Prostatic abscesses are a rare complication of prostatitis.
Prostatic abscesses have become relatively uncommon due to the increased use of antibiotic therapy in patients with prostatitis. It tends to affect diabetic and immunosuppressed patients. Most patients affected are around 50 to 60 years old 7.
Patients commonly present with dysuria, fever, suprapubic pain, and possibly urinary retention. Urinalysis reveals leukocytes. Clinically the condition may appear similar to acute bacterial prostatitis without abscess formation 8.
The organisms usually involved include:
- Escherichia coli
- Staphylococcus spp.
- Gonococcus spp. (rare)
Transrectal sonography (TRUS) is considered a very reliable imaging method to diagnose a prostatic abscess 1,2. It usually demonstrates ill-defined hypoechoic areas within an enlarged and/or distorted prostate gland. There may be inhomogenous echoes within these ill-defined areas 8,9.
- tends to show well defined areas of low attenuation 3
- the prostate gland can either be symmetrically or asymmetrically enlarged
MRI signal characteristics of an abscess include 2
- T1: hypointense
- T2: hyperintense
- T1 C+ (Gd): tends to show peripheral contrast enhancement.
- limited studies only 2
- tends to show restriction of diffusion corresponding to hypoechoic lesions on ultrasound
- limited studies only 2
- mean ADC values within the abscesses have been reported to be very low
Treatment and prognosis
Percutaneous transperineal or transrectal drainage is often considered the first choice for therapy due to the lower risk of complication compared with surgery. A TRUS guided aspiration is also reported to be an effective and minimally invasive treatment modality.
Imaging differential considerations include:
- 1. Barozzi L, Pavlica P, Menchi I et-al. Prostatic abscess: diagnosis and treatment. AJR Am J Roentgenol. 1998;170 (3): 753-7. AJR Am J Roentgenol (citation) - Pubmed citation
- 2. Singh P, Yadav MK, Singh SK et-al. Case series: Diffusion weighted MRI appearance in prostatic abscess. Indian J Radiol Imaging. 2011;21 (1): 46-8. doi:10.4103/0971-3026.76054 - Free text at pubmed - Pubmed citation
- 3. Thornhill BA, Morehouse HT, Coleman P et-al. Prostatic abscess: CT and sonographic findings. AJR Am J Roentgenol. 1987;148 (5): 899-900. AJR Am J Roentgenol (citation) - Pubmed citation
- 4. Papanicolaou N, Pfister RC, Stafford SA et-al. Prostatic abscess: imaging with transrectal sonography and MR. AJR Am J Roentgenol. 1987;149 (5): 981-2. AJR Am J Roentgenol (citation) - Pubmed citation
- 5. Aphinives C, Pacheerat K, Chaiyakum J et-al. Prostatic abscesses: radiographic findings and treatment. J Med Assoc Thai. 2004;87 (7): 810-5. - Pubmed citation
- 6. Curran S, Akin O, Agildere AM et-al. Endorectal MRI of prostatic and periprostatic cystic lesions and their mimics. AJR Am J Roentgenol. 2007;188 (5): 1373-9. doi:10.2214/AJR.06.0759 - Pubmed citation
- 7. Nghiem HT, Kellman GM, Sandberg SA et-al. Cystic lesions of the prostate. Radiographics. 1990;10 (4): 635-50. Radiographics (citation) - Pubmed citation
- 8. Lim JW, Ko YT, Lee DH et-al. Treatment of prostatic abscess: value of transrectal ultrasonographically guided needle aspiration. J Ultrasound Med. 2000;19 (9): 609-17. J Ultrasound Med (citation) - Pubmed citation
- 9. Göğüş C, Ozden E, Karaboğa R et-al. The value of transrectal ultrasound guided needle aspiration in treatment of prostatic abscess. Eur J Radiol. 2004;52 (1): 94-8. doi:10.1016/S0720-048X(03)00231-6 - Pubmed citation
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