Evaluation of acute and chronic bacterial prostatitis and diagnostic management of chronic prostatitis/chronic pelvic pain syndrome with special reference to infection/inflammation

Abstract

The evaluation of acute and chronic bacterial prostatitis and the diagnostic management of chronic prostatitis/chronic pelvic pain syndrome with special reference to infection and inflammation is well defined. Men with symptoms of acute bacterial prostatitis (NIH I) have to undergo urine analysis and culture of the urine. An initial imaging of the prostate is suggested to exclude prostatic abscess. In chronic bacterial prostatitis (NIH II) the 4- and/or the 2-glass test for white blood cell counts and culture are necessary. Culture of semen has a lower sensitivity but is recommended for evaluation in selected men with problems with infertility. Imaging of the prostate is indicated to exclude abscess formations. In patients with chronic prostatitis/chronic pelvic pain syndrome (NIH III) symptom scoring is mandatory using the NIH-CPSI. The 4- and/or the 2-glass test are suggested to rule out bacterial infections. The routinely done analysis of urine and expressed prostatic secretions for leukocytes is debatable, especially due to the fact that the differentiation between patients with inflammatory and non-inflammatory subgroups of CP/CPPS may not be useful for the daily praxis. Optional investigations include the analysis for leukocytes in the ejaculate. Histopathological and molecular microbiological evaluation of prostatic tissue are investigational tests requiring for evaluation. Routine done serum PSA, routine imaging of the prostate and tests for Chlamydia trachomatis and Ureaplasma are not really proven to provide benefit for the patient. In patients with asymptomatic prostatitis (NIH IV) is no evaluation necessary unless considering antimicrobial therapy for elevated PSA or infertility.