Last reviewed: 25 Oct 2020
Last updated: 13 Oct 2020



History and exam

Key diagnostic factors

  • presence of risk factors
  • fever, chills, malaise
  • tender prostate

Other diagnostic factors

  • age <50 years
  • urinary frequency
  • dysuria
  • diminished urinary stream
  • perineal pain
  • warm or soft, boggy gland
  • indwelling urinary catheter
  • recent transrectal prostate biopsy
  • recent transurethral surgery

Risk factors

  • urinary tract infection (UTI)
  • benign prostatic enlargement
  • urinary tract instrumentation/manipulation
  • poor general health/immunosuppression
  • smoking and alcohol consumption
  • genetics

Diagnostic investigations

1st investigations to order

  • urinalysis
  • urine culture
  • culture of prostatic secretions
  • blood cultures
  • serum prostate-specific antigen (PSA)
More 1st investigations to order

Investigations to consider

  • cystoscopy
  • transrectal ultrasound
  • 4-glass test
More investigations to consider

Emerging tests

  • urine cytology
  • prostatic biopsy
  • biochemical analysis of expressed prostatic secretions
More emerging tests

Treatment algorithm


Honorary Senior Lecturer of Urology

University of Sheffield

Consultant Urological Surgeon

Department of Urology

Royal Hallamshire Hospital




CC is an author for Allergan; researcher, author meeting participant, speaker, consultant/advisor for Astellas Pharma, from whom he has received a grant and been involved in scientific studies/trials; consultant/advisor for Bayer Schering Pharma AG, Ferring, Galvani Bioelectronics (GSK), Pierre Fabre, Taris Biomedical, and Urovant Sciences; consultant/advisor and patent holder for Symimetics; meeting participant and speaker for Pfizer; scientific study/trial researcher for Ipsen.

Consultant Urologist

Department of Urology

Royal Hallamshire Hospital




AM declares that he has no competing interests.

Dr Christopher Chapple and Dr Altaf Mangera would like to gratefully acknowledge the contribution of Robyn Webber MB, ChB, MD, FRCSEd (Urol) to this topic. Not disclosed.

Peer reviewersVIEW ALL

Department of Urology and Centre for Research and Development





HH declares that he has no competing interests.

Professor of Medicine

University of Washington

VA Puget Sound Health Care System




BAL has received research funding from, and been a consultant to, several pharmaceutical companies that make antibiotic agents that might be used for treating bacterial prostatitis.

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