Definition
Chronic prostatitis is pelvic pain and lower urinary tract symptoms lasting more than 3 months. It is divided into:
- Chronic bacterial prostatitis — persistent bacterial infection (often recurrent UTIs with the same organism)
- Chronic pelvic pain syndrome (CPPS) — the commonest form, with the same symptoms but no demonstrable infection
Clinical presentation
- Pelvic, perineal, suprapubic or genital pain
- Lower urinary tract symptoms (frequency, dysuria, hesitancy)
- Painful ejaculation, sometimes haematospermia
- Recurrent urinary tract infections point to a bacterial cause
- Examination may reveal a tender prostate
Investigations
- Urine culture (and consider a sexually transmitted infection screen)
- Localisation cultures (pre- and post-prostatic massage) may distinguish bacterial disease
- Investigate red flags to exclude other pathology
Management
- Chronic bacterial prostatitis: a prolonged quinolone (e.g. ciprofloxacin) for 4–6 weeks
- Symptom control for both types: alpha-blockers (tamsulosin), analgesia, and sometimes a trial of antibiotics in CPPS
- Multimodal support for CPPS (physiotherapy, neuropathic agents)
MRCP-specific traps
- Most "prostatitis" is CPPS (non-bacterial) — a negative culture does not exclude the diagnosis.
- Antibiotics for bacterial disease must be prolonged because of poor prostatic penetration.
Summary
Chronic prostatitis is pelvic pain plus urinary symptoms for over 3 months — usually non-bacterial CPPS, occasionally chronic bacterial prostatitis with recurrent UTIs. Treat bacterial disease with a prolonged quinolone; use alpha-blockers and analgesia for symptoms.
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