What are the signs of prostatitis?

Signs of Prostatitis

The signs of prostatitis include pelvic pain, urinary symptoms (frequency, urgency, dysuria), sexual dysfunction, and in acute cases, fever, chills, and systemic symptoms. 1

Types of Prostatitis and Their Presentations

Acute Bacterial Prostatitis

• Tender, enlarged, or boggy prostate on digital rectal examination 2
• Systemic symptoms: fever, chills, nausea, vomiting, and malaise 2
• Urinary symptoms: dysuria, frequency, and possible urinary retention 2
• Pelvic pain 2

Chronic Bacterial Prostatitis

• Subacute infection with variety of pelvic pain symptoms 3
• Recurrent urinary tract infections 3
• Voiding difficulties 3
• Less pronounced systemic symptoms compared to acute form

Chronic Prostatitis/Chronic Pelvic Pain Syndrome

• Persistent pain (perineal, penile, or pelvic) for >3 months 4
• Discomfort and irritative voiding symptoms 4
• Pain during or after ejaculation 4
• New-onset premature ejaculation 4
• No evidence of bacterial infection

Diagnostic Indicators

Physical Examination Findings

• Digital rectal examination may reveal:
  • Tender prostate (especially in acute bacterial prostatitis) 2
  • Enlarged prostate 2
  • Boggy consistency of prostate 2

Laboratory Findings

• Presence of white blood cells (WBCs) in expressed prostatic secretions 4
• Positive urine cultures in bacterial forms 1
• Elevated PSA levels during infection (should normalize after resolution) 1

Validated Assessment Tools

• NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) for quantifying symptoms 1
• AUA Symptom Index/International Prostate Symptom Score (IPSS) for urinary symptoms 1

Important Distinctions Between Types

The Meares and Stamey 2- or 4-glass test is strongly recommended for distinguishing between different types of prostatitis 1. This helps differentiate:

1. Acute bacterial prostatitis (10% of cases) - sudden onset with systemic symptoms 2
2. Chronic bacterial prostatitis - recurrent UTIs with persistent symptoms 3
3. Chronic prostatitis/chronic pelvic pain syndrome (90-95% of cases) - pain and urinary symptoms without bacterial infection 5
4. Asymptomatic inflammatory prostatitis - incidental finding with no symptoms 6

Risk Factors and Special Populations

• Higher risk in patients with:
  • Diabetes 7
  • Cirrhosis 7
  • Immunosuppression 7
  • Recent transrectal procedures (biopsy, catheterization) 2, 7

Clinical Pearls and Pitfalls

• Pitfall: Relying solely on urinary frequency or urgency for diagnosis, as these symptoms are common in other lower urinary tract disorders 1
• Pitfall: Treating with prolonged antibiotics without evidence of bacterial infection 1
• Pearl: Symptoms alone, without documentation of signs or laboratory evidence of inflammation, are not sufficient for retreatment 4
• Pearl: In patients with persistent symptoms >3 months, consider chronic prostatitis/chronic pelvic pain syndrome 4

The diagnosis of prostatitis requires a comprehensive understanding of the presenting symptoms and their impact on quality of life, with appropriate laboratory testing to distinguish between bacterial and non-bacterial forms 1.