Prostatitis: Diagnosis

Acute bacterial prostatitis – This is usually not hard to diagnose. Along with pain in the penis, testicles, groin, or perineum, men complain of fever, chills, possibly burning pain with urination, and general malaise (feel bad all over). The prostate feels “boggy” (softer than usual) and is quite tender to examination. The urinalysis looks infected and bacteria are present.

Non-bacterial prostatitis – The symptoms are similar, but generally no fever or chills. The prostate may or may not feel abnormal. A screening urinalysis may not be helpful. The doctor may do a digital massage of the prostate that could push prostatic secretions to the end of the penis. This discharge can be examined under a microscope for signs of inflammation or infection. If you void after the prostate exam, the urine may contain inflammatory cells that can also help with diagnosis. Non-bacterial prostatitis is divided into two subtypes, those with inflammatory cells in semen or urine, and those with no signs of inflammatory cells.

Chronic bacterial prostatitis – “Chronic” means that symptoms have lasted longer and needed a longer course of antibiotics and possibly anti-inflammatory medication.

• Chronic bacterial and non-bacterial prostatitis, unlike acute prostatitis, may take weeks to fully resolve. Some men who continue to have problems urinating may require additional diagnostic tests such as urodynamics, pelvic imaging, and cystoscopy to search for an abscess or a severe obstruction (urethral stricture, large prostate).