In its acute form, prostate inflammation, or prostatitis, is most often caused by an infection. In its chronic form, however, it more likely implies an imbalance in the urinary microbiota.
Prostatitis affects around 10% of men in the general population1. Symptoms include burning sensation and urinary frequency. Other symptoms may be present, such as pelvic, perianal, or rectal pain, and fever.
Acute prostatitis: an infectious origin
Acute prostatitis is often caused by an infection. It can be sexually transmitted (like chlamydia or gonorrhea) but most often it is caused by enterobacteria, with Escherichia coli implicated in 80% of cases1.
Microbiota involved in chronic forms
The origin of chronic prostatitis is less clear; bacteria are rarely succesfully isolated and the disease could be multifactorial. The etiology comes simultaneously from infectious and inflammatory factors as well as stress. All three play a significant role in interactions between the microbiota and the body2. In patients, correlations between symptoms, severity of pain and dysbiosis of the intestinal microbiota have been found when compared with healthy subjects2. The urinary microbiota is also disrupted, with an overrepresentation of Burkholderia cenocepacia3 and Clostridia4. Modification of the urinary microbiota via antibiotic treatment may be the cause of chronic prostatitis5. These observations suggest that identifying these bacteria could be useful to establish a diagnosis, while modulating them could be used for treatment2.
Chronic forms sometimes difficult to treat
Acute prostatitis is treated with simple antibiotics6. Treatment for chronic forms is more difficult, and sometimes requires a multidisciplinary approach given the more complex etiology2. Probiotic options to rebalance the urinary microbiota are still at an extremely preliminary stage.
1. Nickel JC et al. Prevalence of prostatitis-like symptoms in a population based study using the National Institutes of Health chronic prostatitis symptom index. J Urol 2001 ; 165 (3) : 842-5 https://www.ncbi.nlm.nih.gov/pubmed/11176483
2. Arora HC et al. Gut microbiome and chronic prostatitis/chronic pelvic pain syndrome. Ann Transl Med. 2017 Jan;5(2):30 https://www.ncbi.nlm.nih.gov/pubmed/28217695
3. Nickel JC et al. Search for Microorganisms in Men with Urologic Chronic Pelvic Pain Syndrome: A Culture-Independent Analysis in the MAPP Research Network. J Urol. 2015 Jul;194(1):127-35 https://www.ncbi.nlm.nih.gov/pubmed/25596358
4. Shoskes DA et al. The urinary microbiome differs significantly between patients with chronic prostatitis/chronic pelvic pain syndrome and controls as well as between patients with different clinical phenotypes. Urology, 2016; 92: 26-32. http://www.goldjournal.net/article/S0090-4295(16)00267-3/abstract
5. Amarenco G. Microbiote urinaire et troubles mictionnels. Prog Urol 2015; 25,11:625-27. http://www.urofrance.org/nc/science-et-recherche/base-bibliographique/article/html/microbiote-urinaire-et-troubles-mictionnels.html
6. SPILF 2014. Mise au point. Diagnostic et antibiothérapie des infections urinaires bactériennes communautaires de l’adulte. http://www.infectiologie.com/UserFiles/File/medias/Recos/2014-infections_urinaires-long.pdf