Clinical meaning
Prostatitis encompasses four categories: acute bacterial (Category I), chronic bacterial (Category II), chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS, Category III), and asymptomatic inflammatory (Category IV). Acute bacterial prostatitis results from ascending urethral infection or hematogenous seeding, most commonly by E. coli, Klebsiella, or Pseudomonas. Bacteria colonize the prostatic ductal system, triggering neutrophilic infiltration, glandular destruction, and prostatic abscess formation in severe cases. Chronic bacterial prostatitis involves persistent bacterial biofilm within prostatic calculi or ductal epithelium, causing recurrent UTIs. CP/CPPS (90% of prostatitis cases) involves neurogenic inflammation, pelvic floor muscle dysfunction, and central pain sensitization without identifiable bacterial infection. Prostatic inflammation increases PSA levels and may mimic prostate cancer on screening.
Diagnosis & workup
Diagnostics & workup: - Urinalysis and urine culture (midstream clean-catch) - Pre- and post-prostatic massage urine cultures (Meares-Stamey 4-glass test or 2-glass pre/post massage) - CBC with differential (leukocytosis in acute bacterial prostatitis) - PSA (often elevated in acute prostatitis - defer cancer screening until resolved) - Digital rectal exam: boggy, tender, warm prostate in acute; avoid vigorous massage in acute (bacteremia risk) - Transrectal ultrasound if prostatic abscess suspected