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

From the Guidelines

Prostatitis diagnosis and treatment involve a combination of clinical presentation, laboratory tests, and antibiotic therapy.

Diagnosis

• The diagnosis of acute bacterial prostatitis (ABP) relies on clinical presentation and laboratory tests, including urine cultures and prostate secretion cultures 1.
• Chronic bacterial prostatitis (CBP) diagnosis involves comparing bacteria levels in prostatic fluid and urinary cultures, although definitive testing is debated 1.
• Laboratory tests, such as aerobic culture and Gram stain, can help identify the etiologic agents of prostatitis, including Escherichia coli, Pseudomonas spp, and Staphylococcus aureus 1.

Treatment

• The optimal durations of treatment for ABP and CBP are unknown and have not been established by high-quality studies 1.
• Antibiotic therapy is the primary treatment for bacterial prostatitis, with the choice of antibiotic depending on the suspected or confirmed pathogen 1.
• Enterobacterales are the primary pathogens in ABP, while CBP encompasses a broader spectrum of species, including atypical microorganisms 1.

Key Considerations

• Prostate-specific antigen (PSA) testing appears to be of limited utility in the diagnosis of prostatitis 1.
• Prostate massage and other maneuvers to express prostatic fluid are of limited clinical utility 1.
• Urology consultation may be necessary for patients with prostatitis, particularly those with complex or recurrent cases 1.

From the Research

Diagnosis of Prostatitis

• The diagnosis of prostatitis is primarily based on history, physical examination, urine culture, and urine specimen testing pre- and post-prostatic massage 2
• The differential diagnosis of prostatitis includes acute cystitis, benign prostatic hyperplasia, urinary tract stones, bladder cancer, prostatic abscess, enterovesical fistula, and foreign body within the urinary tract 2
• Symptomology tends to be a reliable guide for treatment, although definitive diagnosis can be hampered by a somewhat cumbersome testing procedure 3

Classification of Prostatitis

• Prostatitis has been divided into 4 different categories based on the National Institutes of Health consensus classification:
  • Acute bacterial prostatitis
  • Chronic bacterial prostatitis
  • Chronic nonbacterial prostatitis and pelvic pain syndrome
  • Asymptomatic inflammatory prostatitis 4, 5
• Chronic prostatitis/chronic pelvic pain syndrome (category III) accounts for 90%-95% of prostatitis cases and is of unknown etiology 5

Treatment of Prostatitis

• The mainstay of therapy for acute and chronic bacterial prostatitis is an antimicrobial regimen 2
• Commonly used medications for chronic pelvic pain syndrome include antimicrobials, alpha blockers, and anti-inflammatory agents, but the effectiveness of these agents has not been supported in clinical trials 2
• Fluoroquinolones are among the most effective agents for symptom management 3
• Other interventions that may be appropriate include alpha-1-adrenergic blockers, a 5-alpha reductase inhibitor, or surgery 3