From the Guidelines
No, a digital rectal examination (DRE) is not always necessary when diagnosing acute prostatitis and is often contraindicated in this condition. According to the guidelines for the prevention, diagnosis, and management of urinary tract infections in pediatrics and adults, a consensus statement published in JAMA Network Open in 2024 1, the clinical review found insufficient quality of evidence to enable a clear recommendation on the diagnostic approach for acute prostatitis. However, the diagnosis of acute prostatitis can typically be made based on clinical presentation, which includes fever, chills, malaise, myalgia, dysuria, urinary frequency, urgency, and perineal or suprapubic pain.
Key Points to Consider
- Laboratory findings such as elevated white blood cell count, pyuria, bacteriuria, and positive urine culture are usually sufficient for diagnosis 1.
- Blood cultures may also be obtained if sepsis is suspected.
- If imaging is needed, a transrectal ultrasound can be performed, though this is not routinely required.
- DRE should be avoided in suspected acute prostatitis because it can be extremely painful for the patient and may potentially cause bacteremia by expressing bacteria into the bloodstream.
- Treatment should be initiated promptly with appropriate antibiotics, along with pain management and adequate hydration. Some key considerations for treatment include:
- The optimal durations of treatment for acute bacterial prostatitis (ABP) are unknown and have not been established by high-quality studies 1.
- Additional prospective studies are needed to determine the appropriate duration of treatment for ABP.
From the Research
Diagnosing Acute Prostatitis
- The diagnosis of acute prostatitis is predominantly made based on history and physical examination, which includes abdominal, genital, and digital rectal examination (DRE) to assess for a tender, enlarged, or boggy prostate 2.
- A DRE should be performed after a midstream urine (MSU) sample has been collected for urine dipstick, microscopy, and culture 3.
- The physical examination, including DRE, is an essential part of the diagnostic process, as it helps to identify the characteristic symptoms of acute prostatitis, such as pelvic pain and urinary tract symptoms.
Importance of DRE in Diagnosis
- While DRE is a crucial part of the physical examination, there is no evidence to suggest that it is always necessary to perform a DRE in every case of suspected acute prostatitis.
- However, the studies suggest that a DRE should be performed as part of the physical examination to assess the prostate for tenderness, enlargement, or boggy texture 2, 3.
- The decision to perform a DRE may depend on the individual patient's symptoms and medical history, as well as the clinical judgment of the healthcare provider.
Laboratory Investigations
- Urine culture and urinalysis are essential laboratory investigations in the diagnosis of acute prostatitis, as they help to identify the causative bacteria and determine the appropriate antibiotic treatment 2, 3.
- Additional laboratory studies may be obtained based on risk factors and severity of illness, but radiography is typically unnecessary in the diagnosis of acute prostatitis 2.