Prostate Enlargement on Ultrasound: Prostatitis or Benign Prostatic Hyperplasia(BPH)?

Date:2024-06-04 click:0

Prostatitis is inflammation of the prostate gland, usually caused by bacterial infections, but can also be non-bacterial. Based on the duration and symptoms, prostatitis can be classified into acute and chronic.


The symptoms of acute prostatitis are severe, including fever, chills, perineal pain, frequent urination, and urgency. The symptoms of chronic prostatitis, on the other hand, are mild but last for a long time, and often manifest as pelvic pain, difficulty urinating, and sexual dysfunction.

Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate, predominantly seen in elderly adults. As men age, the prostate gradually enlarges, which can compress the urethra, leading to urinary difficulties such as frequent urination, urgency, and nocturia.

BPH is a progressive disease. Although it is not cancer, if not treated in time, it can lead to serious urinary system problems.

When a man undergoes an ultrasound examination, and the report indicates prostate enlargement, the question arises whether this enlargement is due to prostatitis or BPH. 

Is prostate enlargement prostatitis or BPH?

Prostate enlargement due to prostatitis generally involves inflammation, in which the prostate tissue does not produce additional cells. Instead, the space between cells is filled with fluid, causing the overall size of the prostate to increase. This type of enlargement is typically associated with increased white blood cells, indicating an inflammatory response.

In contrast, BPH involves an actual increase in the number of cells within the prostate tissue, which may become more solid, fibrotic, or even calcified. This means the tissue itself increases in mass, leading to an enlarged prostate that physically presses against the urethra and bladder.

If the medical report shows prostate enlargement along with an elevated white blood cell count, it suggests the presence of chronic prostatitis. If the ultrasound reveals substantial tissue growth and hardening within the prostate, it is more indicative of BPH. 

Simply relying on ultrasound findings to determine whether a patient has prostatitis or BPH is insufficient. A comprehensive medical evaluation, including further diagnostic tests, is essential for an accurate diagnosis. 

How to Make a More Accurate Diagnosis?

1. Physical Examination: Doctors typically perform a digital rectal exam (DRE) to assess the prostate's size, shape, and texture. Prostatitis usually presents with a soft, tender prostate, while benign prostatic hyperplasia (BPH) is characterized by a uniformly enlarged, non-tender prostate. 

2. Laboratory Tests: Urinalysis can detect infections or hematuria; a prostatic fluid analysis obtained by massaging the prostate can identify inflammatory cells; measuring prostate-specific antigen (PSA) levels helps rule out prostate cancer.

3. Magnetic Resonance Imaging (MRI): In complex cases, MRI can provide more detailed structural information about the prostate.

How to Treat?

Treatment of Prostatitis

1. Antibiotic Therapy: Doctors usually prescribe antibiotics for bacterial prostatitis, such as levofloxacin or ciprofloxacin, typically for 4-6 weeks.

2. Anti-inflammatory Medications: Non-bacterial prostatitis patients may use non-steroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and inflammation.

If antibiotics are ineffective or it is non-bacterial prostatitis, Diuretic and Anti-inflammatory Pill can be considered.

3. Physical Therapy: Heat therapy and prostatic massage can help relieve symptoms.

Treatment of Benign Prostatic Hyperplasia (BPH)

1. Medication: This includes 5-alpha-reductase inhibitors (e.g., finasteride) and alpha-blockers (e.g., tamsulosin) to reduce prostate size and alleviate symptoms.

2. Surgical Treatment: For patients unresponsive to medication, options include transurethral resection of the prostate (TURP) or laser surgery.

3. Minimally Invasive Treatments: Techniques such as prostatic artery embolization (PAE) reduce prostate size by decreasing its blood supply.

When an ultrasound indicates prostate enlargement, patients need to consider their symptoms and undergo professional medical evaluation to determine whether it is prostatitis or BPH. 

Although the treatment approaches for these conditions differ, both require active management and a healthy lifestyle to control the disease effectively.

Recommended Readings:

Can Prostate Enlargement Be Inherited?

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

Does Prostatitis Cause Prostate Enlargement?