Benign prostate enlargement vs. prostatitis: what’s the difference?

Prostatitis and benign prostate enlargement are two of the commonest conditions that can affect the prostate gland, aside from prostate cancer. 

Prostatitis is inflammation of the prostate gland, a chestnut-sized gland that sits just beneath the bladder. It can occur in men of all ages although it is most common in men under the age of 50 years. There are four types of prostatitis:

• Acute bacterial prostatitis
• Chronic bacterial prostatitis
• Chronic pelvic pain syndrome
• Asymptomatic prostatitis

If the symptoms come on very quickly this is known as acute prostatitis. If they come on more gradually or come and go over a period of months, this is known as chronic prostatitis. If the symptoms occur in the absence of proven infection, this is known as chronic pelvic pain syndrome. In some cases, prostatitis causes no symptoms and is found by chance on prostate biopsy specimens. This is known as asymptomatic prostatitis.

Benign enlargement of the prostate gland is considered a normal part of the ageing process and is caused by the male hormone testosterone. This growth of the prostate with age is not cancerous and is known as benign prostatic hyperplasia (BPH). Half of all men aged 65 will have evidence of BPH and this proportion increases further with age. Not all men with an enlarged prostate will experience symptoms and the severity of symptoms is not related to the size of your prostate (even a mild enlargement can cause symptoms in some men)

Who does prostatitis affect vs. benign prostate enlargement?

Prostatitis can affect men of all ages but is most common in men under the age of 50, whereas benign prostate enlargement tends to increase with age, and typically affects men over the age of 50.
 

How do the symptoms compare?

Although the symptoms of both conditions can overlap, there are some differences. Prostatitis can cause a wide range of symptoms which vary between individuals. Common symptoms include:
 

• Pain around the testicles, penis, anus, lower back and lower abdomen
• Pain whilst urinating
• Passing urine more frequently
• Difficulty passing urine
• Blood in your urine (haematuria)
• Pain on ejaculation
• Fevers, chills
• Joint pains
• Feeling generally unwell

With benign prostate enlargement, as the prostate gland enlarges it may put pressure on the urethra. It can lead to symptoms such as:
 

• Difficulty in urinating
• A weak urine flow, which stops and starts
• Feeling like the bladder has not completely emptied
• Straining to pass urine
• Urinating more frequently
• Often waking up during the night to pass urine (nocturia)
• The urge to urinate, which results in leakage if unable to get to the toilet quickly enough
• Recurrent urinary tract infections
• Blood in the urine (haematuria) 
   

When should I see a doctor?

If you have any of the symptoms above and they are bothering you, then you should consult a specialist. There are a number of other conditions that can also cause these symptoms, and so a detailed assessment is required to identify the underlying cause of your symptoms and to treat them most effectively.

If you are worried about prostate cancer you should see a specialist to have further urology tests performed. The Prostate Specific Antigen (PSA) blood test can help to assess your risk of prostate cancer and a multiparametric MRI scan will help to identify any abnormal areas in your prostate.

If there is a suspicion of prostate cancer you will be recommended to have a prostate biopsy (taking small samples of tissue from your prostate) to check for cancerous cells.