Chronic Prostatitis

Diagnosis

If your doctor suspects prostatitis, he or she will ask you to describe your symptoms in detail. Your doctor also may ask about your general medical history, the medications you take, your intake of caffeine and alcohol, and whether you have had sexual contacts that may increase your risk of sexually transmitted diseases (STDs) because some STDs can mimic prostatitis.

Your doctor will examine your prostate gland by inserting a gloved and lubricated finger into your rectum. In chronic prostatitis, the gland may be swollen, firm and tender, or it may feel normal. You may experience pain or a severe need to urinate when pressure is applied to the prostate. Your doctor will examine you to look for other problems that may be causing your symptoms.

The next step will be to examine a urine specimen for evidence of infection, such as white blood cells or bacteria. Often your doctor will ask you to produce separate urine specimens before and after your prostate gland is examined. Typical findings depend on the specific type of chronic prostatitis:

• In bacterial prostatitis, the urine will contain white blood cells and bacteria, especially after the doctor has pressed firmly on the prostate. The urine usually will contain the type of bacteria found in most urinary tract infections.

• In non-bacterial prostatitis, the urine collected after prostate massage may contain white blood cells. However, no bacteria will be seen, and a urine culture will be normal.

• In prostadynia, the urine specimen will be entirely normal, even after the doctor has pressed firmly on the prostate.

In most cases of chronic prostatitis, this simple evaluation is all that is needed to make a diagnosis and begin treatment. Occasionally, a person may have vague or unusual symptoms, and it is important to check for other conditions such as interstitial cystitis, urethritis, benign enlargement of the prostate, or even prostate cancer. In such a situation, your doctor may recommend additional blood or urine tests, an ultrasound of the prostate, an examination of the bladder with a lighted telescope (cystoscopy) or a needle biopsy of the prostate.

Expected Duration

Chronic prostatitis may last for weeks or months before it is diagnosed. Some cases of chronic prostatitis respond promptly to treatment, and symptoms disappear over several days. In other cases, symptoms may linger for weeks or months or may come and go over a period of years.