Treating Prostatitis Effectively

A Challenge for Clinicians

Nhuan Nguyen, PharmD, MBA, CHE


US Pharmacist. 2014;39(4):35-41. 

In This Article

Signs and Symptoms

The National Institutes of Health (NIH) classifies prostatitis into four categories based on signs and symptoms (Table 1).[1–8] Category I (acute bacterial prostatitis [ABP]) is rare, accounting for fewer than 0.02% of prostatitis patients. Approximately 5% of prostatitis cases are category II (chronic bacterial prostatitis [CBP]). Most chronic prostatitis patients (90%-95%) fall into category III (CP/CPPS), which is subdivided into IIIA (inflammation) and IIIB (no inflammation). Category IV (asymptomatic inflammatory prostatitis) is accidentally discovered during a physical examination or office visit for other genitourinary disorders (e.g., benign prostatic hyperplasia, prostate cancer, infertility, overactive bladder, and elevated prostate-specific antigen level).[1–8,12]

ABP is characterized by the acute onset of frequency, urgency (irritative and obstructive voiding), and severe pelvic pain (perineum, suprapubic area, and external genitalia), which are caused by inflammation of the prostate. In addition, patients may have bacteremia (fever, chills, and rigors) and possibly signs of sepsis. If ABP is not treated properly, about 5% of patients progress to CBP.[1–8]

CBP is typically associated with recurrent urinary tract infections (UTIs) with mild-to-moderate pelvic pain symptoms. Symptoms of CBP differ from those of ABP, as the levels of pain and systemic infection are milder (low-grade fever with back or pelvic discomfort) and may occur off and on.[1–8]

CP/CPPS is characterized by irritative urination (frequency and urgency) and chronic pelvic pain, with no evidence of UTI for at least 3 months in the previous 6 months. Chronic pelvic pain is the hallmark of CP/CPPS.[4] In addition, in inflammatory CP/CPPS (category IIIA), leukocytes are found in expressed prostatic secretions (EPS), post–prostatic massage urine, or semen.[1–8]