What are the key clinical features to consider when diagnosing acute prostatitis in a male patient?

Key clinical features to consider when diagnosing acute prostatitis in a male patient include:

• Acute onset of severe urinary symptoms: These typically include dysuria, urinary frequency, urgency, and sometimes acute urinary retention due to prostatic inflammation ¹.
• Systemic symptoms: Patients often present with fever, chills, malaise, and sometimes rigors, indicating systemic infection ¹.
• Perineal, suprapubic, or lower back pain: Pain localized to the perineum, lower abdomen, or lower back is common and reflects prostatic inflammation ¹.
• Tender, swollen, and warm prostate on digital rectal examination (DRE): The prostate is typically exquisitely tender, enlarged, and warm, but DRE should be performed cautiously to avoid bacteremia ¹.
• Urine analysis and culture findings: Evidence of urinary tract infection with pyuria and bacteriuria supports the diagnosis; urine cultures often grow typical uropathogens such as Escherichia coli ¹.
• Exclusion of other causes: Consideration of differential diagnoses such as urinary tract infection without prostatitis, chronic prostatitis, or prostatic abscess is important ¹.
• Risk factors and comorbidities: Immunocompromised state, diabetes mellitus, or pre-existing urological conditions (e.g., benign prostatic hypertrophy, indwelling catheter) increase suspicion and severity ¹.

These clinical features align with the literature emphasizing the acute inflammatory and infectious nature of the condition, characterized by sudden onset of urinary and systemic symptoms, and a tender prostate on examination (Kot and Pettit-Young, 1990; Leigh, 1993). The literature also highlights the importance of recognizing systemic signs to differentiate acute prostatitis from chronic forms and other urological conditions (Kot and Pettit-Young, 1990).