Prostatitis

Question 1

What is the usual cause of acute prostatitis?

Answer 1

• Usually unknown
• Gram negative,
  most common are:
  - E. coli
  - Proteus sp
• STI’s:
  - C. trachomatis
  - Ureaplasma sp
  - Trichomonas vaginalis

Question 2

List common assessment findings associated with acute prostatitis

Answer 2

General:
- Spiking fever
- Chills
- Malaise
- Myalgias
- Feels like:
- “been in a bar fight”
- “been kicked in the ABD”

Pain:
- Pelvic
- Perineum
- Tip of penis

Prostate:
- Enlarged
- Boggy (could also be firm)
- Tender

Urinary:
- Cloudy urine
- Frequency
- Urgency
- Dysuria
- Nocturia
- Hematuria

GI:
- Pain with defecation

Question 3

How is acute prostatitis diagnosed?

Answer 3

• Rectal exam:
  - Prostate gland usually
  EXQUISITELY tender
• UA:
  - Rule out UTI
  - Look for hematuria
  - Get culture but treat
  empirically

NOTE: PSA will be elevated, but don’t order

Question 4

What antibiotics might be appropriate for acute prostatitis?

Answer 4

• TMP-SMX (Bactrim)
• Ciprofloxacin
• Levofloxacin
• Ceftriaxone (500 mg IM for gonorrhea)
• Doxycycline (for chlamydia)

Question 5

How long should antibiotics be administered for acute prostatitis?

Answer 5

4 - 8 weeks –OR– until:
- negative urine
- painless rectal exam
- normal ESR or CRP

NOTE: A negative urine at 7 days on antibiotics predicts cure if full course continues

Question 6

Under what circumstances should a patient with acute prostatic be referred to urology?

Answer 6

If no s/s improvement in 2 - 6 days on antibiotics

Question 7

Other than antibiotics, what treatment should be ordered for acute prostatitis?

Answer 7

• Stool softeners
• Adequate fluids

Question 8

How does PSA fluctuate in relation to acute prostatitis?

Answer 8

PSA will rise in response to infection

NOTE: Defer PSA screening by 1 month after treatment completed

Question 9

How does chronic prostatitis present?

Answer 9

• May be subtle
• S/S of recurrent UTI are common
• Prostate exam = usually normal
• Pain:
  
  • in perineum
  • lower ABD or back
  • testicles
  • with ejaculation

Question 10

How is chronic prostatitis diagnosed?

Answer 10

Diagnosis may be presumptive when:
- persistent s/s
- recurrent bacteriuria

Question 11

What is the treatment for chronic prostatitis?

Answer 11

• Antibiotics for acute prostatitis
  (TMP-SMX or quinolone x 4 - 6 weeks)