Can Prostatitis Be Diagnosed on CT Scan?
CT scan has limited utility for diagnosing prostatitis and is not routinely recommended for initial evaluation, though it may detect complications such as prostatic abscesses in acute bacterial prostatitis. 1
Role of CT in Prostatitis Diagnosis
CT imaging does not appear useful in the routine initial diagnostic workup of prostatitis and may not routinely alter treatment. 1 The diagnosis of prostatitis—whether acute bacterial, chronic bacterial, or chronic pelvic pain syndrome—is predominantly made based on clinical history, physical examination (including digital rectal exam to assess for tender, enlarged, or boggy prostate), urinalysis, and urine cultures. 2, 3, 4
When CT May Be Considered
CT imaging may be useful if symptoms persist or worsen beyond 72 hours or if there are concerns for complications such as prostatic abscess. 1 In acute bacterial prostatitis, contrast-enhanced CT can detect:
- Prostatic abscesses (appearing as rim-enhancing fluid collections) 1
- Perinephric fluid collections 1
- Alternative sources of infection in the abdomen or pelvis 1
Contrast-enhanced CT is preferred over noncontrast CT when imaging is indicated, as IV contrast allows detection of abnormal enhancement and rim-enhancement suggestive of abscess formation. 1
Preferred Diagnostic Approach
The standard diagnostic workup for prostatitis does not require imaging in most cases:
- Acute bacterial prostatitis: Diagnosis based on clinical presentation (fever, chills, pelvic pain, urinary symptoms), physical exam findings, urinalysis, and urine culture. 2, 3
- Chronic bacterial prostatitis: Diagnosed through history of recurrent UTIs from the same bacterial strain, with segmented urine cultures (pre- and post-prostatic massage specimens). 2, 4
- Chronic prostatitis/chronic pelvic pain syndrome: Diagnosed when evaluation excludes other causes (infection, cancer, obstruction) in a patient with ≥3 months of pelvic pain and urinary symptoms. 2, 4
Ultrasound Considerations
Prostatic ultrasound represents the most popular imaging test in the work-up of either acute or chronic prostatitis, though no specific echo pattern has been clearly associated with chronic bacterial prostatitis or chronic pelvic pain syndrome. 5 Transrectal ultrasound may help identify prostatic calcifications and assess for abscess formation. 5
Clinical Pitfalls
- Avoid routine imaging: Radiography is typically unnecessary for prostatitis diagnosis and should only be obtained if likely to alter management. 1, 3
- CT has poor sensitivity for early disease: Most cases of uncomplicated prostatitis will not show specific findings on CT. 1
- Reserve CT for complications: Use CT primarily when concerned about abscess formation, urinary obstruction, or when patients fail to improve with appropriate antibiotic therapy after 72 hours. 1