Prostatitis

Inflammation or infection of the prostate causing pelvic, perineal, or genital pain, often with urinary symptoms and sometimes painful ejaculation. It comes in distinct types — acute bacterial (a medical urgency with fever), chronic bacterial, and chronic pelvic pain syndrome, the most common and least understood form.

Evidence synthesis: Acute bacterial prostatitis is well-characterised — fever, systemic illness, and positive cultures, requiring prompt antibiotics (evidence-based, and delay risks sepsis and abscess). Chronic bacterial prostatitis shows recurrent positive cultures and responds to prolonged targeted antibiotics. Chronic pelvic pain syndrome (CPPS) — 90%+ of cases — has no infection: research implicates pelvic floor muscle spasm, nerve sensitisation, and central pain amplification, which is why antibiotics fail and multimodal approaches (pelvic floor physiotherapy, alpha-blockers) have trial support. Quercetin (500 mg twice daily) has two positive randomised trials in CPPS (Shoskes et al.), the best supplement evidence in this space, likely via anti-inflammatory and mast-cell stabilising effects. Pelvic floor physiotherapy has RCT support for CPPS pain.