Last updated: March 22, 2023

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Prostatitis is an inflammation of the prostate gland that is of either infectious (acute bacterial prostatitis and chronic bacterial prostatitis) or noninfectious (chronic pelvic pain syndrome) origin. Bacterial prostatitis is most often caused by Escherichia coli. Patients with acute bacterial prostatitis typically present with spiking fevers, chills, perineal pain, and symptoms of bladder irritation. The presentation of chronic bacterial prostatitis is more subtle, including symptoms of urinary tract infections such as dysuria and increased urinary frequency and urgency. The prostate is typically tender and boggy in acute bacterial prostatitis and mildly tender or normal in chronic bacterial prostatitis. For bacterial prostatitis, diagnosis aims to identify the causative organism via urine culture, and empirical antibiotic treatment is the primary approach. Acute prostatitis can lead to life-threatening complications (e.g., acute urinary retention, prostatic abscess formation, sepsis) that may require additional treatment, such as suprapubic catheterization or ultrasound-guided abscess drainage. Chronic pelvic pain syndrome (CPPS) is characterized by chronic urogenital pain without evidence of urinary tract infection. Affected individuals may also experience lower urinary tract symptoms and erectile dysfunction. The etiology is unknown. A multimodal treatment approach with a symptomatic focus is recommended.

  • Common urologic diagnosis in men < 50 years of age [1][2]
  • In men, there is an ∼ 8% lifetime risk of developing prostatitis.
  • Bacterial prostatitis (2–5% of cases): most commonly men between 20 and 50 years of age
  • Chronic pelvic pain syndrome (90–95% of cases): primarily men between 40 and 60 years of age

Epidemiological data refers to the US, unless otherwise specified.

Acute prostatitis [3][4][5]

Chronic prostatitis

Other causes for acute or chronic bacterial prostatitis

Overview of clinical features of bacterial prostatitis and chronic pelvic pain syndrome [2][6][7][8]
Acute bacterial prostatitis Chronic bacterial prostatitis Chronic pelvic pain syndrome (CPPS)

Constitutional symptoms

  • Commonly absent
  • Low-grade fever in some patients
  • Commonly absent

Genitourinary tract symptoms

  • Acute bladder irritation
    • Acute dysuria
    • Frequency
    • Urgency
  • Cloudy urine

Genitourinary pain

  • Severe
    • Lower back
    • Perineal
    • Pelvic
    • With defecation
  • Mild


  • Tender, boggy
  • Warm, swollen
  • Often normal
  • May be enlarged and tender
  • Usually normal
  • May be slightly tender

Chronic pelvic pain syndrome (CPPS) [9][10][11]

Bacterial prostatitis is a clinical diagnosis based on history and physical examination, including digital rectal examination (DRE).

Approach [12][13]

Exercise special caution when performing DRE in patients with suspected acute bacterial prostatitis to avoid causing bacteremia. When in doubt, refer to a urologist.

Urine studies [12][13]

Additional evaluation [12][13]

Prostate-specific antigen may be significantly elevated in patients with acute prostatitis but should not be used for diagnostic purposes. Perform an evaluation for prostate cancer if PSA remains elevated 8 weeks after treatment. [12]

General principles [12][13]

Empiric antibiotic therapy [10][12][13]

Supportive care [13]

We list the most important complications. The selection is not exhaustive.

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  11. D'amico AV, Smith MR. Clinical decisions: Screening for prostate cancer. N Engl J Med. 2012; 367 (7): p.e11. doi: 10.1056/NEJMclde1209426 . | Open in Read by QxMD
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