Prostate abscesses are focal purulent collections that develop as complications of acute bacterial prostatitis.
The usual infecting organisms are aerobic gram-negative bacilli or, less frequently, Staphylococcus aureus.
Patients who have had prostate cancer treated with radiation therapy, including brachytherapy (radiation seed placement), may be at somewhat increased risk for abscess formation. The widespread use of sodium-glucose cotransporter-2 (SGLT2) inhibitors has been shown to increase the risk for urinary tract infections and genital infections and could increase the risk of prostate abscess (1).
Reference
1. Liu J, Li L, Li S, et al. Effects of SGLT2 inhibitors on UTIs and genital infections in type 2 diabetes mellitus: a systematic review and meta-analysis. Sci Rep 2017;7(1):2824. doi:10.1038/s41598-017-02733-w
Symptoms of Prostate Abscess
Common symptoms can be similar to those of a urinary tract infection and include
Urinary frequency
Dysuria
Urinary retention
Perineal pressure or pain
Evidence of acute epididymitis, hematuria, and a purulent urethral discharge are less common. Fever is sometimes present.
Rectal examination may disclose prostate tenderness and fluctuance, but prostate enlargement is often the only abnormality, and sometimes the gland feels normal.
Diagnosis of Prostate Abscess
Prostate ultrasound and possibly cystoscopy
Abscess is suspected in patients with persistent perineal pain and continued or recurrent urinary tract infections despite antimicrobial therapy. Such patients should undergo prostate ultrasound and possibly cystoscopy.
Many abscesses, however, are discovered unexpectedly during computed tomography (CT) imaging for other reasons, prostate surgery, or endoscopy; bulging of a lateral lobe into the prostatic urethra or rupture during instrumentation reveals the abscess. Although pyuria and bacteriuria are common, urinalysis may be normal. Blood cultures are positive in some patients.
Treatment of Prostate Abscess
Antibiotics
Drainage
Treatment involves appropriate antibiotics plus drainage by transurethral evacuation or transperineal aspiration and drainage. Pending culture results, empiric antibiotic therapy is begun with a fluoroquinolone (eg, ciprofloxacin), which has high tissue penetration into the prostate.Treatment involves appropriate antibiotics plus drainage by transurethral evacuation or transperineal aspiration and drainage. Pending culture results, empiric antibiotic therapy is begun with a fluoroquinolone (eg, ciprofloxacin), which has high tissue penetration into the prostate.