What are the signs and symptoms of prostatitis?

Signs and Symptoms of Prostatitis

The primary signs and symptoms of prostatitis include pelvic pain (perineal, penile, or pelvic), urinary symptoms (dysuria, frequency, urgency), and sexual dysfunction (pain during ejaculation), with presentation varying based on the specific type of prostatitis. 1

Types of Prostatitis and Their Presentations

Acute Bacterial Prostatitis

• Fever, chills, and systemic symptoms (malaise, lethargy, altered mental status)
• Pelvic and perineal pain
• Dysuria, urgent or frequent urination
• Suprapubic pain or tenderness
• Tender, enlarged, or boggy prostate on digital rectal examination
• Acute urinary retention may occur
• Prostatic abscess in severe cases 2, 3

Chronic Bacterial Prostatitis

• Recurrent urinary tract infections with the same organism
• Persistent pelvic pain (>3 months)
• Lower urinary tract symptoms (dysuria, frequency, urgency)
• Pain during or after ejaculation
• New-onset premature ejaculation
• Less severe symptoms compared to acute bacterial prostatitis 1, 4

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)

• Accounts for >90% of prostatitis cases
• Persistent pelvic pain for at least 3 months
• Urinary symptoms (frequency, urgency, hesitancy)
• Sexual dysfunction (ejaculatory pain, erectile dysfunction)
• No evidence of bacterial infection on cultures
• May have psychosocial components affecting presentation 1, 5

Asymptomatic Inflammatory Prostatitis

• No symptoms
• Incidental finding during evaluation for other conditions
• Presence of white blood cells in expressed prostatic secretions 1, 6

Diagnostic Findings

Physical Examination

• Digital rectal examination may reveal:
  • Tender, swollen prostate in acute bacterial prostatitis
  • Normal or mildly tender prostate in chronic forms
  • Avoid vigorous prostate massage in acute bacterial prostatitis as it may cause bacteremia 3

Laboratory Findings

• Presence of white blood cells in expressed prostatic secretions
• Positive urine cultures in bacterial forms (acute and chronic bacterial)
• Negative cultures in CP/CPPS despite symptoms 1

Differential Diagnosis Considerations

Prostatitis symptoms may overlap with:

• Interstitial cystitis/bladder pain syndrome
• Pelvic floor dysfunction
• Prostate or bladder cancer
• Benign prostatic hyperplasia
• Urolithiasis 4

Clinical Pearls and Pitfalls

Pearls:

• The NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) can help quantify symptoms and monitor treatment response
• Meares and Stamey 2- or 4-glass test is recommended for accurate diagnosis of bacterial forms
• Chronic prostatitis significantly impacts quality of life and may require multimodal management 1

Pitfalls:

• Avoid vigorous prostate massage in suspected acute bacterial prostatitis
• Don't rely solely on antibiotics for CP/CPPS as it's primarily non-bacterial
• Avoid prolonged antibiotic use without evidence of bacterial infection
• Don't overlook psychosocial aspects of chronic pelvic pain 1, 3

By recognizing the specific signs and symptoms of each type of prostatitis, clinicians can more accurately diagnose and appropriately manage this common condition that significantly impacts patients' quality of life.