Type of syndrome		Differential diagnosis	Symptoms	Physical examination	Diagnostic tests	Therapy
I. Acute bacterial prostatitis		Acute cystitis, prostatic abscess	Urinary: straining, urgency, dysuria, hesitancy, frequency, obstruction, irritation Systemic: fever, malaise, arthralgia, myalgia, intense suprapubic pain, mildly to acutely ill appearance, chills, nausea, emesis, and signs of sepsis (tachycardia and hypotension)	Tender, boggy, enlarged prostate on digital rectal examination; distended bladder; prostatic massage contraindicated	Urine culture, postvoid residual	Antimicrobial therapy Hospitalization for severe cases of prostate infection
II. Chronic bacterial prostatitis		Benign prostatic hyperplasia, stones or foreign body within the urinary tract, bladder cancer, prostatic abscess, enterovesical fistula	Irritative voiding symptoms; testicular, low back, or perineal pain; recurrent urinary tract infection; urethritis; epididymitis; distal penile pain	Prostatic massage; prostate can be normal, tender, or boggy on digital rectal examination	2-glass pre- and post-prostatic massage test, postvoid residual	Antimicrobial therapy
III. Chronic pelvic pain syndrome		Benign prostatic hyperplasia, voiding dysfunction, bladder or prostate cancer, prostatic or müllerian duct remnants, interstitial cystitis, radiation cystitis, eosinophilic cystitis, chronic proliferative cystitis, neuropathic pain, ejaculatory duct obstruction	Symptoms of chronic pelvic pain and possible voiding symptoms	Abdominal and digital rectal examination to exclude underlying pathology; no tenderness to diffuse tenderness; findings variable	National Institutes of Health Chronic Prostatitis Symptom Index,* 2-glass pre- and post-prostatic massage test	Multimodal: combination pharmacologic and nonpharmacologic
A. Inflammatory
B. Noninflammatory
IV. Asymptomatic prostatitis		—	No symptoms; incidental finding during evaluation for other conditions (i.e., infertility or elevated prostate-specific antigen level)	No disease-specific abnormalities	Semen analysis, prostate biopsy	No specific therapy required; treatment depends on underlying conditions and reasons for initial evaluation