General Tests for Prostatitis—What to Expect
When your doctor is trying to diagnose the type of your prostatitis, there are several general tests he or she will perform or order. Here’s an idea of the general tests for prostatitis and what you can expect at the doctor’s office during the process of diagnosing prostatitis.
Your doctor will conduct a physical examination, which will include examining your external genitalia, scrotum, perenium, and prostate as well as your abdomen, flank (the side of your body between the ribs and the hip), and back for signs of inflammation. He or she will then perform a series of tests to help make a diagnosis. Following are some of the general tests for prostatitis:
- Medical history & symptoms test (CPSI)
- Digital rectal examination (DRE), which may detect inflammation of the prostate.
- Prostate specific antigen (PSA) test, which requires a blood sample. The PSA level is often elevated in men who have an inflamed prostate.
- Urinalysis (a urine sample), which may reveal the presence of white blood cells and bacteria.
- Milking the prostate, also known as prostate massage, which can be used both for diagnosing prostatitis and treating it
- Meares-Stanley “Four Glass Test” involves urine samples
- Pre- and Post-Massage Test (PPMT), which involves taking urine samples before and after prostate massage, which your doctor will perform.
- MRI and Ultrasound if your doctor needs more information
- Cytoscopy, which is a more invasive test that not every patient requires
- Uroflowmetry a noninvasive test to see the condition and function of your lower urinary tract
- An analysis utilizing UPOINT to classify symptoms to help choose specific treatments
- An analysis of symptoms using the NPAT/CPPS Protocol
- Other tests
Medical History & Symptoms Test
A basic part of what your doctor will do when you make your visit for determining your prostate problem or diagnosing prostatitis is to take your medical history and to inquire about your symptoms. If you are making your first visit to this particular doctor, then you will need to provide your entire medical history. If you are visiting a doctor who already has your medical history, you may be asked to update it. Be sure to share information about your surgical history (particularly urologic), any trauma you have experienced, medications, and allergies.
It is helpful to think about both your personal and family medical history before you go to the doctor. Write down anything that comes to mind beforehand because it is easy to forget details when you are at the doctor’s office. Be sure to give your doctor a list of any drugs, or nutritional or herbal supplements you may be taking. It’s also helpful to write down information about your symptoms before your office visit so you don’t forget any details, such as when symptoms started, how long they last, when they occur, and exactly what you have been experiencing.
During your visit, your doctor will ask you about the symptoms you have been experiencing, and this information will be used to help him or her decide which tests to conduct. A basic test that clinicians use is the National Institute of Health’s Chronic Prostatitis Symptoms Index (CPSI). The CPSI is a test that will ask questions about the severity of your pain, where it is located, the impact of symptoms on your life, and problems with urination and sexual health. Your answers will help your doctor monitor how severe your symptoms are, but it should not be used to diagnose your condition.
Digital Rectal Exam
A digital rectal examination (DRE) is a routine part of screening for prostate cancer, but it also is used to help in the diagnosis of prostatitis. A DRE is a procedure men typically don’t look forward to, but if you relax and urinate before the procedure, you can minimize any discomfort and help your doctor get important information about the status of your prostate. For example, your doctor can determine the size of your prostate and whether there are any abnormalities such as lumps or lesions. He or she will also check the wall of your lower colon for any inconsistencies.
A DRE can be done in one of two ways. Your doctor may ask you to bend forward at the waist and rest your arms on an examination table, or you may be asked to lie on your side on the table with your knees pulled up to your chest. If you have a preference, you should let your doctor know.
The entire procedure takes only a few minutes, and here’s how it works.
Once you are in position, the doctor will insert a lubricated gloved finger into your rectum. He or she will then feel for any abnormalities, including an enlarged prostate. You may feel a need to urinate as well as some discomfort or mild pain, but you can better relax if you focus on your breathing and try to release any tension. If your prostate is enlarged, infected, or cancerous, you may feel more significant pain.
Your doctor may also palpate the muscles to either side of your prostate. If the muscles feel rock hard or if you react when the muscles are palpated, it may be because the doctor has located the source of your prostate pain. In this case, it may be likely that you have a pelvic floor spasm. Doctors do not always know to look for this, but it is estimated that half of the men with chronic pelvic pain syndrome (CPPS) have this condition, and it is fairly easy to find and treat with pelvic floor physiotherapy.
No side effects are associated with a digital rectal examination. Your doctor will discuss his or her findings with you, and the rest of your examination and testing can continue.
