Pathophysiology
Clinical meaning
Prostatitis encompasses four categories: acute bacterial (Category I), chronic bacterial (Category II), chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS, Category III), and asymptomatic inflammatory (Category IV). Acute bacterial prostatitis results from ascending urethral infection or hematogenous seeding, most commonly by E. coli, Klebsiella, or Pseudomonas. Bacteria colonize the prostatic ductal system, triggering neutrophilic infiltration, glandular destruction, and prostatic abscess formation in severe cases. Chronic bacterial prostatitis involves persistent bacterial biofilm within prostatic calculi or ductal epithelium, causing recurrent UTIs. CP/CPPS (90% of prostatitis cases) involves neurogenic inflammation, pelvic floor muscle dysfunction, and central pain sensitization without identifiable bacterial infection. Prostatic inflammation increases PSA levels and may mimic prostate cancer on screening.