Prostatic infections can be debilitating and can arise from gram negative organisms, that ascend in a retrograde fashion, up via the urethra from peroneal flora. They can lead to acute infection of the prostate or a more chronic lingering problem. The patient presents with burning in the urine, pelvic pain, possible urethral discharge, and frequency of urination.
It is imperative to exclude other diagnoses and to isolate the infected organ, by way of a formal urine culture. Antibiotic cover should be directed to the sensitivities of the organism. Anti-inflammatory tablets or suppositories may be required. Baseline ultrasound imaging and possibly a cystoscopic assessment of the prostate may eventually be required. Some prostatic infections expose an underlying enlarged prostatic problem that needs subsequent definitive management by surgery.
Enlarged prostates that allow for urine to be retained in the bladder can lead to urinary infection, that causes prostate infection. The prostate infections cause a transient elevation of the PSA blood test and this can be concerning for patients that there may be underlying prostate cancer, but there typically is not.
The urologist will perform a rectal examination to confirm there is no acute prostatic abscess and that the prostate does not feel malignant. Some prostate infections may be sexually transmitted. A small group of patients develops chronic prostatitis with chronic pelvic pain, that needs referral to a specialist.