Prostatitis

Definition

Prostatitis is inflammation of the prostate gland, which may be acute or chronic, bacterial or nonbacterial, often causing urinary, pelvic, and sometimes systemic symptoms.

Epidemiology

• Common in adult men, with prevalence estimates of 5–10%
• Acute bacterial prostatitis is less common but more severe
• Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is more frequent
• Typically affects men aged 30–50 years
• Accounts for significant urologic morbidity and healthcare visits
• Recurrent urinary tract infections may predispose to prostatitis
• Impact on quality of life is significant, especially for chronic forms

Etiology

• Acute bacterial: usually Escherichia coli or other Gram-negative bacteria
• Chronic bacterial: persistent infection with E. coli or Enterococcus
• Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): nonbacterial, multifactorial
• Inflammatory mediators and immune dysfunction in CP/CPPS
• Post-instrumentation or catheterization
• Urethral strictures or bladder outlet obstruction
• Sexually transmitted infections (Neisseria gonorrhoeae, Chlamydia trachomatis)

Pathophysiology

• Bacterial infection leads to inflammation and edema in acute prostatitis
• Chronic inflammation causes fibrosis, glandular disruption, and pelvic pain
• Immune dysregulation may perpetuate CP/CPPS
• Prostate microflora imbalance contributes to chronic inflammation
• Obstruction of prostatic ducts can exacerbate inflammation
• Neurogenic inflammation may contribute to pain symptoms
• Cytokine and prostaglandin release mediates pain, urinary urgency, and frequency