Adherence of Escherichia coli to uroepithelial cells is an important step in the pathogenesis of urinary tract infection. The process is frequently mediated by pili which undergo phase variation in response to changes in environmental growth conditions in vitro. It is possible that phase variation of pili and other bacterial virulence factors may play a role in the pathogenesis of bacterial prostatitis. The obvious differences in the environmental conditions of urethra, bladder, and prostate could favor strains that have the ability to adapt. For example, adhesion to the urethral and bladder mucosa could be facilitated by pili and their expression could be advantageous in the early phase of prostatitis. However, after the prostate ducts are colonized, pili may be detrimental since they can render E. coli more susceptible to phagocytosis. Further studies on phase variation of virulence factors of bacteria that cause prostatitis appear warranted.