The prostate specific antigen (PSA) test is a standard screening tool for prostate cancer, but it also is used to help in the diagnosis of prostatitis. It is a blood test, and you want to schedule it before you have your digital rectal exam (DRE) because the DRE can temporarily increase your PSA reading. Other activities to avoid for a few days before you have your PSA test are sexual activity, trauma to the area, and riding a bike, all which can temporarily affect the numbers. Some men have an elevated PSA if they have prostatitis, and in men with the rare asymptomatic inflammatory prostatitis, the elevated PSA may be the only sign of their condition.
Urinalysis is a test that evaluates a urine sample. It is one of the most basic and simple tests a doctor can perform; yet it can provide a wealth of information. When urinalysis is used as part of diagnosing prostatitis, a doctor typically is looking for bacteria, proteins, and white blood cells in the urine sample. The presence of these and other substances can help physicians determine if an infection is the cause of prostatitis symptoms or if something else may be involved.
The urine sample for a urinalysis is examined for how it looks, its content, and its concentration. For example, urine that looks cloudy rather than clear suggests a urinary tract infection. Bacteria in the urine also indicates a urinary tract infection, which is common in men who have chronic prostatitis. If high levels of protein are found in urine, it can be a sign of kidney disease.
Your doctor may ask you to bring a urine sample from home or for you to provide one during the office visit. In either case, use the collection cup supplied by the doctor. To get a urine sample follow these steps:
- Wash your hands before collecting the urine.
- Clean the area around your genitals and the head of the penis with medicated towelettes.
- Begin to urinate, and after a few seconds, place the collection cup into the urine stream. Collect about 2 ounces of urine.
- Remove the cup from the urine stream and finish urinating into the toilet.
- Place the lid on the collection cup. If you have collected the urine at home, refrigerate it unless you can reach the lab before 30 minutes.
- Make sure to write your name and time of collection on the cup.
Various medications, supplements, foods, and beverages can have an effect on the results of a urinalysis, so talk to your doctor about any drugs and supplements you are taking. Substances that can impact a urinalysis include diuretics, Dilantin (phenytoin), Rifadin and Rimactane (rifampin), Pyridium (phenazopyridine), vitamin B, beets, blackberries, and rhubarb.
Milking the Prostate
Milking the prostate, which is also referred to as prostate massage, is a technique that improves blood flow to the prostate gland. When your healthcare provider or you (milking the prostate can be learned easily) perform prostate massage, it helps deliver more nutrients and oxygen to the prostate and assists in eliminating toxins from the gland. You might say that milking the prostate moves good stuff in and helps get rid of the bad, which means this technique can help both prevent prostatitis and treat it. Milking the prostate also helps treat an enlarged prostate (benign prostatic hyperplasia, BPH).
Milking the prostate is a natural way to help both in diagnosing prostatitis and treating this condition. Your doctor can milk the prostate during the diagnostic process. In fact, prostate massage is necessary if you undergo PPMT.
To milk the prostate, a physician wears a glove and inserts a lubricated finger into the anus while the man leans forward resting his arms on a table. When doctors make contact with the prostate, they apply gentle pressure to the gland and massage it. This is not a painful procedure when done correctly. It should be noted that while milking the prostate is best done by a doctor during the diagnostic process, men can learn how to do this massage themselves if they want to try this treatment for prostatitis.
Meares-Stanley “Four Glass Test”
The Meares-Stanley “Four Glass Test” is used much less often than other tests for prostatitis because it takes more time and is more expensive than some other testing procedures. However, when doctors perform it or use a shorter version of it (such as a three glass test), it can provide important information about the prostate.
The Meares-Stanley “Four Glass Test” allows your doctor to look for bacteria and white blood cells in your urine under four (or three if the shortened version is used) conditions: first urine released, midstream urine, secretions extracted by using prostate massage, and a urine sample taken after the massage.
Scientists did a study and compared the results of using the Meares-Stanley “Four Glass Test” against taking just two samples (the prostate massage secretions and the urine sample after the massage). A total of 353 men were in the study. Nearly 100% of the results were the same between the two tests. The two-sample test was not as good at finding the bacteria and white cells in all the men but it was 100% effective at identifying the bacteria and white cells. The authors of the study concluded that the simpler test is reasonable for doctors to use when they are first diagnosing prostatitis.
The pre- and post-massage test (PPMT) is a simple and inexpensive screening test for diagnosing prostatitis. It is less time consuming than the Meares-Stanley “Four Glass Test.” To conduct the test, your doctor will collect a urine sample from you both before and after doing prostate massage. The samples are analyzed for signs of inflammation or infection. The results are about 90% accurate.
MRI and Ultrasound
If your doctor is unable to make a clear diagnosis after conducting the above more commonly used tests and procedures, he or she may order an MRI, ultrasound, or other imaging tests. Such tests are typically used when a doctor suspects bacterial prostatitis or already has come to that conclusion and has reason to believe the infection may have spread beyond the prostate. If your doctor suspects that you may have bladder or kidney infections, enlarged prostate, bladder cancer, or prostate cancer, he or she may order these imaging tests to get a better look at what is going on.
