Prostatitis

Prostatitis is a syndrome label, not a single disease. The NIH classification separates bacterial prostatitis from chronic pelvic pain without proven infection. - Category I: acute bacterial prostatitis is an acute infection of the prostate. Enterobacterales, particularly Escherichia coli, are the predominant pathogens. - Category II: chronic bacterial prostatitis causes persistent or recurrent symptoms for at least 3 months, often with recurrent urinary infection caused by the same pathogen. Drug delivery into infected prostatic tissue and fluid can be difficult. - Category III: chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) causes pelvic pain, urinary symptoms, and sometimes sexual symptoms without an identified ongoing infection. - Category IV: asymptomatic inflammatory prostatitis is histologic inflammation found without symptoms, often during evaluation for another reason. A useful first distinction is time course plus systemic illness. Abrupt fever, dysuria, pelvic or perineal pain, and a tender or swollen prostate suggest acute bacterial disease. Persistent or fluctuating pelvic pain with negative cultures instead supports evaluation for CP/CPPS and other causes. A person who has had a radical prostatectomy no longer has a prostate and therefore cannot...