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Acute prostatitis

Last reviewed: 4 Nov 2023
Last updated: 25 Mar 2022



History and exam

Key diagnostic factors

  • fever, chills, malaise
  • tender prostate
More key diagnostic factors

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
Other diagnostic factors

Risk factors

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

Diagnostic investigations

1st investigations to order

  • urinalysis
  • urine culture
  • blood cultures
More 1st investigations to order

Investigations to consider

  • transrectal ultrasound
  • 4-glass or 2-glass test
More investigations to consider

Emerging tests

  • urine cytology
  • cystoscopy
  • prostatic biopsy

Treatment algorithm


signs of sepsis

without signs of sepsis



Christopher Chapple, BSc, MD, FRCS (Urol), FEBU

Honorary Senior Lecturer of Urology

University of Sheffield

Consultant Urological Surgeon

Department of Urology

Royal Hallamshire Hospital




CC is a consultant for Astellas, Contura, Ferring, Symimetic, Takeda, and Urovant Sciences. He is an author for Astellas and Ferring. He is an investigator for Allergan, Astellas, Ferring, Poesis Medical, and Bayer. He is a co-patent holder for Symimetic. He is a speaker for Allergan and Astellas.

Altaf Mangera, MBChB (Hons), MD, FRCS (Urol)

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 reviewers

Hans Hedelin, MD

Department of Urology and Centre for Research and Development





HH declares that he has no competing interests.

Benjamin A. Lipsky, MD, FACP, FIDSA, FRCP

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.

  • Differentials

    • Benign prostatic hyperplasia (BPH)
    • Prostate cancer
    • Urinary tract infection (UTI)
    More Differentials
  • Guidelines

    • Urological infections
    • Acute bacterial prostatitis: diagnosis and management
    More Guidelines
  • Patient leaflets


    More Patient leaflets
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