How is it Diagnosed?
Prostatitis refers to inflammation of the prostate gland and can be acute or chronic,
bacterial or non-bacterial. Diagnosis depends on a combination of clinical history,
physical examination, and laboratory tests.
Acute bacterial prostatitis presents with sudden onset of fever, chills, dysuria, pelvic or
perineal pain, and sometimes urinary retention. Chronic prostatitis may cause less
intense symptoms, including pelvic discomfort and recurrent urinary tract infections.
Digital rectal examination (DRE) reveals a tender, swollen, or boggy prostate in acute
cases. In chronic forms, the prostate may feel normal or slightly enlarged.
Urinalysis and urine culture are primary investigations. In acute bacterial prostatitis,
pyuria and bacteriuria are evident, and the culture typically isolates a uropathogen
(commonly E. coli). Blood tests may show elevated white blood cell count and
inflammatory markers.
The “four-glass” Meares-Stamey test is the traditional method for localizing prostatitis,
though it is rarely used. A simplified “two-glass” test compares pre- and post-prostatic
massage urine samples to detect inflammation and bacteria.
Prostate-specific antigen (PSA) may be elevated during active inflammation and should
not be used for cancer screening during an acute episode.
Transrectal ultrasound or MRI may be employed in chronic cases or to rule out
abscesses.
Diagnosis helps classify prostatitis into acute bacterial, chronic bacterial, chronic pelvic
pain syndrome, or asymptomatic inflammatory prostatitis, guiding appropriate antibiotic
therapy and symptom management.