Prostatic abscesses can be a rare complication of prostatitis.
It has become relatively uncommon in clinical practice due to antibiotic therapy in those with prostatitis. It tends to affect diabetic and immunosuppressed patients. Most patients tend to present in the 5th to 6th decade 7.
Common presenting features are dysuria, fever, suprapubic pain +/- urinary retention. Urine examination usually reveals pus cells. Clincal presentation can sometimes be similar to acute bacterial prostatitis without abscess formation 8.
The prostate is a relatively uncommon gland for abscess formation.
The organisms usually involved include:
- Escherichia coli
- Staphylococcus spp.
- Gonococcus spp. (rare)
Transrectal sonography (TRUS) is considered 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. They may be inhomogenous echoes within 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
- 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 of 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
- prostate tumours
- infections of the prostate
- benign prostatic hypertrophy
- cystic lesions of the prostate
- prostate cancer