Prostatic abscess (PA) is a rare urological condition typically associated with predisposing factors such as diabetes, immunosuppression, or prior instrumentation. Although gram-negative organisms more commonly cause it, Staphylococcus aureus remains a rare pathogen, even in immunocompromised individuals. Early diagnosis and prompt treatment are crucial to prevent severe complications. In this study, we reported a case of PA, and the shape and size of the abscess, in addition to patient background characteristics and the clinical course, were evaluated, and the treatment strategy for prostatic abscess was examined.

We present a case in which transurethral drainage was effective. A 40-year-old man with poorly controlled diabetes mellitus, diagnosed during a health checkup two years ago. He presented to our hospital with cellulitis, which had been treated with antibiotics but failed to improve. His HbA1c was 14%, and laboratory results showed a significant leukocytosis (WBC: 42,800) and elevated C-reactive protein (CRP: 28.49). Despite initial antibiotic therapy, the inflammatory response worsened. A CT scan revealed two prostatic abscesses, measuring 2.3 × 1.3 cm and 1.4 × 1.4 cm, with septations. Cultures from blood, urine, and the abscess identified Staphylococcus aureus as the causative pathogen. The patient underwent Transurethral Resection of the Prostate (TURP) for abscess drainage and received intravenous Cefazolin, resulting in complete clinical resolution. Thus, while some cases were successful with drainage, others were successful with conservative treatment. All patients with a diagnosis of prostatic abscess in Showa University Hospital and Hitachi Medical Center between 2003 and 2025 were retrospectively reviewed. Regarding the treatment options, the patients were divided into two groups: the conservative therapy group and the drainage group. In each group, background characteristics, culture reports, shape and size of abscess, and the presence of recurrence were evaluated.

All 19 patients with a diagnosis of prostatic abscess were retrospectively reviewed; 13 patients improved with conservative treatment alone, but drainage was performed in 6 patients with poor response to antibiotic therapy. All 6 cases requiring transurethral drainage were multifocal abscesses. Drainage should be considered in patients with poorly controlled diabetes and persistent fever, especially if the inflammatory response does not respond to standard antibiotic therapy.

This case highlights the need for prompt recognition of prostatic abscess as a potential diagnosis in young men with unresolved symptoms. Early intervention, including targeted antibiotic therapy and surgical drainage, can lead to favorable outcomes. If the abscess is the multifocal type, drainage should be considered.