Prostatitis

Inflammation of the prostate gland is uncommon and is usually caused by coliform bacteria. Acute and chronic forms are recognised. Predisposing factors include urinary tract infection and instrumentation. It is often a nasty, painful disease, diagnosed on rectal examination by a very tender prostate.

Summary:

• acute bacterial prostatitis consists of a urinary tract infection (UTI) that includes infection of the prostate, typically associated with fever or chills and caused by gram-negative bacteria, such as Escherichia coli, Klebsiella, or Pseudomonas
  • first-line therapy for acute prostatitis is broad-spectrum intravenous or oral antibiotics, such as intravenous piperacillin-tazobactam, ceftriaxone, or oral ciprofloxacin, which has a 92% to 97% success rate when prescribed for 2 to 4 weeks for people with febrile UTI and acute prostatitis (1)
    
    
• chronic bacterial prostatitis is defined as a persistent bacterial infection of the prostate, typically presenting as recurrent UTIs from the same strain
  • the majority of chronic bacterial prostatitis diagnoses are due to gram-negative organisms, such as E coli
  • affects all age groups, with predominance for the middle age group in contrast to the other prostatic pathologies, which predominantly affect older men (2)
    • is no racial predisposition or preference
  • first-line therapy for chronic bacterial prostatitis is a minimum 4-week course of levofloxacin or ciprofloxacin
    
    
  • chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) presents as pelvic pain or discomfort for at least 3 months and is associated with urinary symptoms, such as urinary frequency
    • formerly called prostatodynia, and defined as recurrent or chronic genitourinary, prostatic, or pelvic pain without evidence of a urinary tract infection (2)
    • is generally accepted that the use of antibiotics in the absence of proven infection is unhelpful in the treatment of CP/CPPS (2)
      • however, a short 2 or 4-week clinical trial of antibiotics in newly diagnosed, previously untreated symptomatic prostatitis patients is reasonable as many patients will respond
      • first-line oral therapy for CP/CPPS with urinary symptoms is α-blockers (eg, tamsulosin, alfuzosin) (1)
        • other oral therapies are associated with modest changes in NIH-CPSI score compared with placebo, including anti-inflammatory drugs (eg, ibuprofen), pregabalin, and pollen extract

Reference:

1. Borgert BJ, Wallen EM, Pham MN. Prostatitis: A Review. JAMA. 2025;334(11):1003–1013.
2. Pendegast HJ, Leslie SW, Rosario DJ. Chronic Prostatitis and Chronic Pelvic Pain Syndrome in Men. [Updated 2024 Jan 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.