Investigations
1st investigations to order
urinalysis
Test
Microscopic examination of the urine may demonstrate the presence of leukocytes and bacteria.
Should be requested for all patients.
Result
presence of leukocytes, bacteria
urine culture
Test
Acute prostatitis is most commonly caused by organisms from the Enterobacteriaceae group of bacteria, with up to 80% of infections due to Escherichia coli.[18]
Should be requested for all patients.
Result
positive for bacteria
blood cultures
Test
Performed in patients with acute bacterial prostatitis and are likely to show the same organism as urine culture.
Required in patients who are febrile.
Result
identification of organism
Investigations to consider
transrectal ultrasound
Test
Should be reserved for patients who do not respond to initial therapy. The European Association of Urology advises it is unreliable as a diagnostic tool for prostatitis, but may be useful in selected cases to rule out prostatic abscess.[12] May also be useful to make the diagnosis of prostatic cysts, abscesses, and seminal vesicle obstruction.[36][37][38]
Result
variable findings
4-glass or 2-glass test
Test
Prostatic massage should not be performed in acute bacterial prostatitis as it can induce bacteraemia and sepsis.[12][29] However, in patients with chronic prostatitis (symptoms persisting for more than three months), consider performing quantitative bacterial localisation cultures and microscopy of the segmented urine and expressed prostatic secretion to categorise clinical prostatitis in patients with chronic bacterial prostatitis.[12] The 2-glass test (pre-massage and post-massage specimens) has been shown to have similar diagnostic sensitivity to the 4-glass test.[29][31]
Rarely performed in contemporary practice because of its expense and complexity.[29]
Result
presence of leukocytes, bacteria
Emerging tests
urine cytology
Test
For patients with haematuria or other symptoms (e.g., weight loss) not typical of prostatitis.
There is controversy over whether this test should be used in routine clinical evaluation of prostatitis.
Result
normal
cystoscopy
Test
Not indicated in most patients with prostatitis and is usually reserved for patients refractory to standard treatment, or whose presentation suggests an alternative diagnosis.
Result
variable findings
prostatic biopsy
Test
Prostate biopsy is not recommended as part of routine work-up and is not advisable in patients with untreated bacterial prostatitis because of the increased risk of sepsis.[12] If a prostate biopsy is considered necessary (for example, if another diagnosis such as carcinoma of the prostate is suspected) European guidelines recommend using the transperineal approach because this is associated with lower sepsis rates than transrectal biopsy.[12]
Perineal prostate biopsies may also be taken to help in the detection of difficult to culture micro-organisms, but these are recommended only for research purposes.
Result
acute or chronic inflammation
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