Asymptomatic inflammatory prostatitis (National Institutes of Health, category IV) has been introduced as a separate clinical entity among other prostatitis syndromes. Asymptomatic inflammatory prostatitis is characterized by the presence of significant amount of leukocytes (white blood cells) in prostate-specific samples (post-prostatic massage urine, expressed prostatic secretion, semen, and prostate biopsy) but no subjective symptoms are found, and is therefore diagnosed solely in the laboratory. There have been many questions regarding the clinical role of asymptomatic inflammatory prostatitis and its impact on the management of prostate disease and sterility. This review presents the current definition of asymptomatic inflammatory prostatitis, summarizes the clinical evidence on the two important issues prostate specific antigen and pyospermia, and discusses the optimal approaches to reduce its confounding impact on prostate cancer screening and indiscriminate use of antibiotics.