Last updated: May 6, 2022

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Prostatitis is an inflammation of the prostate gland that may be of infectious (acute and chronic bacterial prostatitis) or noninfectious origin (chronic pelvic pain syndrome, or CPPS). Acute and chronic bacterial prostatitis are most often caused by Escherichia coli, while in CPPS no causative organism can be identified. Patients with acute bacterial prostatitis typically present with spiking fevers, chills, perineal pain, and symptoms of bladder irritation. The presentation of chronic bacterial prostatitis and CPPS is more subtle, including symptoms of chronic or recurrent urinary tract infections and genitourinary pain. Findings on examination include a tender, boggy prostate in acute bacterial prostatitis, and mildly tender or normal prostate in chronic bacterial prostatitis and CPPS. Diagnostics aim to identify a potential causative organism via urine culture or fractional urine examination. Empirical antibiotic treatment is the primary therapeutic approach for acute and chronic bacterial prostatitis, whereas treatment for CPPS is multimodal, including pharmacological treatment, psychological support, and physiotherapy. Acute bacterial prostatitis can lead to complications (e.g., acute urinary retention, prostatic abscess formation, sepsis) that may require additional treatment, such as suprapubic catheterization or ultrasound-guided abscess drainage.

  • Common urologic diagnosis in men < 50 years of age [1][2]
  • In men, there is an ∼ 8% lifetime risk of developing prostatitis.
  • Bacterial prostatitis (2–5% of cases): most commonly men between 20 and 50 years of age
  • Chronic pelvic pain syndrome (90–95% of cases): primarily men between 40 and 60 years of age

Epidemiological data refers to the US, unless otherwise specified.

Acute prostatitis [3][4][5]

Chronic prostatitis [7]

Other causes for acute or chronic bacterial prostatitis

Chronic pelvic pain syndrome (CPPS) [8][9]

  • Exact etiology unknown
  • CPPS has been associated with:
    • Pathogens that are difficult to detect (e.g., Mycoplasma, Ureaplasma)
    • Increased prostatic tissue pressure
    • Autoimmune processes
    • Psychosomatic dysfunction
Overview of clinical features of bacterial prostatitis and chronic pelvic pain syndrome [2][10][11][12]
Acute bacterial prostatitis Chronic bacterial prostatitis Chronic pelvic pain syndrome (CPPS)

Constitutional symptoms

  • Commonly absent
  • Low-grade fever in some patients
  • Commonly absent

Genitourinary tract symptoms

  • Acute bladder irritation
    • Acute dysuria
    • Frequency
    • Urgency
  • Cloudy urine

Genitourinary pain

  • Severe
    • Lower back
    • Perineal
    • Pelvic
    • With defecation
  • Mild


  • Tender, boggy
  • Warm, swollen
  • Often normal
  • May be enlarged and tender
  • Usually normal
  • May be slightly tender

Clinically suspected bacterial prostatitis is confirmed by detection of bacteria in urinalysis and culture. Chronic pelvic pain syndrome is a diagnosis of exclusion. [13][14][15]

Laboratory tests

Acute bacterial prostatitis

Chronic bacterial prostatitis

  • Fractional urine examination
    • Collection of urine from a specified quantity or during a few specified hours instead of the entire amount voided during a full day
    • Can be used to diagnose conditions affecting the kidneys or prostate
  • The following two tests are methods for diagnosing chronic bacterial prostatitis that are based on fractional urine examination.

Four-glass test

  • Overview
    • Used to determine the location of the infection by culturing various urine samples
    • Difficult technique, therefore not performed often
  • Procedure: 4 samples are taken and cultured
    • 1st glass (initial urine): urethral sample
    • 2nd glass (mid‑stream urine): bladder sample
    • 3rd glass (fluid expressed during prostatic massage): prostatic sample
    • 4th glass (urine after prostatic massage): prostatic sample

Two-glass test

  • Overview
  • Procedure: 2 samples are taken and cultured
    • 1st glass: premassage urine
    • 2nd glass: postmassage urine

Further diagnostics

These tests should not be performed routinely and are only indicated if a complication is suspected or to exclude differential diagnoses in CPPS.

