History and exam

Key diagnostic factors

common

presence of risk factors

Urinary tract infection is the single greatest risk factor for developing prostatitis.[18][19]

fever, chills, malaise

Acute bacterial prostatitis is defined by acute onset of not only local but usually systemic symptoms.

tender prostate

In men with acute bacterial prostatitis, digital rectal examination will reveal an intensely tender prostate gland. A DRE should be performed gently; avoid prostatic massage because it can induce bacteraemia and sepsis.​[12][29]​

Other diagnostic factors

common

age <50 years

More common in men <50 years old, but acute prostatitis is also the third most common urological diagnosis in men >50 years old.[40]

urinary frequency

Acute bacterial prostatitis is characterised by a severe urinary tract infection, which may present with irritative (also known as storage, e.g., frequency, urgency) or voiding (e.g., weak stream, dribbling, dysuria, straining) urinary symptoms.[26]

dysuria

Acute bacterial prostatitis is characterised by a severe urinary tract infection, which may present with irritative (also known as storage, e.g., frequency, urgency) or voiding (e.g., weak stream, dribbling, dysuria, straining) urinary symptoms.[26]

diminished urinary stream

Acute bacterial prostatitis is characterised by a severe urinary tract infection, which may present with irritative (also known as storage, e.g., frequency, urgency) or voiding (e.g., weak stream, dribbling, dysuria, straining) urinary symptoms.[26]

perineal pain

The most common site for pain is in the region of the prostate and perineum. Pain in the scrotum and testes is also common, while a small proportion of patients complain of pain in the penis, suprapubically, or in the lower back.[28]

warm or soft, boggy gland

In acute bacterial prostatitis the prostate gland may feel warm and soft or mushy to the touch.

uncommon

indwelling urinary catheter

Associated with the development of prostatic infection.

recent transrectal prostate biopsy

Transrectal biopsy may precede prostatic infection, particularly in patients not given prophylactic antibiotics.

recent transurethral surgery

Transurethral resection of the prostate may be associated with the development of prostatic infection, particularly in patients who have an untreated urinary infection at the time of their prostatic surgery.

Risk factors

strong

urinary tract infection (UTI)

Acute bacterial prostatitis is associated with the presence of UTI. Escherichia coli is the most common causative organism.[18][19]

benign prostatic enlargement

After adjusting for age, prostatic enlargement is significantly associated with increased odds of prostatitis.[20]

urinary tract instrumentation/manipulation

Urinary tract instrumentation/manipulation (including prostate biopsy, catheterisation and procedures on the urinary tract) increases the risk of acute bacterial prostatitis.[21][22][23]

weak

poor general health/immunosuppression

Poor physical and mental health have been linked with an increased risk of prostatitis history.[20] In patients with immune deficiency or HIV infection, prostatitis may be caused by unusual pathogens.[12]

smoking and alcohol consumption

Prostatitis symptoms have been shown to have an association with smoking and alcohol consumption in a Chinese population-based study.[24] Smoking is associated with acute prostatic inflammation; however, the clinical implications of histological prostate inflammation are not completely defined.[25]

genetics

Twin studies have suggested a genetic predisposition to prostatitis (acute and chronic).[8]

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