Table 1.

Differential Diagnosis of Acute Bacterial Prostatitis.

Diagnosis	Distinguishing characteristics	Tests to rule out differential diagnoses
Benign prostatic hypertrophy	Obstructive voiding symptoms; enlarged, nontender prostate; negative urine culture	Inferior abdominal ultrasound and uroflowmetry
Chronic bacterial prostatitis	Recurrent UTIs with the same organism in prostatic secretions at least 3 months	Urinalysis with each episode; DRE; Meares–Stamey four-glass test or PPMT
Chronic pelvic pain syndrome	Pain attributed to the prostate with no demonstrable evidence of infection	Urinalysis and midstream urine culture; DRE
Prostate cancer	Presence of constitutional symptoms; presence of nodules on prostate examination	PSA testing; MRI; TRUS; prostate biopsy (only if prostate cancer suspected based on PSA and/or DRE results)
Acute cystitis	Irritative voiding symptoms; normal prostate examination	DRE; inferior abdominal ultrasound
Acute pyelonephritis	Chills; fever; lumbago and backache; urine sediment microscopic examination revealed the leucocytes casts	Physical examination; urine sediment microscopic examination
Epididymitis	Tenderness to palpation on affected epididymis; irritative voiding symptoms	Physical examination; US
Proctitis	Tenesmus; rectal bleeding; feeling of rectal fullness; passage of mucus through the rectum	DRE; stool routine examination; proctoscopy

UTI, urinary tract infection; PPMT, pre- and post-massage test; DRE, digital rectal examination; PSA, prostate-specific antigen; MRI, magnetic resonance imaging; US, ultrasonography.