Summary
Definition
History and exam
Key diagnostic 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 tests
1st tests to order
- urinalysis
- urine culture
- blood cultures
Tests to avoid
- prostatic biopsy
- serum prostate-specific antigen (PSA)
Tests to consider
- transrectal ultrasound
- 4-glass or 2-glass test
Treatment algorithm
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
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
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.
Differentials
- Benign prostatic hyperplasia (BPH)
- Prostate cancer
- Urinary tract infection (UTI)
More DifferentialsGuidelines
- Urological infections
- Acute bacterial prostatitis: diagnosis and management
More GuidelinesPatient information
Prostatitis
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