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Acute prostatitis

Last reviewed: 2 Apr 2025
Last updated: 21 Feb 2025

Summary

Definition

History and exam

Key diagnostic factors

  • fever, chills, malaise
  • tender prostate
Full details

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
Full details

Risk factors

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

Diagnostic tests

1st tests to order

  • urinalysis
  • urine culture
  • blood cultures
Full details

Tests to avoid

  • prostatic biopsy
  • serum prostate-specific antigen (PSA)
Full details

Tests to consider

  • transrectal ultrasound
  • 4-glass or 2-glass test
Full details

Treatment algorithm

ACUTE

signs of sepsis

without signs of sepsis

Contributors

Authors

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

Honorary Senior Lecturer of Urology

University of Sheffield

Consultant Urological Surgeon

Department of Urology

Royal Hallamshire Hospital

Sheffield

UK

Disclosures

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

Sheffield

UK

Disclosures

AM declares that he has no competing interests.

Acknowledgements

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

Karnsjukhuset

Skovde

Sweden

Disclosures

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

Seattle

WA

Disclosures

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Rothman JR, Jaffe WI. Prostatitis: updates on diagnostic evaluation. Curr Urol Rep. 2007 Jul;8(4):301-6. Abstract

Krieger JN, Lee SW, Jeon J, et al. Epidemiology of prostatitis. Int J Antimicrob Agents. 2008 Feb;31(suppl 1):S85-90.Full text  Abstract

European Association of Urology. Guidelines on urological infections. 2022 [internet publication].Full text

Nickel JC. Prostatitis. Can Urol Assoc J. 2011 Oct;5(5):306-15.Full text  Abstract

National Institute for Health and Care Excellence. Prostatitis (acute): antimicrobial prescribing. Oct 2018 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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