From the Guidelines
Prostatitis should be managed based on its type, with acute bacterial prostatitis requiring antibiotics for 2-4 weeks, chronic bacterial prostatitis needing longer antibiotic courses, and chronic pelvic pain syndrome treated with 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 chronic bacterial prostatitis (CBP) 1. The optimal durations of treatment for acute bacterial prostatitis (ABP) and CBP are unknown and have not been established by high-quality studies 1.
Key Considerations
- Acute bacterial prostatitis (ABP) often presents abruptly with febrile UTI symptoms, while chronic bacterial prostatitis (CBP) involves more persistent symptoms or recurrent UTIs 1.
- The European Association of Urology guidelines advise using the classification proposed by the National Institute of Diabetes, Digestive, and Kidney Diseases, which distinguishes bacterial prostatitis from chronic pelvic pain syndrome 1.
- Supportive measures for all types of prostatitis include increased fluid intake, warm sitz baths, avoiding alcohol and caffeine, and over-the-counter pain relievers.
- If symptoms don't improve with initial treatment, further evaluation is necessary to rule out other conditions like prostate cancer.
Diagnostic Approach
- A midstream urine dipstick and culture may be used to guide diagnosis and tailor antibiotic treatment in patients with ABP symptoms 1.
- Blood culture and total blood count may be taken in patients presenting with ABP 1.
- Accurate microbiological evaluation for atypical pathogens such as Chlamydia trachomatis and Mycoplasma species may be performed in patients with CBP 1.
- Transrectal ultrasound may be used in selected cases to rule out the presence of prostatic abscess 1.
From the Research
Definition and Symptoms of Prostatitis
- Prostatitis is an infection of the prostate gland that can cause pelvic pain and urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention 2.
- Systemic symptoms, such as fevers, chills, nausea, emesis, and malaise, may also occur 2.
- Chronic bacterial prostatitis (CBP) may present with symptoms of an acute urinary-tract infection, and the only symptoms of CBP may be those of an acute urinary-tract infection 3.
Diagnosis of Prostatitis
- Diagnosis of acute bacterial prostatitis is predominantly made based on history and physical examination, but may be aided by urinalysis 2.
- Urine cultures should be obtained in all patients who are suspected of having acute bacterial prostatitis to determine the responsible bacteria and its antibiotic sensitivity pattern 2.
- Simultaneous quantitative urine cultures represent the most accurate method for diagnosing CBP 3.
Treatment of Prostatitis
- Most patients with acute bacterial prostatitis can be treated as outpatients with oral antibiotics and supportive measures 2.
- Typical antibiotic regimens for acute bacterial prostatitis include ceftriaxone and doxycycline, ciprofloxacin, and piperacillin/tazobactam 2.
- For CBP, trimethoprim-sulfamethoxazole is the current drug of choice, but carbenicillin indanyl sodium and erythromycin appear to be effective alternatives 3.
- Ciprofloxacin has been used to treat refractory CBP, with eradication of Escherichia coli in 7 of 10 cases and other pathogens in 2 of 5 cases 4.
- A randomized, double-blind trial found that 6-week therapy with ciprofloxacin or tamsulosin did not substantially reduce symptoms in men with long-standing chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) 5.
- Long-term therapy of CBP with trimethoprim-sulfamethoxazole has been shown to be effective, with 19 patients (31.6%) being totally cured and 9 of 23 (39.1%) gram-negative organisms being permanently cleared from prostatic fluid 6.