Prostatitis vs BPH: How to Tell the Difference

Inflammation features an increase in the size of a given tissue. Hyperplasia is almost the same thing, triggered by different reasons. Thus, two different ailments in the prostate require a closer look to tell the difference.

Prostatitis features inflammation, and BPH features hyperplasia. They have similar symptoms in a similar group of male patients.

As they are, they would be challenging to differentiate if we were not aware of a few key points.

In the next paragraphs, we are going to summarize the most important differences and similarities between Benign Prostatic Hyperplasia (BPH) and prostatitis.

After a highlight of the article, we are going to have a deeper look at both conditions. How can you tell the difference? What treatments are available, and what’s your prognosis in each case?

Comparison of differences and similarities

The most important similarities and differences between prostatitis vs BPH are as follows:


  • They share similar urinary symptoms, including increased urinary frequency and urgency

  • Chronic prostatitis and BPH can be treated with alpha-blockers

  • Natural treatments in both conditions may include saw palmetto extracts


  • Prostatitis features inflammation, and BPH is a structural problem of the prostate

  • BPH has more urinary symptoms that won’t be seen in a case of prostatitis

  • Prostatitis has symptoms of infectious diseases, such as fever and chills

  • Prostatitis is treated with antibiotics

What is prostatitis?

Prostatitis is an inflammation or swelling of the prostate gland. In these cases, inflammatory substances invade the tissue of the prostate gland. They modulate the permeability of the blood vessels.

As a result, more liquid is retained in the prostate, and more white blood cells stay in the gland. White blood cells keep on releasing more inflammatory substances, and the process continues forward.

There are many causes of prostatitis and two main types. Acute bacterial prostatitis has a sudden onset. Thus, the symptoms are often more severe. Chronic prostatitis has an insidious onset, and the symptoms are not as severe.

Among the most frequent causes, we have urinary infections and sexually transmitted diseases. However, in many cases, the cause of prostatitis remains unknown (1).

What is BPH?

BPH is short for Benign Prostatic Hyperplasia. It is an alteration of the prostate tissue itself. There are two types of growth in human tissues. One of them is called hypertrophy, and the other is called hyperplasia. Hypertrophy is an increase in the size of the cells in which the affected cells grow without dividing.

A characteristic example would be muscle hypertrophy, which is common in bodybuilders. On the other hand, hyperplasia is a type of growth that features an increase in the number of cells. Each cell is the same size as the healthy tissue, but there are more than usual.

Hypertrophy and hyperplasia can be triggered in the body in normal circumstances. But, in the case of BPH, hyperplasia is not considered normal, and it affects the normal function of the urinary tract.

The current investigation tries to elucidate the reasons behind prostatic hyperplasia. However, what we do know is that there are risk factors. One of the most important is the individual’s age because it is more common as we grow older. Genetics play a role as well, especially if a first-degree relative (father or brother) has the condition (2).

Are prostatitis and BPH the same prostate gland problem?

Prostatitis and BPH are often mistaken, especially when they both appear in older patients with urinary symptoms. However, they are not caused by the same problem and will not be treated similarly. Prostatitis is an inflammatory problem, and it is caused by inflammatory cytokines.

The leading traceable cause is an infection of the urinary tract by sexually transmitted pathogens or any other. Prostatitis does not feature an increase in the number or size of prostate cells. Instead, the prostate gland swells by fluid accumulation. It may increase the size of the gland, but not as BPH does.

On the contrary, BPH features an enlarged prostate that often causes urinary obstruction. This enlargement tends to be very severe and cause many urinary symptoms. Unlike prostatitis, benign prostatic hyperplasia is never an acute problem. It is always slow-progressing and insidious, as you will see next (1,2).

How can I tell the difference between prostatitis and BPH (signs and symptoms)?

The symptoms of prostatitis and BPH are similar to each other, and that’s why they are often mistaken. However, let us review each ailment and the most important signs and symptoms:

Signs and symptoms of BPH

These are the most important symptoms of BPH (2):

  • It is sometimes asymptomatic: Not every patient with prostate enlargement has symptoms. In many cases, BPH symptoms start when the prostate has grown very large. Other patients have a rising incidence and severity of symptoms. Thus, they may not realize they have symptoms if they are insidious for many years.

