Prostatitis: A state-of-the-art review of diagnosis and therapy

Consider the diagnosis of prostatitis in any man who has signs or symptoms of urinary tract infection or irritation; abdominal, pelvic, perineal, or rectal pain; or disturbance of sexual function. Order prostate- specific antigen testing if you detect prostatic induration or if the patient has a family history of prostate cancer or is older than 50. If you suspect acute bacterial prostatitis, transabdominal ultrasonography may be useful for ruling out prostatic abscess. Antibiotics are the primary therapy for all forms of prostatitis; options include trimethoprim-sulfamethoxazole, erythromycin, tetracycline, doxycycline, and fluoroquinolones. Pain control is particularly important for patients who have nonbacterial prostatitis; unfortunately, non-narcotic pain medications are only moderately effective. Prostatic massage remains one of the most enduring methods of managing nonbacterial prostatitis.