Acute prostatitis in middle-aged men: a prospective study.
OBJECTIVE
To determine the clinical outcome of middle-aged men with acute prostatitis, the optimum time for re-assessing their prostate-specific antigen (PSA) levels, and to detect any possible echotextural and vascular changes that remain as a consequence of acute inflammation.


METHODS
Persistent fever prompted a re-evaluation for prostatic abscess formation in 28 middle-aged men, using transrectal ultrasonography (TRUS) colour Doppler imaging, undertaken at the 3-, 6- and 12-month visits. The results of TRUS were compared with laboratory data and clinical outcome.


RESULTS
Two abscesses were detected; 19 (68%) of the patients remained infection-free at the 3-month visit. Serum PSA levels were elevated in 11 (39%) of the patients at this visit; three prostate carcinomas were diagnosed. Increased intraprostatic colour flow was detected in 68% and there were hypoechoic areas in 46% of the patients.


CONCLUSIONS
The re-evaluation for abscess formation should not be postponed for > 48 h. Patients with acute prostatitis tend to have persistent infection. PSA levels could be high even up to 3 months after an acute episode. Middle-aged men with carcinoma could be missed during the acute phase of inflammation. PSA and TRUS monitoring are strongly recommended.
Kravchick
S
S
Department of Urology, Barzilai Medical Centre, Ashkelon, Israel. cambell@netvision.net.il
Cytron
S
S
Agulansky
L
L
Ben-Dor
D
D
D000038:Abscess / Q000188:drug therapy; D000208:Acute Disease; D000368:Aged; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005334:Fever / Q000209:etiology; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011472:Prostatitis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D018615:Ultrasonography, Doppler, Color
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D000667:Ampicillin; D017430:Prostate-Specific Antigen