What are the diagnostic tests for prostatitis (inflammation of the prostate gland)?

From the Guidelines

Testing for prostatitis should involve a combination of clinical presentation, laboratory tests, and diagnostic procedures, with a strong recommendation against performing prostatic massage in acute bacterial prostatitis (ABP) and a strong recommendation to perform the Meares and Stamey 2- or 4-glass test in chronic bacterial prostatitis (CBP) 1. The diagnostic approach for prostatitis typically starts with a detailed medical history and physical examination, including a digital rectal exam to check for prostate tenderness or enlargement.

• Laboratory tests are essential, including:
  • Urinalysis to detect infection
  • Urine culture to guide diagnosis and tailor antibiotic treatment 1
  • Blood tests, such as total blood count, in patients presenting with ABP 1
• In some cases, imaging studies such as transrectal ultrasound might be used to rule out other conditions, like prostatic abscess 1
• For chronic prostatitis, accurate microbiological evaluation for atypical pathogens, such as Chlamydia trachomatis and Mycoplasma species, should be performed 1
• The Meares and Stamey 2- or 4-glass test is a recommended diagnostic procedure for CBP, as it helps to compare bacteria levels in prostatic fluid and urinary cultures 1 It's worth noting that the quality of evidence for some diagnostic approaches is insufficient, and additional prospective studies are needed to determine the optimal diagnostic and treatment strategies for prostatitis 1.

From the Research

Testing for Prostatitis

To test for prostatitis, the following methods can be used:

• A thorough history and examination, including a digital rectal examination (DRE) to check for nodules on the prostate 2
• Urine tests, such as a midstream urine (MSU) sample for urine dipstick, microscopy, and culture 2, 3
• Prostatic massage to collect urine specimens pre- and post-massage for testing 3
• Urinalysis to aid in diagnosis, particularly in cases of acute bacterial prostatitis 4
• Blood tests, such as prostate-specific antigen (PSA) testing, although its role in diagnosing prostatitis is limited 5, 6

Classification of Prostatitis

Prostatitis can be classified into four types:

• Acute bacterial prostatitis
• Chronic bacterial prostatitis
• Chronic prostatitis/chronic pelvic pain syndrome
• Asymptomatic prostatitis 2, 3

Diagnostic Challenges

Diagnosing prostatitis can be challenging, particularly in cases of chronic pelvic pain syndrome, which may be multifactorial and part of a more generalized pain disorder 2 The diagnosis of chronic pelvic pain syndrome is often based on exclusion of other urologic conditions, such as voiding dysfunction and bladder cancer 3

Laboratory Investigations

Laboratory investigations, such as urine culture and sensitivity testing, can help determine the responsible bacteria and its antibiotic sensitivity pattern in cases of bacterial prostatitis 4 Additional laboratory studies, such as blood tests and imaging studies, may be necessary in some cases, depending on the severity of symptoms and risk factors 4