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Prostate

Prostatitis


Reviewers: Gladell Paner, M.D., (see Reviewers page)
Revised: 12 February 2012, last major update January 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Inflammation of the prostate; includes granulomatous and non-granulomatous prostatitis; the latter overlaps with spectrum of prostatitis syndrome
● 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
● >10 WBC/HPF in prostatic secretions without pyuria; prostatic secretion cultures should have bacterial counts 10x urethral/bladder cultures

Prostatitis syndrome:
● Group of inflammatory and non-inflammatory conditions of prostate characterized by genitourinary or pelvic pain
● 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)
● Histopathologic diagnosis less crucial or may not be required for diagnosis
● Includes acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome and asymptomatic inflammatory prostatitis

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

Chronic abacterial prostatitis:
● Similar clinically to chronic bacterial prostatitis but negative cultures

Clinical features
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● Elevated PSA

Treatment
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● Difficult because antibiotics penetrate poorly into prostate

Micro description
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● Macrophages in stroma, neutrophils in ducts/acini are specific for acute prostatitis and usually localized
● Lymphoid aggregates are common with aging and nodular hyperplasia and not specific for prostatitis

Micro images
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Acute prostatitis

Differential diagnosis
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Differential diagnosis of lymphoid aggregates: SLL/CLL

End of Prostate > Prostatitis


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