What are the typical findings on physical examination and blood tests for prostatitis (inflammation of the prostate gland)?

From the Guidelines

Prostatitis findings on examination and blood tests typically include tenderness and swelling of the prostate gland on digital rectal examination, along with potential elevation in white blood cell count, C-reactive protein, and erythrocyte sedimentation rate in acute bacterial cases.

Key Findings

• The diagnosis of bacterial prostatitis relies on clinical presentation and laboratory tests, including midstream urine dipstick, midstream urine culture, blood culture, and total blood count 1.
• Prostatic massage during examination should be avoided in acute prostatitis due to the risk of bacteremia, as recommended by the European Association of Urology guidelines 1.
• The Meares-Stamey 2- or 4-glass test is recommended for patients with chronic bacterial prostatitis to differentiate between urethral, bladder, and prostatic infections 1.
• Additional findings may include pyuria and bacteriuria in urine samples, elevated PSA levels which typically normalize after treatment, and specific bacteria identification through culture.

Diagnostic Approach

• The clinical presentation of acute bacterial prostatitis (ABP) often includes febrile UTI symptoms, while chronic bacterial prostatitis (CBP) involves more persistent symptoms or recurrent UTIs 1.
• The diagnosis of CBP involves comparing bacteria levels in prostatic fluid and urinary cultures, yet definitive testing is debated 1.
• Testing for prostate-specific antigen (PSA) appears to be of limited utility in the diagnosis of prostatitis 1.

Treatment

• The optimal durations of treatment for ABP or CBP are unknown and have not been established by high-quality studies 1.
• Fluoroquinolones like ciprofloxacin or levofloxacin, or trimethoprim-sulfamethoxazole, are commonly used to treat bacterial prostatitis, but the treatment duration varies depending on the severity and type of infection.
• Additional prospective studies are needed to determine the appropriate duration of treatment for ABP and CBP 1.

From the Research

Prostatitis Findings on Examination

• A digital rectal examination should be performed after a midstream urine (MSU) sample has been collected for urine dipstick, microscopy and culture 2
• The prostate should be checked for nodules 2
• In acute bacterial prostatitis, the MSU is the only laboratory investigation required 2

Prostatitis Findings on Bloods

• There is no specific mention of blood tests in the provided studies as a primary diagnostic tool for prostatitis
• However, urine culture and urine specimen testing pre- and post-prostatic massage are used in the diagnosis of acute and chronic bacterial prostatitis 3

Classification and Diagnosis of Prostatitis

• The National Institutes of Health Classification System for prostatitis consists of category I (acute bacterial prostatitis), category II (chronic bacterial prostatitis), category III (chronic prostatitis/chronic pelvic pain syndrome - CP/CPPS) and category IV asymptomatic inflammatory prostatitis 4
• The evaluation of a patient with category I and category II bacterial prostatitis consists of history and physical examination and urine culture for lower urinary tract localization cultures, respectively 4
• The clinical tests for the evaluation of CP/CPPS can be classified as mandatory, recommended and optional 4

Diagnostic Challenges

• Prostatitis may present with a lack of abnormal findings on physical examination, laboratory tests, and radiographic images 5
• The diagnosis and treatment of prostatitis present numerous challenges for the physician, including a lack of understanding of the pathology of chronic pelvic pain syndrome 3