Acute prostatitis, defined as an infection of the prostate, is one of the types of urinary tract infections in males. Dysuria, increased urinary frequency, and pain in the pelvic region are main symptoms, whereas fever and systemic manifestations can be reported in more severe forms. Clinical findings, together with a complete laboratory workup, particularly urinalysis and urine cultures, are necessary to make the diagnosis.
Acute prostatitis is a term describing an infection of the prostate, arising due to reflux of urine contaminated by various bacterial pathogens    . Enterobacteriaceae (E. coli, klebsiella spp., pseudomonas aeruginosa, proteus mirabilis), as well as E. faecalis and staphylococcus aureus, are the main causative agents   . The presence of indwelling catheters is perhaps the greatest risk factor for a urinary tract infection (UTI) of any kind, including prostatitis, while invasive procedures (cystoscopy, transrectal prostate biopsy) can significantly increase the risk of prostatitis   . In addition, immunosuppression and diabetes mellitus are also depicted as potential risk factors  . The clinical presentation includes an abrupt onset of lower urinary tract symptoms (dysuria, increased urgency to urinate, increased frequency, incomplete voiding and a weak urine stream), painful ejaculation (even hematospermia), and perineal, rectal, or pelvic pain    . In addition, prostatitis often causes systemic symptoms - fever, chills, and malaise   . In cases when the prostate becomes enlarged, urinary tract obstruction might occur  . Many reports have emphasized the serious nature of prostatitis, as it may cause acute urinary retention, potential progression to a chronic infection, but also systemic dissemination and even sepsis, which could be life-threatening in the absence of appropriate therapy    .
A thorough clinical workup by the physician can provide sufficient clues to make an initial diagnosis. Firstly, a detailed patient history, including the onset of symptoms, their characteristics, as well as the assessment of risk factors (catheterization, immunosuppression), should be obtained  . More specific findings of prostatitis, however, are identified during the physical examination. A properly conducted digital rectal exam will reveal an enlarged prostate that is tender on palpation, one of the key features of prostatitis   . Physicians must be careful when performing a prostate exam, as prostate massage is contraindicated in the case of acute prostatitis due to an increased risk of subsequent bacteremia and sepsis  . As soon as clinical criteria suggest an infection of the urinary tract, laboratory studies (a complete blood count with basic biochemical parameters and serum inflammatory markers), together with urinalysis, urine cultures (of midstream urine), and blood cultures if systemic signs are present, are the next step    . If the diagnosis remains inconclusive, or if patients do not respond to antibiotic therapy, imaging studies such as transrectal prostatic ultrasonography (TRUS), pelvic ultrasonography or computed tomography (CT) can be implemented . The use of prostate-specific antigen (PSA) is not recommended, as it is often elevated due to the inflammatory changes in the prostate , which could mislead the physicians toward other diagnoses.