pain • Pain on ejaculation • Dysuria •
, Irritative voiding • Normal, boggy or focally indurated prostate
Nonbacterial Prostatitis - ANSWER • Pelvic pain • Irritative voiding • Abnormal flow •
Similar to chronic bacterial prostatitis, tender on palpation
prostatitis - ANSWER CBC—leukocytosis UA—bacteria, pyuria, +/- hematuria In chronic
prostatitis—must culture expressed prostate secretions—urologist referral needed if
you are not going to do prostatic massage In nonbacterial disease—UA will show WBCs
but the culture will be negative If you suspect abscess or cancer—CT or transrectal US
Mgmt - ANSWER Majority managed outpatient Hospitalize those that are toxic,
immunosuppressed, have proven or suspected abscess and those that have sepsis
Keep the patient hydrated Percutaneous suprapubic cath may be needed if urinary
retention occurs—foley cath is contraindicated in those with acute bacterial prostatitis
[don't want to traumatize the inflamed gland and seed the infection
Acute bacterial disease - ANSWER › Levaquin 750 mg PO for 5 days OR Cipro 750 mg
every 12 hours for 5 days But because quinolones have a BB warning— other options
should be used 1st **TMP/SMX DS 1 tablet BID for 10-14 days—and may be extended for
another 14 days if patient remains symptomatic after 2 weeks
Chronic bacterial disease - ANSWER 75% eradication rate with Levaquin 750 mg orally
per day for 4-6 weeks › Ofloxacin or Moxifloxacin › Like in acute disease—quinolones
have a BB warning so consider other drugs first › **TMP-SMX, Azithromycin, Fosfomycin
for 4-6 weeks, and an additional 4-6 week course can be given if the first course only
gives a partial response
Nonbacterial prostatitis—etiology unclear - ANSWER Treated symptomatically › To
reduce pain and discomfort: ➢Anti-inflammatory agents ➢ Muscle relaxants ➢Sitz
baths ➢Fluid adjustments (avoid caffeine) ➢Anticholinergic agents
A small percentage of cases involve occult infections—empiric antibiotic therapy is
often used - ANSWER Restricted to cases where expressed prostate secretions have
>10 WBCs per hpf › Erythromycin 250 mg QID › TMS-SMX DS 1 tab every 12 hours ›
Nitrofurantoin 100 mg daily › These are used alone or with a quinolone
