Tests

1st tests to order

urinalysis

Test
Result
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
Result
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][20]

Should be requested for all patients.

Result

positive for bacteria

blood cultures

Test
Result
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 avoid

serum prostate-specific antigen (PSA)

Recommendations
Rationale
Recommendations

Do not order serum PSA in patients with suspected acute prostatitis.[14][27]

Rationale

PSA levels may be elevated during active prostatitis; therefore, PSA testing should be avoided as it offers no practical diagnostic information for prostatitis.[14]

Tests to consider

transrectal ultrasound

Test
Result
Test

Should be reserved for patients who do not respond to initial therapy. The European Association of Urology advises that transrectal ultrasound is unreliable as a diagnostic tool for prostatitis, but may be useful in selected cases to rule out prostatic abscess.[14] May also be useful to make the diagnosis of prostatic cysts, abscesses, and seminal vesicle obstruction.[37][38][39]

Result

variable findings

4-glass or 2-glass test

Test
Result
Test

Prostatic massage should not be performed in acute bacterial prostatitis as it can induce bacteremia and sepsis.​[14][30]​​​ However, in patients with suspected chronic prostatitis (symptoms persisting for at least three months), consider performing quantitative bacterial localization cultures and microscopy of the segmented urine and expressed prostatic secretion to categorize clinical prostatitis.[14] The 2-glass test (premassage and postmassage specimens) has been shown to have similar diagnostic sensitivity to the 4-glass test.[30][32]

Rarely performed in contemporary practice because of its expense and complexity.[30]

Result

presence of leukocytes, bacteria

urine cytology

Test
Result
Test

For patients with hematuria 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. The main clinical benefit is to help to rule out urothelial cancer, but the sensitivity is low in patients with low-grade cancers.[41]

Result

normal

Use of this content is subject to our disclaimer