Prostatitis

Aka: Prostatitis

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II. Epidemiology

  1. Prostatitis accounts for 25% genitourinary complaints in men

III. Types: NIH Consensus Classification of Prostatitis

  1. Infectious Prostatitis: Categories 1 and 2 (10% of Prostatitis cases)
    1. Acute Bacterial Prostatitis
      1. Severe, acute prostate Bacterial Infection with an ill, toxic appearing patient
    2. Chronic Bacterial Prostatitis
      1. Symptoms >3 months with culture demonstrating the same organism
      2. Presents with Recurrent Urinary Tract Infections after complete clearing of prior infection
  2. Noninfectious Prostatitis: Categories 3 and 4 (90% of Prostatitis cases)
    1. Chronic Nonbacterial Prostatitis
      1. Symptoms >3 months with inconsistent culture results
      2. May be Inflammatory (White Blood Cells >10 per HPF) or Non-Inflammatory
      3. Causes Chronic Pelvic Pain in Men
    2. Asymptomatic Prostatitis
      1. White Blood Cells >10 per HPF despite lack of symptoms

IV. Symptoms

  1. Irritative urinary symptoms
    1. Dysuria
    2. Urinary Frequency
    3. Urinary urgency
    4. Ejaculatory pain
    5. Hematospermia
  2. Referred pain
    1. Low pack pain
    2. Perineal pain
    3. Lower Abdominal Pain
    4. Scrotal Pain
    5. Pain in penis
    6. Pain in inner thighs
  3. Systemic symptoms (e.g. fever)
    1. Suggests Acute Prostatitis, Prostate abscess or other significant acute infection
  4. Obstructive urinary symptoms (diminished urinary stream, hesitancy, straining)
    1. Suggests Acute Prostatitis, Benign Prostatic Hyperplasia

V. Exam

  1. Abdominal exam including Pelvis and flank
  2. Genitourinary exam (scrotal exam and penis exam)
  3. Digital Rectal Exam
    1. Avoid Prostatic Massage in suspected Acute Bacterial Prostatitis
    2. Obtain Urinalysis and Urine Culture before and after Prostatic Massage

VI. Differential Diagnosis

  1. Acute Bacterial Prostatitis
  2. Chronic Bacterial Prostatitis
  3. Prostate Abscess
  4. Sexually Transmitted Infection (STI)
  5. Benign Prostatic Hyperplasia
  6. Urinary Tract Infection
  7. Diverticulitis
  8. Epididymitis or Orchitis
  9. Proctitis
  10. Prostate Cancer
  11. Bladder Cancer

VII. Precautions

  1. Cystoscopy (and urine cytology) Indications
    1. Hematuria and Bladder Cancer risk factors (Tobacco Abuse, age >40 years old)

VIII. Management

  1. See Acute Bacterial Prostatitis
  2. See Chronic Bacterial Prostatitis
  3. See Chronic Nonbacterial Prostatitis

IX. References

  1. Cooner (1994) Am Fam Physician, p. 9-15
  2. Coker (2016) Am Fam Physician 93(2): 114-20 [PubMed]
  3. Holt (2016) Am Fam Physician 93(4):290-6 [PubMed]
  4. Lam (2024) Am Fam Physician 110(1): 45-51 [PubMed]
  5. Krieger (1999) JAMA 281(3): 236-7 [PubMed]
  6. Nickel (2011) Can Urol Assoc J 5(5):306-15 +PMID: 22031609 [PubMed]

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