Clinical Prostatalgia

Physical of Prostatalgia

No finding is pathognomonic.
Examination of the genitalia reveals normal results.
Digital rectal examination may reveal a tight anal sphincter. When the anal sphincter tone is hyperactive, a verifiable spastic neuropathy must be excluded. The hyperactivity may otherwise indicate a spasmodic hyperirritability of the pelvic floor musculature, which may be amenable to medical and biofeedback therapies.

The prostate and adjacent tissues may be moderately to severely tender, and the gland itself may be slightly congested or boggy. However, the presence of a small, relatively firm gland does not exclude the possibility of CPPS type III. Extreme tenderness upon gentle palpation of the prostate should raise suspicion for acute bacterial prostatitis or even a prostatic abscess.
The value of this examination is to exclude other diagnoses, such as prostate cancer, chronic urethritis/meatitis, and granulomatous prostatitis.

Causes of Prostatalgia


An informative review of the possible role for fastidious bacteria (ie, bacteria that cannot be isolated on standard culture media) in the development of chronic prostatitis (CP)/CPPS has recently been presented by a leader in this field, Professor John N. Krieger at the University of Washington.Among the fastidious organisms that have been implicated are Chlamydia trachomatis, the genital mycoplasmas (ie, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium), a protozoan (ie, Trichomonas vaginalis), Neisseria gonorrhoeae, genital tract viruses (eg, herpes simplex virus types 1 and 2, cytomegalovirus), fungi, anaerobic bacteria, and gram-positive bacteria.

Only 10 (8%) of 135 patients with CP/CPPS in this series tested positive for fastidious organisms. However, in another series, 79 (47%) of 170 specimens from patients with CP/CPPS exhibited gene sequencing (16S rDNA) positive for the presence of microbes, while only 21 (20%) of 117 control specimens from patients undergoing radical prostatectomy were positive (P <.01). These observations support a potential role for uncommon organisms in CP/CPPS.

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