What is the diagnosis and treatment for prostatitis (inflammation of the prostate gland)?

From the Guidelines

Prostatitis should be diagnosed and treated based on its classification, with acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP) requiring antibiotic treatment, while chronic pelvic pain syndrome (non-bacterial prostatitis) may involve multimodal management approaches including alpha-blockers, anti-inflammatories, and pelvic floor physical therapy. The diagnosis of prostatitis involves clinical presentation and laboratory tests, with the Meares and Stamey 2- or 4-glass test recommended for CBP diagnosis 1. For ABP, treatment typically involves antibiotics such as ciprofloxacin 500mg twice daily or trimethoprim-sulfamethoxazole 160/800mg twice daily for 2-4 weeks, while CBP requires longer antibiotic courses, often 4-12 weeks 2. Some key points to consider in the diagnosis and treatment of prostatitis include:

• Avoiding prostatic massage in ABP diagnosis 1
• Taking a midstream urine dipstick and culture to guide diagnosis and tailor antibiotic treatment 1
• Performing accurate microbiological evaluation for atypical pathogens in CBP 1
• Considering transrectal ultrasound to rule out prostatic abscess in selected cases 1
• Not routinely performing microbiological analysis of the ejaculate alone to diagnose CBP 1 Symptoms of prostatitis vary by type but often include pelvic pain, difficult or painful urination, and sometimes fever, and prompt treatment is important to prevent complications, especially for bacterial forms 3. In terms of management, increased fluid intake and avoiding caffeine, alcohol, and spicy foods may reduce irritation, and warm sitz baths for 10-15 minutes several times daily can help relieve symptoms. Overall, the diagnosis and treatment of prostatitis should be guided by the most recent and highest quality evidence, with a focus on preventing complications and improving patient outcomes 2, 1.

From the Research

Diagnosis of Prostatitis

• Prostatitis is a collection of signs and symptoms that occur as a result of inflammation or swelling of the prostate gland, with various causes including infection, and occasionally no clear etiology for the inflammation is found 4
• Diagnosis of prostatitis is based on history, physical examination, urine culture, and urine specimen testing pre- and post-prostatic massage 5
• The National Institutes of Health Classification System for prostatitis categorizes the condition into four categories: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis 6

Treatment of Prostatitis

• Effective treatment often depends on identification of the cause, but a microbiologic organism is not always detectable, especially in cases of chronic prostatitis 4
• Bacterial prostatitis can be acute or chronic and always requires some degree of antimicrobial therapy, with fluoroquinolones being the preferred agents for most patients 4
• For chronic prostatitis, treatment responses to α-blockers appear to be greater with longer durations of therapy, and combination therapy with an α-blocker, an anti-inflammatory, and a muscle relaxant does not appear to offer significant advantages over monotherapy 4
• Patients who have had multiple unsuccessful treatment regimens may benefit from direct stimulation of the pelvic muscles through electromagnetic or electroacupuncture therapy 4
• Nonsteroidal anti-inflammatory drugs, alpha-blocking agents, anticholinergic agents, or other therapies may provide symptomatic relief for chronic nonbacterial prostatitis 7

Classification of Prostatitis

• The four common forms of prostatitis are acute bacterial prostatitis, chronic bacterial prostatitis, nonbacterial prostatitis, and prostatodynia 8
• The National Institutes of Health Classification System for prostatitis has been accepted by the North American and International urology community, and consists of four categories: category I (acute bacterial prostatitis), category II (chronic bacterial prostatitis), category III (chronic prostatitis/chronic pelvic pain syndrome), and category IV (asymptomatic inflammatory prostatitis) 6