Prostatitis is one of the more common inflammatory conditions encountered in urological practice. It may be due to acute or chronic bacterial infections and non-bacterial prostatitis can also occur in the absence of bacterial growth. Demonstration of bacteria in the postprostatic massage urine or expressed prostatic secretions when the midstream urine specimen shows no growth is highly diagnostic of bacterial prostatitis. Bacterial prostatitis is often caused by Escherichia coli or Klebsiella and Proteus species. Pseudomonas and enterococcus are less common. Prostatitis is seen in men of all ages and typically is associated with pain in the perineum and suprapubic areas associated with frequency and urgency of micturition. Abdominal examination is normally unremarkable but the characteristic feature is a very tender prostate on rectal examination. Occasionally a fluctuant abscess may be palpable within the prostate.

Acute bacterial prostatitis is often associated with generalized malaise and fever associated with symptoms localized to the prostate and acute cystitis. It responds dramatically to antimicrobial drugs. Sometimes it is necessary to treat the patient in hospital and prolonged oral antibiotic therapy of at least 30 days is recommended to prevent the development of chronic bacterial prostatitis.

Chronic bacterial prostatitis is one of the most common causes of relapsing urinary tract infection in men and in the past has been difficult to treat, although the newer fluoroquinolone antibiotics have been shown to be safe and effective in treatment of this condition.

Non-bacterial prostatitis is more common than bacterial prostatitis, although the aetiology is unknown and the treatment is often empirical and of variable effectiveness. Chlamydia trachomatis remains a possible aetiological agent although the evidence for its role is far from definite. A trial of tetracycline or one of its derivatives, associated with anti-inflammatory drugs, is sometimes effective. &agr;-Adrenergic blocking agents are sometimes of help, especially in patients with perineal pain from the prostate as the region of the prostate is known to be rich in &agr;-adrenergic receptors and symptoms may be relieved by these drugs.

A significant number of patients with prostatitis have an underlying anxiety about carcinoma, and reassurance where appropriate plays an important role in management.