A 34-year-old man presents with fever and perineal pain. What physical examination finding is consistent with acute prostatitis?

Acute prostatitis is an infection or inflammation of the prostate gland, which often presents with specific symptoms and physical examination findings. When assessing a patient suspected of having acute prostatitis, the presence of a tender, warm, and swollen prostate during the digital rectal examination is a classic finding.

The physiologic response to infection causes increased vascularity and edema, making the prostate gland palpable as tender and enlarged. This is critical in diagnosing acute prostatitis, as it distinguishes the condition from other causes of pelvic pain in males. The warmth of the prostate further indicates an inflammatory response consistent with an infectious process.

Mild suprapubic tenderness might be seen in other conditions, such as urinary tract infections, and does not specifically point towards prostatitis. Scrotal swelling and tenderness could indicate conditions like epididymitis or testicular torsion, while costovertebral angle tenderness usually suggests renal involvement rather than issues with the prostate. Hence, the specific findings of the prostate being tender, warm, and swollen are key indicators of acute prostatitis, making this the correct option.