Prostatitis Differential Diagnoses

  • Author: Paul J Turek, MD; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Jun 27, 2011
 
 

Diagnostic Considerations

The differential diagnosis of prostatitis is based on the history, physical examination findings, and, frequently, analysis of expressed prostatic secretions.[13] Absence of systemic symptoms and persistence of pain for at least 3 months indicate chronic prostatitis rather than acute disease.[14] In addition to prostatitis, other conditions to consider include the following:

  • Benign prostatic hyperplasia
  • Chronic pain syndromes (ie, inflammatory bowel disease)
  • Cystitis
  • Erectile dysfunction
  • Prostate cancer
  • Radiculopathies
  • Testicular cancer
  • Urolithiasis

See the following for more information:

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Paul J Turek, MD  Director, The Turek Clinic; Former Professor in Residence, Academy of Medical Educators Endowed Chair, Department of Urology, Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine

Paul J Turek, MD is a member of the following medical societies: American Association of Clinical Urologists, American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Society for the Study of Male Reproduction

Disclosure: BioQuiddity, Inc Ownership interest Board membership; HealthLoop.com Ownership interest Board membership; MandalMed, Inc Intellectual property rights Management position

Coauthor(s)

Tarlan Hedayati, MD  Assistant Professor of Emergency Medicine, Rush Medical College, John H Stroger Hospital of Cook County

Tarlan Hedayati, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Christine R Stehman, MD  Resident Physician, Department of Emergency Medicine, John H Stroger Hospital of Cook County

Disclosure: Nothing to disclose.

Specialty Editor Board

David S Howes, MD  Professor of Medicine and Pediatrics, Section Chief and Emergency Medicine Residency Program Director, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eddy S Lang, MDCM, CCFP(EM), CSPQ  Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH  Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

References

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  2. Murphy AB, Macejko A, Taylor A, Nadler RB. Chronic prostatitis: management strategies. Drugs. 2009;69(1):71-84. [Medline].

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  9. Schaeffer AJ. Clinical practice. Chronic prostatitis and the chronic pelvic pain syndrome. N Engl J Med. Oct 19 2006;355(16):1690-8. [Medline].

  10. Awadh B, Watson K, Abdou NI. Wegener prostatitis presenting with acute urinary retention. J Clin Rheumatol. Feb 2006;12(1):50-1. [Medline].

  11. Huong DL, Papo T, Piette JC, Wechsler B, Bletry O, Richard F, et al. Urogenital manifestations of Wegener granulomatosis. Medicine (Baltimore). May 1995;74(3):152-61. [Medline].

  12. Middleton G, Karp D, Lee E, Cush J. Wegener's granulomatosis presenting as lower back pain with prostatitis and ureteral obstruction. J Rheumatol. Mar 1994;21(3):566-9. [Medline].

  13. Donovan DA, Nicholas PK. Prostatitis: diagnosis and treatment in primary care. Nurse Pract. Apr 1997;22(4):144-6, 149-56. [Medline].

  14. [Guideline] Grabe M, Bishop MC, Bjerklund-Johansen TE, et al. Prostatitis and chronic pelvic pain syndrome. Guidelines on the management of urinary and male genital tract infections. Arnhem, The Netherlands: European Association of Urology (EAU). Mar 2008;79-88. [Full Text].

  15. McNaughton Collins M, MacDonald R, Wilt TJ. Diagnosis and treatment of chronic abacterial prostatitis: a systematic review. Ann Intern Med. Sep 5 2000;133(5):367-81. [Medline]. [Full Text].

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  17. de la Rosette JJ, Giesen RJ, Huynen AL, Aarnink RG, van Iersel MP, Debruyne FM, et al. Automated analysis and interpretation of transrectal ultrasonography images in patients with prostatitis. Eur Urol. 1995;27(1):47-53. [Medline].

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  19. Centers for Disease Control and Prevention. Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. Apr 13 2007;56(14):332-6. [Medline]. [Full Text].

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  24. Sindhwani P, Wilson CM. Prostatitis and serum prostate-specific antigen. Curr Urol Rep. Jul 2005;6(4):307-12. [Medline].

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  26. Wise GJ, Shteynshlyuger A. How to diagnose and treat fungal infections in chronic prostatitis. Curr Urol Rep. 2006;7(4):320-8. [Medline].

 
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Bacterial prostatitis. Expressed prostatic fluid contains more than 10 white blood cells per high-power field, indicating prostatitis.
A nonspecific mixed inflammatory infiltrate that consists of lymphocytes, plasma cells, and histiocytes is typical in chronic bacterial prostatitis.
Urine culture with greater than 100,000 colony-forming units (CFU) of Escherichia coli, the most common pathogen in acute and chronic prostatitis. Chronic bacterial prostatitis must be confirmed and diagnosed using a urine culture.
 
 
 
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