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Chronic bacterial prostatitis
Background
Overview
Definition
CBP is caused by a chronic bacterial infection of the prostate gland characterized by recurrent UTIs caused by the same bacterial strain, pelvic pain, and LUTS.
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Pathophysiology
CBP is caused by a chronic bacterial infection commonly involving E. coli and enterococci.
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Disease course
Clinical manifestations include pain, which may be poorly localized (pelvis, genitalia, lower back, or hypogastrium), and LUTS (weak stream, straining, hesitancy, urgency, frequency, dysuria).
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Prognosis and risk of recurrence
CBP is not associated with increased mortality.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of chronic bacterial prostatitis are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2025), the American Academy of Family Physicians (AAFP 2024), the Prostatitis Expert Reference Group (PERG 2015), and the Canadian Urological Association (CUA 2011).
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Classification and risk stratification
Staging: as per PERG 2015 guidelines, classify patients as being:
in the early stages of the disease, if they have experienced persistent, recurrent symptoms for < 6 months and are antibiotic-naïve
in the later stages of the disease, if they have experienced persistent, recurrent symptoms for > 6 months and are refractory to initial pharmacotherapy.
B
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Severity assessment
Diagnostic investigations
Physical examination: as per CUA 2011 guidelines, perform a physical examination (including the abdomen, external genitalia, perineum, prostate, and pelvic floor) in patients with suspected CBP or chronic prostatitis/chronic pelvic pain syndrome.
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Microbiological testing
PSA
Transrectal ultrasound
Cystoscopy
Pelvic imaging
Urodynamic testing
Psychosocial assessment
Medical management
General principles: as per PERG 2015 guidelines, ensure a multidisciplinary team care including urologists, pain specialists, nurse specialists, physiotherapist, general physicians, cognitive behavioral/psychological therapists and sexual health specialists.
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Antibiotic therapy
Analgesic therapy
Alpha-blockers
5-ARIs
Pentosan polysulfate
Nonpharmacologic interventions
CBT: as per PERG 2015 guidelines, consider offering CBT in conjunction with other treatments to improve pain and QoL in later-stages of CBP or chronic prostatitis/chronic pelvic pain syndrome.
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Physiotherapy
Alternative medicine
Surgical interventions
Drainage of prostatic abscess: as per CUA 2011 guidelines, perform incision and drainage of the prostatic abscess, preferably via transurethral route.
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Prostatectomy
Specific circumstances
Patients with asymptomatic prostatitis
As per CUA 2011 guidelines:
Do not screen or evaluate for asymptomatic prostatitis.
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Do not treat patients with asymptomatic prostatitis.
D
Consider initiating antimicrobial therapy in selected patients with asymptomatic prostatitis with elevated PSA, infertility, and in patients scheduled to undergo prostate biopsy. D