  • Frequent urination: This is one of the most common initial symptoms of BPH. Patients report a frequent need to go to the bathroom. This is because the capacity of the urinary bladder becomes impaired. The prostate is growing too large, and affecting the normal storage function of the bladder.

  • Nocturia: In other words, it is waking up many times every night to urinate. These patients often have sleep problems and may even wet their sheets. Nocturia is a common problem, and in severe cases, it will not improve after reducing water intake at night.

  • Urgency to urinate: Patients with BPH often have a sudden and very urgent need to urinate. This may even lead to a type of incontinence called urgency urinary incontinence.

  • Reduced flow of urine: It is imperative to evaluate the caliber of the flow of urine. Most patients realize their urine flow is reduced and slower than usual. Sometimes, they feel they have not yet emptied their bladder after they stop urinating.

  • Hesitancy and intermittency: BPH patients may need to push harder in order to start urinating. This is called urinary hesitancy and sometimes causes urinary retention. Another symptom is intermittency or interrupted urinary flow. Instead of being continuous, patients need to stop and push again to continue urinating.

  • Terminal and post micturition dribble: Patients with BPH often have a terminal dribble. This means they start dribbling urine after the main flow. Moreover, after the patient has finished passing urine, he may have a post-micturition dribble. This can be mistaken with incontinence.

Signs and symptoms of prostatitis

These are the most important symptoms of prostatitis (1):

  • It is sometimes asymptomatic: Especially in the case of asymptomatic inflammatory prostatitis.

  • Weak urinary stream: Similar to BPH, patients with prostatitis may sometimes experience a weak urinary flow. They may need to push to continue urinating, and the symptoms can be acute or chronic. In chronic cases, weak urinary stream symptoms are intermittent.

  • Increased urinary frequency and urgency: Another similarity in prostatitis is that patients have an urgency to urinate and increased frequency. These symptoms are due to an inflammation of the prostate gland. Since the gland is continuous with the bladder, it irritates this organ.

  • Fever and chills: This is where prostatitis starts to be different from BPH. Instead of solely having urinary symptoms, patients may also experience fever. High-temperature levels are indicative of infection and common in acute bacterial prostatitis.

  • Muscle and joint pain: It is a part of their inflammatory process. That’s why patients with prostatitis may experience joint pain and muscle pain.

  • Prostatic pain, pelvis, or low back pain: In prostatitis, patients will have swelling and tenderness of the prostate gland. Doctors need to evaluate how a digital examination triggers pain. In some cases, patients complain of dull pain in the pelvic area. In other cases, it is moderate back pain associated with prostatitis.

  • Urethral discharge: Some patients with prostatitis will also have a urethral discharge. These cases are associated with sexually transmitted diseases of the urinary tract, causing urethritis.

  • Painful urination: In other cases, patients with prostatitis will also have painful urination, primarily when associated with cystitis or lower urinary tract infections.

  • Recurrent urinary infections: Men should not have urinary infections, or at least not as commonly as women. Urinary infections in men should be considered a complication of another process. They also cause potential complications such as prostatitis. Therefore, recurrent urinary infections should be investigated, especially in male patients.

How do you tell the difference?

In the lists above, you have probably seen that both prostatitis and BPH have urinary symptoms in common. They include voiding symptoms, storage symptoms, and post-micturition symptoms. In prostatitis, the most predominant are storage symptoms.

For example, having urinary urgency, incontinence, waking up several times at night to urinate, and having increased volume and frequency of urination.

Voiding symptoms such as weak urinary flow may appear in patients with prostatitis. However, they are much more common in BPH. Post-micturition symptoms are almost solely found in BPH patients.

On the contrary, chronic inflammation and bacterial infection are only found in prostatitis. They are not featured in BPH. If you have symptoms such as fever, chills, urethral discharge, joint, and muscle pain, prostatitis is likely involved instead of BPH. It is prostatitis that causes prostate pain triggered by the digital examination (3).

