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Prostatitis and its Management

Take home message

Prostatitis has been classified in infectious and inflammatory prostate-related entities. Microbiological analysis plays a fundamental role in diagnosis of infectious prostatitis. For diagnosis and therapy of Chronic Pelvic Pain Syndrome, a multimodal approach is necessary in order to diagnose and treat the symptoms which may not be related to the prostate.

Publication: European Urology Supplements 2016 Aug 25

PII: S1569-9056(16)30081-1

DOI: 10.1016/j.eursup.2016.03.001

Classification of Prostatitis Syndrome

The diagnosis of symptomatic prostatitis refers to a variety of entities which may be related to infection and inflammation of the prostate gland (bacterial prostatitis), inflammatory and non-inflammatory chronic pelvic pain syndrome, and pelvic pain not related to prostatitis.

Clinical Diagnostics

In acute bacterial prostatitis, clinical symptoms are typical. Infection is defined by midstream urine analysis. In CBP, the key point of diagnosis is the use of a 2-glass test, with or without additional ejaculate analysis. The same test is used to define or exclude inflammation and / or infection in CPPS. In CPPS, symptomatic evaluation is based on a validated NIH-CPSI questionnaire. Additional phenotyping may be helpful in characterizing the predominant symptoms.


Antibiotics surely play a fundamental role in bacterial prostatitis therapy. They should be introduced empirically in acute prostatitis with a high intravenous dose and always guided by resistance determination in chronic cases. Thanks to their pharmacokinetic properties and antimicrobial spectrum, fluoroquinolones remain the most highly recommended antibiotics. The most appropriate treatment for chronic pelvic pain syndrome is a multimodal approach based on phenotyping including alpha-blockers, antibiotics, anti-inflammatory medication, hormonal therapy, phytotherapy, antispasmotics and non-drug-related strategies, such as psychotherapy and attempts to improve relaxation of the pelvic floor. The response can be evaluated by a drop in symptoms, using the scoring of the NIH-CPSI.