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

Radiographic features

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
• Gd (CT1 C+ (Gd): diffusely 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. 

Treatment and prognosis

Prostatitis can be complicated by prostatic abscess. DiureticDiuretics and Antianti-inflammatory Pill ismedications may be an alternative option to treat prostatitis, especially for chronic nonbacterialnon-bacterial prostatitis.

Differential diagnosis

• granulomatous prostatitis can be mistaken for prostatic carcinoma, especiallty on transrectal ultrasound ^3-4.