Beware of Self-Diagnosis Errors: Diseases That Mimic But Are Not Chronic Prostatitis

Chronic prostatitis is a common disease in men, but many patients often confuse it with other urinary system diseases, leading to misdiagnosis. When treating chronic prostatitis, it is necessary to adopt corresponding treatment methods for different causes.

Generally, antibiotics, traditional Chinese medicine Diuretic and Anti-inflammatory Pill, and others are used for treatment.

In addition, physical therapy and thermotherapy can be used to alleviate symptoms. At the same time, improving diet and lifestyle habits is important to enhance immunity. If other symptoms appear or other diseases are suspected, timely medical consultation for related examinations and treatment is advised.

Here are some diseases similar to chronic prostatitis that need to be differentiated:

1. Prostatic abscess: This is a complication of acute bacterial prostatitis, mostly occurring in individuals aged 50-60. Patients usually have symptoms such as acute urinary retention, frequent urination, difficulty urinating, discomfort in the rectum, and pus discharge from the urethra, and some may also have epididymitis. During a rectal exam, the affected side of the prostate is enlarged and soft to the touch, and fluctuation can be felt.

2. Prostatodynia: These patients present with persistent frequent urination, painful urination, difficulty urinating, and discomfort in the perineum, lower abdomen, and lumbosacral areas, which worsens after sitting for a long time or cycling. Rectal examination shows significant tenderness on both sides of the levator ani muscle, but the prostate feels normal and without tenderness upon palpation. This condition was previously known as the piriformis-levator ani syndrome, with normal prostate fluid microscopy and no bacterial growth in culture.

3. Prostate tuberculosis: The symptoms are similar to chronic prostatitis, but there is often a history of urinary system tuberculosis or tuberculosis in other parts of the body. During a rectal exam, the prostate feels irregularly nodular, the epididymis is enlarged and hardened, and there are beaded hard nodules on the vas deferens. Direct smear or PCR testing of prostate fluid for tuberculosis bacillus can detect tuberculosis.

4. Prostate stones: Refers to stones formed in the prostate acini and ducts, related to inflammation in the location of the prostate, retention of prostate fluid, ductal stenosis, and metabolic disorders. Inorganic salts such as calcium oxalate, calcium phosphate, and magnesium phosphate deposit on the prostatic acini's amyloid bodies, epithelial cells, and inflammatory exudates to form stones. 

Patients may exhibit various symptoms of chronic prostatitis. But rectal examination can detect a friction feel of prostate stones, pelvic X-rays show a positive stone shadow on one side of the pubic symphysis, and ultrasound can show a strong echo band at the prostate stone site, along with shadowing.

5. Pubic osteitis: Clinically, it often presents symptoms of chronic prostatitis, but anal examination and prostate fluid examination are normal. The main feature is significant tenderness at the pubic symphysis; pelvic X-ray shows the pubic symphysis gap widened >10mm, the difference in the level of both pubic branches >2mm, irregular edges of the pubic symphysis, with erosion and reactive bone sclerosis appearing.

6. Prostate cancer: In the late stage, symptoms such as frequent urination, painful urination, and difficulty urinating may appear, but patients often have significant systemic symptoms such as weight loss, fatigue, anemia, and loss of appetite. During a rectal exam, the prostate has hard stone masses with an uneven surface, increased serum prostate-specific antigen, and prostatic acid phosphatase. 

Prostate biopsy can find cancer cells, and ultrasound shows an enlarged gland, irregular boundary echoes or defects, uneven internal spots, brighter spots, or masses in cancerous areas. CT scans show asymmetrical prostate morphology, and if the tumor infiltrates outside the capsule, the tissue gap between the seminal vesicles and the posterior wall of the bladder disappears. CT can determine the infiltration depth of prostate cancer.

7. Acute pyelonephritis: Acute pyelonephritis is mostly seen in women, rarely in men. The back pain caused by acute pyelonephritis is mostly on one side of the kidney area, with significant percussion pain. The back pain caused by acute prostatitis is mostly in the center of the lumbosacral area, without percussion pain in the kidney area. In acute prostatitis, many pus cells can be seen in the prostatic fluid, while in acute pyelonephritis, the main change is in urine.

Recommended Readings:

Summer Care: Effective Strategies of Traditional Chinese Medicine for Treating Chronic Prostatitis

Afraid to Drink Water? "Dehydration" is The Enemy of Chronic Prostatitis!

Men with Prostatitis: Abstain from Sex or Not, That is the Question