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 NICE CKS.
• Systemic symptoms: Patients often present with fever, chills, malaise, and sometimes rigors, indicating systemic infection NICE CKS.
• Perineal, suprapubic, or lower back pain: Pain localized to the perineum, lower abdomen, or lower back is common and reflects prostatic inflammation NICE CKS.
• 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 NICE CKS.
• 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 NICE CKS.
• Exclusion of other causes: Consideration of differential diagnoses such as urinary tract infection without prostatitis, chronic prostatitis, or prostatic abscess is important NICE CKS.
• Risk factors and comorbidities: Immunocompromised state, diabetes mellitus, or pre-existing urological conditions (e.g., benign prostatic hypertrophy, indwelling catheter) increase suspicion and severity NICE CKS.

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 & Pettit-Young 1990Leigh 1993. The literature also highlights the importance of recognizing systemic signs to differentiate acute prostatitis from chronic forms and other urological conditions Kot & Pettit-Young 1990.