The perplexing problem of prostatitis.

Prostatitis presents the physician with a perplexing problem. It is seen often but is not easily treated. The acute form is serious but responds to antibiotic therapy. Chronic prostatitis does not respond well to any form of therapy, and opinion is divided regarding its cause. Bacterial localization tests have helped significantly in the diagnosis of chronic prostatitis. When Gram-negative organisms are found only in the prostatic fluid or in the last voided urine, bacterial prostatitis can be diagnosed. Most antibiotics, however, do not cross prostatic epithelium to combine with prostatic fluid; those that do are not effective against Gram-negative organisms. New agents hold promise but lack the test of time. While some cases of chronic disease definitely are caused by bacterial infection, most probably are not. The diagnosis in these instances is abacterial prostatitis. Treatment is symptomatic and varied. A phenomenon that adds to the mystery of etiology is the fact that antibiotics, particularly tetracycline, may help. Psychotherapy often is needed but seldom is accepted. The physician must rule out underlying causes, such as a physical abnormality of the urinary system, for any form of prostatitis before considering it an isolated disorder.