Diagnosis of Prostatitis

The correct diagnosis of prostatitis is very important for it to be optimally managed.  It is then also important to differentiate between bacterial prostatitis or non-bacterial prostatitis.

  • Medical History
  • A thorough medical history regarding symptoms and current and previous treatment is required. The onset, duration and severity of symptoms are important to differentiate from acute and chronic prostatitis. A history of other medical conditions is also part of the medical history. The amount of stress and how the patient deals with this stress is also important to know. A sexual history is another significant part of the medical history when a patient is suspected of having prostatitis.

  • Medical Examination
  • A medical examination always starts with a general basic examination which should include pulse, blood pressure measurement, temperature and a basic systemic examination. When prostatitis is suspected a thorough genital examination should also be done.

    digital_rectum_exam

    A digital rectal exam to determine whether the prostate is enlarged or tender

  • Rectal Examination
  • The medical examination for prostatitis includes a digital rectal exam to determine whether the prostate is enlarged or tender. The digital rectal exam is a relatively easy and inexpensive test for a qualified medical doctor to perform. It is needed to evaluate the prostate. The prostate lies anterior to the rectum so it can be felt during rectal examination. The doctor will insert a well-lubricated, gloved finger into the rectum to feel for any abnormalities of the prostate. The doctor may also massage the prostate to force a small amount of fluid into the urethra. This fluid can then also be examined. The examination can cause some discomfort but only lasts for about a minute and it should not be painful.

  • Referral to Urologist
  • In the case of chronic prostatitis or when prostatitis has failed to respond to treatment, a general physician should refer the patient to an urologist for specialist management.

  • Prostatic Fluid Analysis
  • Expressed prostate fluid may be obtained during a rectal exam. This fluid may be analysed to determine if bacterial growth is present. If bacterial growth is present a culture and sensitivity test can be done to determine which antibiotics will work best for the patient.

  • Urine analysis
  • A post prostate massage urine analysis may be sent to determine if bacteria is the cause of the prostatitis. Microscopic culture and sensitivity testing can also be done on the urine.

  • Transrectal Ultrasound
  • Transrectal ultrasound of the prostate is usually done by an urologist to diagnose prostatitis and also to exclude prostate cancer and prostate hypertrophy. Transrectal ultrasound uses sound waves to make an image on the monitor’s screen which can be interpreted by an experienced professional. A well-lubricated probe is inserted into the rectum. This may be uncomfortable but should not be painful, and is easily done as an outpatient procedure.

  • Prostate Biopsy
  • A prostate biopsy can be done under ultrasound guidance. A prostate biopsy can be used to confirm the diagnoses of prostatitis and possibly help to determine its cause.

  • Voiding studies
  • Prostatitis causes different urinary tract symptoms. Voiding studies (studies of urination) can be used to determine the severity of urinary tract symptoms and can also monitor if symptoms improve with treatment.

  • Blood Tests
  • Blood tests used to help detect prostatitis are not very specific. PSA (prostate specific antigen) can be drawn. Prostatitis elevates PSA levels. PSA levels also rise during prostatic hypertrophy and prostate cancer. Inflammation and infection can also elevate white cell count, ESR and CRP levels in the blood. These bloods will be raised in any type of inflammation or infection and is not specific for prostatitis.