Exams and Tests

• Acute bacterial prostatitis

• Usually an enlarged, firm, and tender prostate is enough to make a diagnosis and start treatment.

• Because you always have bacteria in your urine, your doctor will perform a urinalysis and culture to determine the bacterial cause.

• If you have symptoms outside your prostate, a blood culture may be positive.

• A doctor will likely perform an ultrasound to confirm the diagnosis and to rule out an abscess. If this ultrasound is not available, the doctor may perform a CT scan or MRI of your pelvis.

• Chronic bacterial prostatitis

• The classic test is a Meares-Stamey 3-glass test. Three separate urine samples are collected and examined during this test. The last sample is taken after prostatic massage.
• The Meares-Stamey test is difficult to perform. The prostatic secretions are not easy to obtain, and interpreting test results is controversial. Sometimes disease is present but not detected. For these reasons, doctors have proposed another test that is simpler to perform, more practical, and much less expensive.
  

• Premassage and postmassage test (PPMT)
  • In this test, urine samples are obtained before (pre-M) and after (post-M) prostatic massage and are sent for microscopic exam and culture.
  • You will be diagnosed with chronic bacterial prostatitis if both bacteria and white blood cells are present in your post-M sample.
  • In healthy men, the number of white blood cells in prostatic fluid could be as high for up to 2 days after ejaculation.

• Men with recurrent urinary tract infections should have ultrasound imaging of their upper urinary tract and a plain abdominal x-ray or an intravenous urography (IVU) to exclude a possible structural problem or a kidney stone.

• Conditions with similar symptoms: Certain other disorders, which are very common, display symptoms similar to chronic bacterial prostatitis-pelvic area pain, decreased sex drive, and impotence. No one knows what causes them. Men who have these disorders often become depressed. Symptoms may be worsened by a number of factors, for example, diet, posture, or alcohol.
  • Doctors use the same tests, premassage and postmassage test (PPMT) or Meares-Stamey test, to diagnose these disorders. Doctors also use similar treatment methods.
  • General home care measures include hot baths, regular ejaculations, increasing fluids, and avoiding factors that worsen the condition.
• The role of antibiotics is unclear. Because prostate infections often go unnoticed, doctors may try antibiotics. Antibiotics reported to be helpful include erythromycin (E-Mycin, Erythrocin), doxycycline (Atridox, Vibramycin), or a fluoroquinolone (Ciprofloxacin, Ofloxacin).
• Other possible treatments include the following:
  • Frequent prostatic massage
  • Transurethral microwave thermotherapy
  • Biofeedback
  • Relaxation techniques
  • Muscle relaxants