- A 60-year-old man presents to his urologist for a 4-month history of pelvic pain. He denies fevers or chills and any recent sexual activity. His physical exam reveals a mildly tender prostate on digital rectal exam. His urinalysis is unremarkable. He is started on tamsulosin and ciprofloxacin.
- Clinical definition
- infectious or non-infectious inflammation of the prostate
- acute prostatitis
- typically infectious
- < 35 years of age
- most commonly C. trachomatis and N. gonorrhoeae
- > 35 years of age
- most commonly E. coli, P. aeruginosa, K. pneumoniae
- chronic prostatitis
- can be due to recurrent infections lasting > 3 months (10% of chronic prostatitis)
- can be due to chronic pelvic pain (90% of chronic prostatitis)
- > 3 months of pain in the absence of other identifiable causes
- noninfectious etiology but often unknown
- can be due to trauma, psychological stress, and increased prostate tissue pressure
- 10-15% men have it once in their lifetime
- risk factors
- benign prostatic hypertrophy
- urinary frequency
- urinary urgency
- straining with urination or interrupted stream (obstruction)
- lower back pain
- Physical exam
- digital rectal exam
- enlarged prostate
- very tender on exam may indicate acute prostatitis
- less tender on exam may indicate chronic prostatitis
- Urine studies for bacterial infection
- Urinary tract infection
- acute or chronic bacterial infection
- drugs chosen empirically based on local resistance patterns
- trimethoprim and sulfamethoxazole
- sexually transmitted pathogens
- chronic pelvic pain syndrome or noninfectious chronic pain
- typically given alongside a fluoroquinolone for initial therapy
AVERAGE 5.0 of 1 RATINGS
Qbank (0 Questions)
Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions,
Personal Observations, and Biomechanic Studies)
Sharp VJ, Takacs EB, Powell CR. Prostatitis: diagnosis and treatment. Am Fam Physician. 2010 Aug 15;82(4):397-406.
PMID:20704171 (Link to Abstract)
- First Aid for the USMLE STEP 2 CK. Le Tao. New York: McGraw-Hill Medical, 2012.
- Brochert's Crush Step 2. O'Connell, Theodore. Philadelphia: Elsevier Saunders, 2013.
- Master the Boards USMLE Step 2 CK. Fischer, Conrad. New York: Kaplan Publishing, 2012.
- Boards and Wards for USMLE Steps 2 and 3. Ayala, Carlos. New York: Lippincott Williams and Wilkins, 2012.