Testing for prostatitis often involves a prostatic massage. This is unquestionably uncomfortable, but not actually painful. Urine is subsequently sent for analysis to rule out prostate infection as the cause of your symptoms. You'll also probably have a prostate test called transrectal ultrasound, which has a similar level of discomfort.
If your prostate doctor suspects that you have prostatitis or another prostate problem, he or she might refer you to a prostate urologist (a doctor who specializes in diseases of the urinary tract and the male reproductive system) to confirm the diagnosis.
Patients typically undergo a comprehensive prostate examination, including a digital rectal exam. Then, if the prostate doctor is still not sure what you have, more tests, such as a biopsy test, voiding studies, or MRI test might be conducted.
If your prostate dr. suspects that you have prostatitis, he or she will begin with a complete medical history and physical exam. The type of prostatitis you have cannot be determined solely from your history and symptoms. Your prostate doctor will do tests to determine 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 determine 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 health professionals believe that massaging an infected prostate increases the risk of developing a bacterial infection of the blood (septicemia).
More tests may be necessary if: Your prostate symptoms do not improve with treatment. You continue to have prostate infections. The symptoms could be caused by bladder or prostate cancer. Your prostate dr. 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) to rule out prostate cancer.
Prostatitis is not diagnosed easily because the symptoms can often be the sign of a different infection, or the symptoms are varied. The following prostate tests can be done to check for prostatitis:
A digital rectal examination (DRE) where the doctor places a gloved finger into the rectum, is often used to feel if the prostate gland is swollen or tender.
A three-part urinalysis can also be used. Two urine samples are collected and analyzed, the prostate is then massaged and a third urine sample taken that contains fluid from the prostate. Urine is tested to see if white blood cells (leukocytes) are present in the urine. Leukocytes help the body to fight infection, so if there are more leukocytes in the urine than normal, this suggests a bacterial infection. Nonbacterial prostatitis is diagnosed when no bacteria is found in the urine or prostate fluid as part of a three-part urinalysis.
A PSA test may be taken when checking prostate health. The PSA test measures the level of prostatic specific antigen (PSA) in the blood, which is an important marker for prostate cancer, although it is not cancer specific. The levels of PSA can be raised in benign prostatic diseases, such as prostate enlargement and prostatitis.
As part of a physical examination for prostatitis, a prostate doctor may do the following tests: Medical history Digital rectal examination (DRE) Blood and urine tests PSA test Transrectal ultrasound guided (TRUS) biopsy
A digital rectal examination (DRE) is the main part of a physical examination to check the size, shape and feel of the prostate.
Your doctor may refer you to an prostate urologist (a doctor who specializes in the urinary tract) after an initial assessment to look at the severity of the prostate problem. The specialist will ask more detailed questions and may do further prostate tests. Other prostate tests may include further blood tests, special x ray testing, or tests to assess how blocked the urine flow is. These prostate tests will help in deciding what type of treatment is best for your prostate problem.
Medical history Detailed questioning by the prostate doctor is done to find out the extent, if any, of urination problems. Some men may have no prostate symptoms, but present to the prostate doctor for a general prostate check up. Even if no prostate symptoms are present, this does not take away the possibility of a diagnosis of prostate disease.
Digital rectal examination (DRE) Digital rectal examination (DRE) is an important part of any physical examination for the assessment of the size, shape and feel of the prostate. The prostate doctor places a gloved finger in the back passage (rectum), and presses on the abdomen to feel for any problems with the prostate gland. If prostatitis is present, the prostate may feel tender, enlarged, firm and warm. If BPH is present, the prostate doctor may feel an enlarged prostate gland that tends to feel smooth, firm and elastic. If prostate cancer is present, the prostate gland may be abnormally large and its shape and hardness may become more uneven, and may make the prostate doctor think it is prostate cancer.
Blood tests Blood tests may be done to look for evidence of infection in the blood or urinary tract. The diagnosis of prostatitis may be made if these tests show that an infection is present. It is also possible to test for infection from a sample of the secretions from the prostate gland. This is obtained by the prostate doctor pressing on the prostate gland through the rectum as part of the digital rectal examination.
Other blood tests (for example, urea, creatinine, glucose) may be done to check that the kidneys are working normally.
Prostate Specific Antigen (PSA) Test A blood test to measure the level of prostate-specific antigen (PSA) in the blood is often done. PSA is a protein that is made mainly in the prostate gland. It is mostly used as a marker of prostate cancer, but because it is not cancer-specific, BPH can raise PSA levels two to three times higher than normal. However, the higher the PSA level, the greater the chance that prostate cancer is present.
Transrectal ultrasound guided (TRUS) biopsy A transrectal ultrasound guided (TRUS) biopsy of the prostate gland will be done if the prostate doctor suspects that prostate cancer is present from the results of other tests performed. To perform the biopsy an ultrasound probe is placed in the rectum and "sound" waves are used to obtain an image of the prostate. This image helps the prostate doctor choose which area of the prostate to biopsy. A TRUS biopsy collects tissue from certain parts of the prostate gland which are then looked at under the microscope and can help to confirm the presence of prostate cancer.
To find out more about the problem of prostatitis, prostate doctors sometimes do other prostate tests. These may include:
Urine Prostate tests Urine is often tested to check for signs of infection or cancer (malignancy) in the urinary tract or kidneys. Cancer in the urinary tract or kidneys is quite rare.
Urinary Tract Ultrasound Prostate Test This examination checks the health of the kidneys and also helps find out how well the bladder is emptying. Using sound waves, an ultrasound takes images or pictures by painlessly moving a special instrument across the stomach. It is a safe and non-invasive procedure. No anaesthetic or cuts (incisions) are needed.
Voiding flow rate Prostate Test This involves voiding, or passing a full bladder of urine, into a special measuring device to test how quickly the urine is flowing. Feeling a need to strain is a prostate symptom of BPH and the pattern of urination this produces can be a sign that an obstruction (blockage) is present. It is therefore important not to strain when passing urine in this test as this can produce misleading results.
Cystoscopy Prostate Test This examination is normally only needed if diagnosis is unclear or if there appears to be bleeding or repeated infection. Under anaesthetic, a thin-tube like instrument (a cystoscope) is inserted into the penis via the urethra. A small camera on the end of the tube takes an image of the bladder and urethra from the inside to check if there is any other cause for the bleeding (for example, bladder cancer).
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