Prostatitis

What is prostatitis?

Prostatitis is inflammation of the prostate gland, a small walnut-sized organ below the bladder that produces seminal fluid. It is not a single condition but a spectrum of related disorders, classified into four categories:

• Acute bacterial prostatitis is a sudden, serious infection causing fever and severe pain. It is rare but requires urgent antibiotics.

• Chronic bacterial prostatitis is a recurring infection that causes persistent urinary and pelvic discomfort over the long term.

• Chronic pelvic pain syndrome (CPPS) is the most common type (90% of cases). It causes ongoing pain without a clear infection, likely due to a mix of nerve, muscle, and inflammatory factors.

• Asymptomatic inflammatory prostatitis causes no pain or symptoms. It is usually discovered during routine tests for other issues.

Symptoms of prostatitis

Symptoms vary considerably between the different forms of prostatitis. Common signs include:

• Pain or burning during urination

• Frequent or urgent need to urinate, particularly at night

• Difficulty starting urination or a weak urine stream

• A feeling of incomplete bladder emptying

• Pain in the perineum, lower abdomen, groin, or lower back

• Pain during or after ejaculation

• In acute bacterial prostatitis, fever, chills, nausea, and feeling severely unwell, which needs immediate medical attention

With chronic pelvic pain syndrome, symptoms tend to come and go over time, and they can take a real toll on quality of life, sexual function, and mental health.

What causes prostatitis?

The cause depends heavily on which form of prostatitis is involved.

Bacterial prostatitis happens when bacteria, most often E. coli and other gram-negative organisms, enter the prostate. Contributing factors include:

• Urinary tract infections that ascend to the prostate

• Urethral instrumentation or catheterisation

• Anatomical abnormalities of the urinary tract

• Sexually transmitted infections in younger men

Chronic pelvic pain syndrome is less well understood, but a few factors seem to contribute:

• Pelvic floor muscle dysfunction and tension

• Neurogenic inflammation and central sensitisation

• Psychological stress amplifying pain perception

• Incomplete treatment of previous bacterial prostatitis

How is prostatitis detected?

Prostatitis is detected through a combination of clinical assessment, pelvic MRI, and targeted blood testing.

Pelvic MRI Elfcare’s full-body MRI directly images the prostate to spot inflammation or abscesses. It's especially useful when PSA is elevated, giving context alongside the blood results. Active inflammation can itself cause changes on MRI that resemble cancer, so a finding suggestive of cancer during a prostatitis flare is usually followed by treating the inflammation and reassessing, rather than proceeding straight to biopsy.

Blood tests assess markers of infection, inflammation, and prostate health. Relevant markers in Elfcare's panel include:

• Total and free PSA ratio: these levels often rise during inflammation, which makes PSA an unreliable way to distinguish prostatitis from cancer while inflammation is present. Standard practice is to treat the prostatitis first and recheck PSA once symptoms have settled, at which point the result is far more meaningful.

• CRP: a high level helps confirm a sudden, active infection.

• Full blood count including white blood cell count and neutrophils: elevated white cells indicate active infection in acute bacterial prostatitis.

• HbA1c and glucose: provides metabolic context, as poorly controlled blood sugar is a recognized risk factor for infection generally, including in the urinary tract.

• Testosterone and SHBG: provides broader hormonal context; these are not direct markers of prostatitis but may be relevant to overall urological and sexual health when symptoms overlap.

Why early detection matters

Acute bacterial prostatitis, caught and treated promptly with antibiotics, resolves fully in most cases. Left untreated, it can progress to a prostatic abscess or systemic sepsis needing hospitalisation. Chronic bacterial prostatitis benefits from early, targeted antibiotic therapy based on urine and prostatic secretion cultures, which lowers the risk of recurrent infection and long-term symptoms.

Catching chronic pelvic pain syndrome early opens the door to combined treatment, pelvic floor physiotherapy, alpha blockers, and psychological support, that can meaningfully improve quality of life before symptoms become entrenched. Recognising PSA elevation as a result of prostatitis rather than cancer also avoids an unnecessary biopsy and the anxiety that comes with an unexplained PSA rise.

How Elfcare can help

Elfcare's pelvic MRI images the prostate directly, identifying inflammation, structural changes, and any findings that may indicate prostate cancer as an alternative or coexisting diagnosis when PSA is elevated. For men with prostatitis, this is one of the most useful parts of the assessment, since PSA elevation from inflammation can cause real anxiety, and the MRI helps put that result in context.

Our blood panel covers total PSA, free PSA ratio, CRP, full blood count, kidney function, and metabolic markers. This builds a fuller picture of the inflammation and the systemic factors most relevant to its cause and management.

If our MRI or blood tests identify findings consistent with prostatitis or a suspicious finding requiring further assessment, we take care of further diagnostics or refer you to the appropriate specialist.