Not every patient needs a cystoscopy when diagnosing prostatitis. The doctor inserts a cystoscope into the penis to see the urethra and bladder. Through this procedure your doctor can get an idea of how hard the prostate squeezes the urethra and can see if you have residual urine in your bladder after you have urinated. You doctor can rule out a urethral stricture and see if you have any prostate stones or other prostate problems like tiny pouches, called diverticulae. There is no such thing as a classic appearance of prostatitis, but your doctor could see what may be causing your symptoms.
Cystoscopy may be performed with local, spinal, or general anesthesia. The most common side effect is swelling of the urethra, and that may make it harder for you to urinate. Sometimes there is bleeding. Your doctor may prescribe an antibiotic to prevent a mild urinary tract infection from developing after the procedure.
The doctor performs uroflowmetry to see the condition and function of your lower urinary tract. This quick and noninvasive test measures how much urine you release and how fast you are releasing it. This test can help determine if you have an obstruction of normal urine outflow. First you may be asked to drink four glasses of water. You will urinate into a device that will record information as you urinate.
A new system that doctors can use to make more effective treatment decisions for patients with chronic pelvic pain syndrome (CPPS) is UPOINT. It stands for the following domains: Urinary, Psychosocial, Organ specific, Infection, Neurologic/systemic, and Tenderness. A urologist developed this system to help doctors and patients customize their treatment program for CPPS. A patient is classified as “yes” or “no” for each of the six domains in UPOINT. Once the doctor can see the problem areas and where the symptoms lie, he or she can provide treatments that have proven to effective for those problems.
The NPAT/CPPS treatment protocol recognizes that pain and chronic pelvic discomfort are grounded in lifestyle, diet, nutrition, and other factors that lie outside the prostate that may contribute to chronic tension. This holistic program individually analyzes each patient’s symptoms to form a complete treatment program that incorporates natural and alternative remedies for prostatitis such as acupuncture, pelvic therapy, trigger point release, phytotherapy (quercetin and pollen extract), stress management, and others.
NPAT stands for:
- Natural treatments (ALCAT, elimination diets, and wheat-free diets)
- Phytotherapy (pollen and quercetin together with probiotics)
- Alternative Treatments (acupuncture, prostate massage, pelvic rehabilitation and therapy)
- Total body (exercise, chronic stress management, lifestyle)
Developed by Dr. Geo Espinosa, the NPAT CPPS treatment program specifically focuses on pelvic tension because many chronic prostatitis causes stem from problems that take place outside of the prostate and elsewhere in the body. About 50% of CPPS cases are due to tension in the pelvic floor muscles and can even stem from stress and emotional health problems. The chronic prostatitis causes that involve tension include pelvic floor disorders, neuromuscular tension, and chronic tension disorders. Inflammation from other places in the body usually accompanies chronic tension in the pelvic floor and is a major contributor to CPPS. Immune disorders and allergies (such as food intolerances) also play a role, and that is why a well-rounded whole body approach to diagnosis and treatment can help CPPS patients to reduce inflammation.
Chronic pelvic pain syndrome (CPPS) is nonbacterial and does not respond to treatment with antibiotics. Some men are deeply affected by the ongoing pelvic pain, discomfort, and psychological effects of CPPS, and that is why a holistic whole body approach such as the NPAT protocol can offer a complete treatment approach to regaining health and relief.
Patients who follow Dr. Geo’s program learn what is causing their symptoms and employ treatments for those causes. Each patient’s treatment is individualized to treat his specific symptoms and causes of pelvic tension. Treatments might vary, but patients will generally employ several different natural and alternative therapies. Patients may even learn to avoid foods that can exacerbate their symptoms such as spicy foods, acidic foods, wheat, gluten, and caffeine. A multimodal approach to prostatitis is the most successful treatment program, and that is why Dr. Geo’s “NPAT” CPPS treatment program works so well as a natural treatment approach where other traditional treatments fail to provide relief.
There are some other general tests for prostatitis. Your doctor may order blood cultures if you are experiencing signs of an infection that has spread outside the prostate (e.g., chills or high fever). Your doctor may perform imaging tests while diagnosing prostatitis, such as ultrasound, computed tomography, or magnetic resonance imaging (MRI) to help verify an infection that has spread and to look for signs of an abscess. Doctors also frequently order imaging tests for men who have been experiencing recurrent urinary tract infections to help rule out kidney stones or structural problems. Throughout the process of diagnosis, your doctor may use the UPOINT system to analyze your symptoms so that he or she can customize your treatment with therapies that have shown effectiveness in treating your specific symptoms.