How is prostatitis diagnosed?

No single test or diagnostic procedure can confirm a case of prostatitis. If you experience urinary discomfort, like painful or burning urination or pain in the pelvic area, your doctor will start to look for signs of inflammation and infection by performing a digital rectal exam, or DRE. An inflamed prostate feels swollen and mushy to the doctor, like an overripe piece of fruit. This finding strongly suggests prostatitis, although it's not necessary for a diagnosis. In some cases of prostatitis, the gland feels normal.

The DRE is usually followed by a simple urine test to check for bacteria and white blood cells, which indicate an infection. If both bacteria and white blood cells are found, your condition is probably one of the bacterial forms. If only white blood cells are discovered, which is usually the case, you may have one of the nonbacterial types.

In the past, if no signs of infection or inflammation were found in the urinalysis, doctors might test the prostate's secretions. This was done by massaging the gland, causing it to release some fluid into the urine. The fluid would then be tested for bacteria or white blood cells. However, studies have shown that this test yields little information, so most practitioners have abandoned it.

If your doctor suspects that you have prostatitis, he or she will begin with a complete medical history and physical exam. The type of prostatitis that you have cannot be determined solely from your history and symptoms. Your doctor will do tests to find out the cause of your prostatitis.

Acute prostatitis is the least common type but the easiest to diagnose. If acute prostatitis is suspected, a urine culture will be done to test for the presence and type of bacteria.

If your history and physical exam show that you do not have acute prostatitis, a pre- and post-massage test (PPMT) or expressed prostatic secretions test may be done to find out which type of prostatitis you have. An expressed prostatic secretions test is not done if acute prostatitis is suspected, because when the prostate is inflamed or infected, massaging it to obtain a sample for tests is very painful and possibly dangerous. Some doctors believe that massaging an infected prostate increases the risk of developing a bacterial infection of the blood (septicemia).

More tests may be needed if:

• Your symptoms do not improve with treatment.
• You continue to have prostate infections.
• The symptoms could be caused by bladder or prostate cancer.
• Your doctor suspects you have a complication related to prostatitis, such as an abscess.

Tests that may be done include:

• Complete blood count (CBC).
• Digital rectal exam, to check for growths in the prostate gland or to see if it is larger than normal.
• Blood culture, to check for bacteria in your blood if you have acute prostatitis.
• Computed tomography (CT) scan or magnetic resonance imaging (MRI) of your pelvic area.
• Transrectal ultrasound of your pelvic area.
• Prostate specific antigen (PSA).

Prostatitis (acute or chronic inflammation of the prostate gland) is diagnosed by a digital rectal exam (DRE), possibly with a sample of prostate gland secretions obtained by massaging the prostate, and a urine sample. The urine and prostate gland secretions are analyzed for infectious organisms.

Take the RealAge Test!