Bacterial prostatitis [2][14][16][17]

Chronic pelvic pain syndrome [14]

We list the most important complications. The selection is not exhaustive.

  1. Collins MM, Stafford RS, O'leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol. 1998; 159 (4): p.1224-1228.
  2. Lipsky BA, Byren I, Hoey CT. Treatment of bacterial prostatitis. Clin Infect Dis. 2010; 50 (12): p.1641-1652. doi: 10.1086/652861 . | Open in Read by QxMD
  3. McConaghy JR, Panchal B. Epididymitis: An Overview.. Am Fam Physician. 2016; 94 (9): p.723-726.
  4. Millán-rodríguez F, Palou J, Bujons-tur A, et al. Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract. World J Urol. 2005; 24 (1): p.45-50. doi: 10.1007/s00345-005-0040-4 . | Open in Read by QxMD
  5. Domingue GJ Sr, Hellstrom WJ. Prostatitis.. Clin Microbiol Rev. 1998; 11 (4): p.604-13.
  6. Brede CM, Shoskes DA. The etiology and management of acute prostatitis. Nature Reviews Urology. 2011; 8 (4): p.207-212. doi: 10.1038/nrurol.2011.22 . | Open in Read by QxMD
  7. Prostatitis-nonbacterial. Updated: July 31, 2019. Accessed: June 18, 2020.
  8. Mehik A, Hellström P, Nickel JC, et al. The chronic prostatitis-chronic pelvic pain syndrome can be characterized by prostatic tissue pressure measurements. J Urol. 2002; 167 (1): p.137-140.
  9. Pontari MA, Ruggieri MR. Mechanisms in prostatitis/chronic pelvic pain syndrome. J Urol. 2004; 172 (3): p.839-845. doi: 10.1097/01.ju.0000136002.76898.04 . | Open in Read by QxMD
  10. Müller A, Mulhall JP. Sexual dysfunction in the patient with prostatitis. Curr Opin Urol. 2005; 15 (6): p.404-409.
  11. Sönmez NC, Kiremit MC, Güney S, Arisan S, Akça O, Dalkılıç A. Sexual dysfunction in type III chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) observed in Turkish patients. Int Urol Nephrol. 2010; 43 (2): p.309-314. doi: 10.1007/s11255-010-9809-5 . | Open in Read by QxMD
  12. D'amico AV, Smith MR. Clinical decisions: Screening for prostate cancer. N Engl J Med. 2012; 367 (7): p.e11. doi: 10.1056/NEJMclde1209426 . | Open in Read by QxMD
  13. Loeb S, Gashti SN, Catalona WJ. Exclusion of inflammation in the differential diagnosis of an elevated prostate-specific antigen (PSA). Urol Oncol. 2009; 27 (1): p.64-66. doi: 10.1016/j.urolonc.2008.04.002 . | Open in Read by QxMD
  14. Rees J, Abrahams M, Doble A, Cooper A, Prostatitis Expert Reference Group (PERG). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015; 116 (4): p.509-525. doi: 10.1111/bju.13101 . | Open in Read by QxMD
  15. Nickel JC, Shoskes D, Wang Y, et al. How does the pre-massage and post-massage 2-glass test compare to the Meares-Stamey 4-glass test in men with chronic prostatitis/chronic pelvic pain syndrome?. J Urol. 2006; 176 (1): p.119-124. doi: 10.1016/S0022-5347(06)00498-8 . | Open in Read by QxMD
  16. Nickel JC. Prostatitis. Can Urol Assoc J. 2011; 5 (5): p.306-315. doi: 10.5489/cuaj.11211 . | Open in Read by QxMD
  17. Sharp VJ, Takacs EB, et al.. Prostatitis: Diagnosis and Treatment. Am Fam Physician. 2010; 82 (4): p.397-406.
  18. Kim DS, Kyung YS, Woo SH, Chang YS, Kim H-J. Efficacy of Anticholinergics for Chronic Prostatitis/Chronic Pelvic Pain Syndrome in Young and Middle-Aged Patients: A Single-Blinded, Prospective, Multi-Center Study. International Neurourology Journal. 2011; 15 (3): p.172-175. doi: 10.5213/inj.2011.15.3.172 . | Open in Read by QxMD

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