Are the treatments for prostatitis and BPH different?

It is fundamental to make a clear difference between prostatitis and BPH. Being clear on what is really happening will allow us to create an appropriate treatment schedule.

Both conditions are treated differently. Moreover, various types of prostatitis will have different treatment options for each one. Thus, let us review the medical treatment of BPH and compare it with the most common types of prostatitis (acute and chronic prostatitis).

Medical treatment for BPH

Selected drugs used to treat BPH depend on the patient, his symptoms, and the extent of the disease. They are as follows (4):

  • Alpha receptor blockers: It is a medication designed to relax the smooth muscle. It works in the muscle of the urinary tract, the bladder, and the prostate. Thus, the urinary tract won’t be constricted, and the urine will have a better flow. One of the most common is tamsulosin or Flomax. Other alternatives include terazosin, doxazosin, and alfuzosin.

  • Anticholinergic agents: They are useful for patients with overactive bladder symptoms. They should be used only when there is no bladder outlet obstruction. They can be combined with alpha-receptor blockers, but this should be done with care.

  • Phosphodiesterase inhibitors: They are a useful alternative to alpha-receptor blockers. One of the possible mechanisms of action includes the relaxation of the smooth muscle. However, phosphodiesterase inhibitors reduce hyperactivity in the autonomic nervous system that causes an increased frequency of urination, urgency, and other symptoms.

  • Surgical removal of the prostate: In selected cases, it may be an option to remove the prostate. This is usually done through transurethral resection of the prostate, a procedure also known as TURP.

Medical treatment for acute prostatitis

Acute prostatitis is often a medical emergency. The symptoms are more severe and have a sudden onset. The most common medical treatments for acute prostatitis are as follows (5):

  • Antibiotic therapy: Acute prostatitis is often caused by a bacterial infection of the prostate. Thus, the most appropriate treatment is antibiotics. With trimethoprim or fluoroquinolones, prostatitis usually resolves in a few days. However, treatment should be maintained for as long as instructed by the doctor.

  • Nonsteroidal anti-inflammatory drugs: Your doctor may also recommend NSAIDs. These anti-inflammatory medications are useful to control pain symptoms associated with prostatitis.

Medical treatment for chronic prostatitis

The treatment of chronic prostatitis is similar to what we have described in acute prostatitis. However, recovery often takes longer. It is also more common to use multiple medications in the same patient to control the symptoms. The most important drugs are as follows (6):

  • Antibiotics: Once again, infection is often the cause of chronic bacterial prostatitis. However, in this case, the infection may take a very long time to cure, and therapy may extend for more than two months.

  • Alpha-blockers: Patients with urinary tract symptoms and prostate pain usually need alpha-blockers. They are often diagnosed with chronic pelvic pain syndrome and need these drugs to relieve their urinary tract symptoms.

  • Nonsteroidal anti-inflammatory drugs: They are required in most cases of chronic prostatitis. It is especially the case of chronic pelvic pain syndrome.

Natural treatments for each

After reviewing the medical treatment of BPH and prostatitis, let’s consider the most important natural treatments, too.


  • Quercetin: Quercetin is a potent anti-inflammatory substance. It relieves the symptoms of prostatitis by countering the prostate inflammation (7).

  • Turmeric: It is a widely used spice in India and many other parts of Asia. Turmeric has powerful anti-inflammatory potential. It also displays antibacterial properties. Thus, it reduces inflammation and helps the organism fighting pathogen microbes (8).

  • Saw Palmetto: This herb is very abundant and widely used in North America. It helps patients improve their hormonal balance and contain a very potent group of antioxidants called flavonoids. These flavonoids are powerful anti-inflammatory substances. They reduce inflammation and improve urinary symptoms (9).

Benign Prostatic Hyperplasia

  • Ellagic Acid: It is an antioxidant found in various foods, especially in many types of berries and pomegranates. It slows down the progression of benign prostatic hyperplasia and prevents the onset of prostate cancer (10).

  • Stinging Nettle: It is a traditional herb against back pain, joint pain, and BPH. Stinging nettle is known to reduce the post-void residual urine in patients with BPH. In other words, it allows for complete emptying of the urinary bladder (11).

