Prostatitis

Prostatitis refers to an infection or inflammation of the prostate gland that presents as several syndromes with varying clinical features. Prostatitis is a clinical diagnosis and imaging is useful to evaluate abscess formation. 

The National Institutes of Health (NIH) classified prostatitis into four distinct syndromes 1:

  • I: acute bacterial prostatitis
  • II: chronic bacterial prostatitis
  • III: chronic prostatitis and chronic pelvic pain syndrome (CPPS); further classified as inflammatory or noninflammatory)
  • IV: asymptomatic inflammatory prostatitis
CT 

Contrast enhanced CT is the best imaging tool if abscess suspected and will demonstrate a diffusely enlarged, edematous gland with predilection for peripheral zone involvement.

When an abscess is present it is seen as a rim-enhancing, unilocular or multilocular, hypodensity in the peripheral zone. Central zone involvement is encountered in post transurethral resection of the prostate (TURP). The infection can extend through capsule into periprostatic tissues, seminal vesicles, and peritoneum.

MRI

The prostate will be diffusely enlarged, often with associated inflammatory changes of periprostatic fat and of the seminal vesicles 6.

Acute prostatitis
  • T1: peripheral zone iso- or hypo-intense to transitional zone
  • T2: hyperintense
  • T1 C+ (Gd) diffusely enhancing 6
Ultrasound

Focal hypoechoic region in the peripheral zone of the gland. Discrete fluid collection suggests abscess formation. Colour Doppler ultrasound demonstrates increase flow in the periphery of the abscess. 

Prostatitis can be complicated by prostatic abscess. Diuretics and anti-inflammatory medications may be an alternative option to treat prostatitis, especially for chronic non-bacterial prostatitis.


Prostate pathology
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Article Information

rID: 19078
System: Urogenital
Section: Pathology
Tag: cases
Synonyms or Alternate Spellings:
  • Inflammation of the prostate
  • Inflammation of the prostate gland

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Cases and Figures

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    Case 1: acute bacterial prostatitis and abscess
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    Prostatic abscess
    Case 2: prostatic abscess with extraprostatic spread
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    Case 3: prostatitis with abscess formation
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