Acute prostatitis (men with fever + pelvic / perineal pain + dysuria)
Recommended: Clinical diagnosis; imaging only for failed therapy or abscess concern is generally not preferred as the imaging study for acute prostatitis (men with fever + pelvic / perineal pain + dysuria). Uncomplicated cases treated empirically.
Recommended study
Clinical diagnosis; imaging only for failed therapy or abscess concern
Uncomplicated cases treated empirically. Image if failure to respond, structural abnormality suspected, or abscess concern.
If the default doesn't apply
Failure of antibiotics / abscess concern
US
TRUS or MRI Prostate
No contrast
Watch-outs
Avoid prostate massage in acute prostatitis
Can precipitate bacteremia / sepsis.
Pearls
- Boggy, tender prostate on DRE — but limit DRE in acute setting.
- E. coli > 80% of cases; treat 4-6 weeks (fluoroquinolone or TMP-SMX).
- Chronic bacterial prostatitis — different entity, requires longer therapy and may need imaging.