Prostatic Pain
Acute or chronic prostatitis is very painful. Acute prostatitis
is usually caused by a bacterial infection and responds to antibiotic therapy. Chronic
prostatitis is due
to inadequate treatment of acute infection, recurrent infection, or prostatic uroliths.
Treatment includes prostatic massage, NSAIDs, antibiotics, and surgical drainage.
Adenocarcinoma of the prostate is the most common male cancer
and is usually painless. Rectal or sacral pain with prostatic cancer may be a sign
of metastatic disease. Patients with sacral or pelvic pain should be investigated
for bone metastasis. Oral or parenteral high-dose opiates are the mainstay of treatment
initially. Permanent placement of an epidural catheter or intrathecal implantable
pump for continuous delivery of medications and radiation therapy should be considered
for metastatic disease.
