What are the signs and symptoms of prostatitis?

Signs and Symptoms of Prostatitis

Acute Bacterial Prostatitis

Acute bacterial prostatitis presents with systemic infection symptoms including fever, chills, and potentially hypotension, combined with urinary tract infection symptoms. 1, 2

• Patients typically experience fever and chills as prominent systemic features 1, 3
• Lower urinary tract symptoms include dysuria, urinary frequency, and difficulty voiding 4, 3
• The inflamed prostate may cause urinary obstruction or retention 3
• Patients may present with acute onset of severe symptoms requiring urgent evaluation 2

Critical pitfall: Do not perform prostatic massage in acute bacterial prostatitis due to risk of bacteremia 4, 5

Chronic Bacterial Prostatitis

Chronic bacterial prostatitis characteristically presents as recurrent urinary tract infections with the same bacterial organism, accompanied by pelvic pain and ejaculatory discomfort. 1, 3

• Recurrent UTIs from the same uropathogen are the hallmark diagnostic feature 6, 3
• Pelvic pain is a consistent symptom between infection episodes 3
• Urinary symptoms include frequency, urgency, and dysuria 6, 3
• Painful ejaculation is a distinguishing feature 3

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

CP/CPPS is defined by pelvic pain or discomfort lasting at least 3 months, with pain localized to the perineum, suprapubic region, testicles, or tip of the penis, often exacerbated by urination or ejaculation. 5, 7, 1

Pain Characteristics

• Pain in the perineum is a primary location 5, 7
• Suprapubic pain or discomfort is common 5, 7
• Pain at the tip of the penis is characteristic 5
• Testicular pain may be present 5, 7
• Pain worsens with urination or ejaculation 5, 7
• Many patients describe "pressure" rather than "pain" 5

Urinary Symptoms

• Urinary frequency is a prominent feature 1, 6
• Urinary urgency occurs, though patients experience a more constant urge to void to relieve pain 5
• Sense of incomplete bladder emptying is common 5, 7
• Nocturia (nighttime urination) is present 5
• Dysuria may occur 6

Sexual Symptoms

• Painful ejaculation is a key symptom 6, 3
• New-onset premature ejaculation lasting >3 months should raise suspicion 4
• Sexual discomfort and dysfunction may be present 8

Duration Criteria

Persistence of pain, discomfort, and irritative voiding symptoms beyond 3 months should alert clinicians to the possibility of CP/CPPS. 4, 1

Important Diagnostic Considerations

CP/CPPS and interstitial cystitis/bladder pain syndrome (IC/BPS) have overlapping clinical characteristics, and some men meet criteria for both conditions. 5, 7

• IC/BPS should be strongly considered in men whose pain is perceived to be bladder-related 5, 7
• The clinical presentations are very similar between these conditions 5, 7
• Combined treatment approaches may be necessary for patients meeting criteria for both 5, 7

Asymptomatic Inflammatory Prostatitis

Asymptomatic inflammatory prostatitis (Category IV) is, by definition, without symptoms and is typically discovered incidentally during evaluation for infertility or prostate cancer. 6, 3

• No pain or urinary symptoms are present 3
• Often diagnosed during prostate biopsy or semen analysis 2
• Clinical significance remains unknown 6, 3