Diagnosis for Prostatitis

Prostatitis is a broad term for an infection or inflammation of the prostate. Over the past decade, urologists have identified four types of prostatitis:

Acute bacterial prostatitis is a sudden-onset infection that lasts for several days.
Chronic bacterial prostatitis is a recurrent infection that can last for weeks, subside, and then flare-up again.
Chronic non-bacterial prostatitis/chronic pelvic pain syndrome (CPPS) is diagnosed when no infectious organism can be identified.
Asymptomatic inflammatory prostatitis is diagnosed when white blood cells are found in the prostatic secretions or prostate tissue of a man who has no symptoms of prostatitis.
 

A thorough diagnostic work-up for prostatitis is critical for several reasons. Some symptoms of prostatitis overlap with those of urethritis (inflammation of the urethra), cystitis (inflammation of the bladder), benign prostatic hyperplasia, and prostate cancer, and these conditions must be ruled out. It’s also essential to distinguish between the various types of prostatitis because treatment that is effective for one type may have no effect on another.

Recognizing and accurately reporting your prostatitis symptoms is the first step in obtaining a correct diagnosis. After taking a detailed history of your symptoms, your urologist will conduct a number of diagnostic tests to rule out other conditions and to identify the type of prostatitis you have. Common tests include:

Digital rectal exam (DRE). A digital rectal exam will tell your physician whether the prostate is swollen, tender, warm, and firm (suggesting an acute bacterial infection) or enlarged and either soft or firm (suggesting a chronic bacterial infection). Your physician may also press on the muscles and ligaments supporting the pelvic floor and the perineum to evaluate any discomfort or pain you may have in the area.

Urine analysis. Your urine will be analyzed for the presence of bacteria. If chronic prostatitis is suspected, another urine sample may be collected after prostate massage. The sample will be examined for signs of bacteria or inflammation.

Prostate secretion analysis. A sample of prostate fluid obtained with prostate massage will be examined for signs of infection or inflammation.

Prostate-specific antigen (PSA) test. An elevated PSA level can indicate an inflamed prostate or prostate cancer.

If more information is needed to make a diagnosis, one or more of the following tests may be ordered:

Cystoscopy. A thin, flexible, tubelike viewing device (cystoscope) is passed through the urethra and into the bladder. This allows the physician to examine the urethra, bladder, and prostate for abnormalities.

Urine flow studies. These “voiding” studies evaluate the strength and other characteristics of your urine flow.

Transrectal ultrasound. A narrow ultrasound probe is inserted into the rectum to provide ultrasound images of the prostate.

Prostate biopsy. If the diagnosis remains uncertain, your urologist may want to perform a biopsy of the prostate tissue.
The take-home message on prostatitis diagnosis

Acute bacterial prostatitis is the easiest form of the disease to identify and cure. Chronic non-bacterial prostatitis/ CPPS—the most common type— is the most difficult to treat. With chronic non-bacterial prostatitis/ CPPS especially, the key is to seek the best available medical care, preferably from a urologist with expertise in prostatitis. With an accurate diagnosis, expert care, and perseverance, you should be able to find ways to manage your most difficult symptoms.