Prostate
Prostatitis
General

Author: Kenneth Iczkowski, M.D. (see Authors page)

Revised: 11 May 2016, last major update May 2016

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Prostatitis [title]

Cite this page: Prostatitis - General. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/prostateprostatitis.html. Accessed December 11th, 2016.
Definition / General
  • Inflammation of the prostate
  • Includes acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis / chronic pelvic pain syndrome and granulomatous prostatitis
Essential Features
  • Should not be diagnosed on needle biopsy alone
  • Clinical diagnosis based on quantitative bacterial cultures and microscopic examination of fractionated urine specimens (first 10 ml of urine is urethral, midstream urine is from bladder) and expressed prostatic secretions
Epidemiology
  • Chronic pelvic pain syndrome (CPPS), which includes prostatodynia, category III or abacterial prostatitis, is the most common urological diagnosis in men older than 50 years
  • Current evidence indicates inverse relationship between inflammatory cells and cancer
  • Clinically diagnosed prostatitis may increase prostate cancer risk and this may be race dependent (Prostate Cancer Prostatic Dis 2015 Dec 1), whereas histological prostatic inflammation decreases the likelihood of cancer detection (Mod Pathol 2012;25:1023)
Clinical Features
  • Elevated PSA, particularly with acute prostatitis
Diagnosis
  • Chronic abacterial prostatitis / Chronic pelvic pain syndrome (CPPS):
    • Includes prostatodynia, category III or abacterial prostatitis
    • Defined by the International Prostatitis Collaborative Network under the National Institute of Health and diagnosis follows clinical, microbiological and laboratory criteria (JAMA 1999;282:236, Prostate Cancer Prostatic Dis 2016 Mar 8)
    • Histopathologic diagnosis less crucial or may not be required for diagnosis
    • Clinically similar to bacterial prostatitis, with persistent pain, especially after ejaculation but no bacteria are cultured from expressed prostatic secretions (EPS)
    • Excessive white blood cells (WBC) may be present or absent
    • The WBC number fluctuates within the same patient and does not correlate with symptom severity
    • Essentially incurable

  • Acute bacterial prostatitis:
    • Same bacteria types as urinary tract infections (E. coli, gram negative rods, enterococci, staphylococci), usually due to reflux, also following surgical manipulation or sexually transmitted disease
    • Usually localized, may cause obstruction, retention, abscess

  • Chronic bacterial prostatitis:
    • Symptoms of low back pain, dysuria, perineal and suprapubic discomfort
    • Often have history of urinary tract infection by same organism
    • May have NO symptoms

  • Granulomatous prostatitis:
    • Necrotizing or non-necrotizing granulomas may be seen in men who have undergone BCG treatment for bladder cancer
    • Also occurs post-transurethral resection
    • Otherwise, most cases are idiopathic and do not require acid-fast stain
Laboratory
  • Bacterial: prostatic secretion cultures should have bacterial counts 10x urethral / bladder cultures
  • Non-bacterial: > 10 WBC / HPF in prostatic secretions without pyuria
Treatment
  • Difficult because antibiotics penetrate poorly into prostate
Micro Description
  • Macrophages in stroma, neutrophils in lumen spaces are specific for acute prostatitis and usually localized
  • Lymphoid aggregates are not specific for prostatitis
  • WBCs in biopsied prostatic tissue do not correlate with the degree of pain in CPPS
  • Density of lymphocytes in the prostate is remarkably constant across age groups and races (Prostate 2003;55:187)
Micro Images

Images hosted on PathOut servers:

Reactive chronic inflammation

Acute inflammation
in lumens

Idiopathic granuloma
in a TURP