State-of-the-Art Review: Diagnosis and Management of Acute and Chronic Bacterial Prostatitis

Acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP) are poorly defined clinical entities, and diagnosis can be challenging. A clinical diagnosis of ABP can be made in the setting of an acute urinary tract infection (UTI) with systemic illness and evidence of prostatic involvement as defined by prostatic tenderness or fluctuance on digital rectal examination or prostatic abscess identified on imaging. Management includes a minimum of 2 weeks of antibiotics with surgical intervention reserved for refractory cases or prostatic abscess (depending on size). Chronic bacterial prostatitis should be suspected in a male patient with chronic urinary symptoms or recurrent UTIs. Diagnostic evaluation should include a 4- or 2-glass Meares-Stamey test, with a positive test confirming the diagnosis. Management includes 6 weeks of antibiotics. Surgery can be considered for particularly refractory cases. Future research into ABP and CBP can address questions about epidemiology, role of radiographic imaging, and duration of antimicrobial therapy.