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

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Last updated: March 18, 2025 • View editorial policy

From the Guidelines

Prostatitis should be diagnosed and treated based on the classification proposed by the National Institute of Diabetes, Digestive, and Kidney Diseases, which distinguishes bacterial prostatitis from chronic pelvic pain syndrome. The diagnosis and treatment of prostatitis involve a comprehensive approach to manage the condition effectively and prevent complications.

Diagnosis

The diagnosis of prostatitis can be challenging, but it is essential to distinguish between bacterial prostatitis and chronic pelvic pain syndrome. According to the European Association of Urology guidelines 1, prostatitis is a frequent diagnosis, yet fewer than 10% of cases are confirmed to have bacterial infection.

Treatment

For acute bacterial prostatitis, treatment typically involves antibiotics such as ciprofloxacin 500mg twice daily or trimethoprim-sulfamethoxazole 160/800mg twice daily for 2-4 weeks 2. Chronic bacterial prostatitis requires longer antibiotic courses, often 4-12 weeks. For chronic pelvic pain syndrome (non-bacterial prostatitis), treatment may include alpha-blockers like tamsulosin 0.4mg daily, anti-inflammatories such as ibuprofen 400-600mg three times daily, and pelvic floor physical therapy.

Supportive Measures

Supportive measures for all types of prostatitis include:

  • Increased fluid intake
  • Warm sitz baths
  • Avoiding alcohol and spicy foods
  • Regular ejaculation to help drain the prostate These measures can help alleviate symptoms and prevent complications.

Prevention of Complications

Prompt treatment is crucial to prevent complications like abscess formation or chronic pain syndromes. According to the European Association of Urology guidelines 3, accurate microbiological evaluation for atypical pathogens such as Chlamydia trachomatis and Mycoplasma species is essential in patients with chronic bacterial prostatitis. Additionally, performing the Meares and Stamey 2- or 4-glass test in patients with chronic bacterial prostatitis can help guide diagnosis and treatment.

From the Research

Diagnosis of Prostatitis

  • Prostatitis can be diagnosed based on history, physical examination, urine culture, and urine specimen testing pre- and post-prostatic massage 4
  • The National Institutes of Health (NIH) has redefined prostatitis into four distinct entities: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and asymptomatic inflammatory prostatitis 5
  • Diagnosis of CP/CPPS relies on separating this entity from chronic bacterial prostatitis, and if there is no history of documented urinary tract infections with a urinary tract pathogen, then cultures should be taken when patients are symptomatic 5

Treatment of Prostatitis

  • Treatment of prostatitis should follow evidence-based guidelines, and acute prostatitis should be treated with antibiotics such as ciprofloxacine, ofloxacine, or cotrimoxazole for 4 weeks 6
  • Chronic bacterial prostatitis can be treated with antibiotics such as ciprofloxacine, ofloxacine, norfloxacine, or cotrimoxazole for 4 weeks 6
  • Fluoroquinolones are the preferred agents for treating bacterial causes of prostatitis and have demonstrated efficacy in some cases of chronic prostatitis when an organism has not been identified 7
  • Treatment of CP/CPPS often involves a multimodal approach using a combination of antibiotics, α-blockers, antimuscarinic, and anti-inflammatory drugs 8
  • Symptomatic relief can be achieved with a 4- to 6-week course of a fluoroquinolone, and second-line pharmacotherapy involves anti-inflammatory agents for pain symptoms and alpha-adrenergic receptor antagonists (alpha-blockers) for urinary symptoms 5

Treatment Options for Chronic Prostatitis/Chronic Pelvic Pain Syndrome

  • The current recommended treatment for CP/CPPS is predominantly a multimodal approach using a combination of antibiotics, α-blockers, antimuscarinic, and anti-inflammatory drugs 8
  • Potentially more effective is pelvic floor training/biofeedback, but randomized controlled trials are needed to confirm this 5
  • Third-line agents include 5alpha-reductase inhibitors, glycosaminoglycans, quercetin, cernilton (CN-009), and saw palmetto 5
  • For treatment refractory patients, surgical interventions can be offered, such as transurethral microwave therapy to ablate prostatic tissue 5

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Prostatitis: diagnosis and treatment.

American family physician, 2010

Research

[The treatment of prostatitis].

La Revue de medecine interne, 2002

Research

Identification, pharmacologic considerations, and management of prostatitis.

The American journal of geriatric pharmacotherapy, 2011

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.