Acute prostatitis + persistent fever / pelvic pain, suspected prostatic abscess
Recommended: Transrectal Ultrasound or MRI Prostate is the preferred imaging study for acute prostatitis + persistent fever / pelvic pain, suspected prostatic abscess. Hypoechoic / cystic area within prostate with rim.
Recommended study
Transrectal Ultrasound or MRI Prostate
Hypoechoic / cystic area within prostate with rim. TRUS-guided aspiration is diagnostic and therapeutic.
If the default doesn't apply
MRI for surgical planning
MRI
MRI Prostate
IV contrast
Watch-outs
Diabetes / immunocompromise predisposes
Image early if persistent symptoms on antibiotics — diabetics and HIV-positive patients are at higher risk.
Pearls
- E. coli most common; consider drug-resistant organisms in healthcare-associated cases.
- Drainage via transrectal or transperineal approach.
- Distinguish from acute prostatitis without abscess (no drainable collection).