  • Saw Palmetto: Similar to prostatitis, saw palmetto is beneficial in BPH. In these patients, it reduces the incidence and severity of urinary symptoms (9).

What is the prognosis for BPH and prostatitis?

Unlike prostate cancer, prostate BPH is a benign disease. Prostatitis is also benign and even more manageable than BPH. Thus, both disorders have a very favorable prognosis.

However, patients with prostatitis and BPH should undergo careful follow-up. This is a useful way to make sure their condition is being controlled appropriately. Otherwise, they would become affected by other complications that will affect their quality of life.

Among the most important methods to evaluate the prognosis, we have PSA levels. With PSA, it is possible to tell when the increase in the size of the prostate is caused by prostate cancer.

In the majority of cases, a prostate biopsy won’t be required. On the other hand, prostatic abscess formation is a complication of prostatitis. It is very rare and often appears in immunocompromised patients.

In chronic prostatitis, it is a more insidious process, but with more consequences. Prostatitis does not cause mortality but impair the patient’s quality of life. Chronic cases are associated with erectile dysfunction when they feature severe symptoms (12).


In a nutshell, while prostatitis and BPH are not mortal, they do affect the quality of life in various ways. They both feature urinary symptoms, and prostatitis may also be associated with pelvic pain. The degree of severity varies, and patients should have a close follow-up to prevent complications.


  1. Ramakrishnan, K., & Salinas, R. C. (2010). Prostatitis: acute and chronic. Primary Care: Clinics in Office Practice, 37(3), 547-563.
  2. Ramsey, E. W. (2000). Benign prostatic hyperplasia: a review. The Canadian journal of urology, 7(6), 1135-1143.
  3. Collins, M. M., Stafford, R. S., O’Leary, M. P., & Barry, M. J. (1999). Distinguishing chronic prostatitis and benign prostatic hyperplasia symptoms: results of a national survey of physician visits. Urology, 53(5), 921-925.
  4. Foster, H. E., Barry, M. J., Dahm, P., Gandhi, M. C., Lightner, M. D., Parsons, J. K., … & Welliver, C. (2018). AUA GUIDELINE.
  5. Ludwig, M. (2008). Diagnosis and therapy of acute prostatitis, epididymitis and orchitis. Andrologia, 40(2), 76-80.
  6. Rees, J., Abrahams, M., Doble, A., Cooper, A., & Prostatitis Expert Reference Group (PERG). (2015). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU international, 116(4), 509-525.
  7. Duclos, A. J., Lee, C. T., & Shoskes, D. A. (2007). Current treatment options in the management of chronic prostatitis. Therapeutics and clinical risk management, 3(4), 507.
  8. James, M. I., Iwuji, C., Irving, G., Karmokar, A., Higgins, J. A., Griffin-Teal, N., … & Morgan, B. (2015). Curcumin inhibits cancer stem cell phenotypes in ex vivo models of colorectal liver metastases, and is clinically safe and tolerable in combination with FOLFOX chemotherapy. Cancer letters, 364(2), 135-141.
  9. Barry, M. J., Meleth, S., Lee, J. Y., Kreder, K. J., Avins, A. L., Nickel, J. C., … & McCullough, A. (2011). Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. Jama, 306(12), 1344-1351.
  10. Bell, C., & Hawthorne, S. (2008). Ellagic acid, pomegranate and prostate cancer—a mini review. Journal of Pharmacy and Pharmacology, 60(2), 139-144.
  11. Koch, E. (2001). Extracts from fruits of saw palmetto (Sabal serrulata) and roots of stinging nettle (Urtica dioica): viable alternatives in the medical treatment of benign prostatic hyperplasia and associated lower urinary tracts symptoms. Planta medica, 67(06), 489-500.
  12. Krsmanovic, A., Tripp, D. A., Nickel, J. C., Shoskes, D. A., Pontari, M., Litwin, M. S., & McNaughton-Collins, M. F. (2014). Psychosocial mechanisms of the pain and quality of life relationship for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Canadian Urological Association Journal, 8(11-12), 403.

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