prostatitis

Prostatitis is an inflammation of the prostate gland that can cause a range of urinary and pelvic symptoms. It is categorized into several clinical syndromes with different causes, courses, and treatments.

Acute bacterial prostatitis is an abrupt onset infection often caused by urinary tract bacteria that ascend to the prostate. It can present with fever, chills, perineal or pelvic pain, irritative and obstructive urinary symptoms, and sometimes sepsis. Chronic bacterial prostatitis involves recurrent urinary tract infections and pelvic discomfort, with identifiable bacteria present over time. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most common form and is characterized by pelvic or groin pain lasting at least three months, with or without urinary symptoms, but without a consistent bacterial infection. Asymptomatic inflammatory prostatitis is identified incidentally, usually during examinations for other conditions, and does not produce symptoms.

Causes vary by type. Bacterial prostatitis results from infection of the prostate, often by urinary bacteria such as Escherichia coli. CP/CPPS may involve nonbacterial inflammation or pelvic floor muscle dysfunction; the exact cause is not well understood. Risk factors for prostatitis include recent urinary tract instrumentation, urinary obstruction, and, in older men, benign prostatic enlargement.

Diagnosis relies on clinical evaluation, urinalysis, urine cultures, and sometimes tests assessing inflammation or infection in the prostate. Digital rectal examination can reveal tenderness but is not always definitive. In some cases, specialized tests are used to differentiate bacterial from nonbacterial forms.

Treatment depends on the type. Acute and chronic bacterial prostatitis are usually treated with antibiotics for several weeks, sometimes combined with alpha-blockers and anti-inflammatory medications. CP/CPPS is managed with a multimodal approach, including pain relief, physical therapy, and lifestyle modifications. Prognosis varies by form; chronic syndromes can be persistent but are usually manageable with appropriate care.