Medical History & Prostatitis Symptoms Test
In order to detect and undertake prostatitis diagnosis tests your doctor may first ask you questions about your urinary function and may also give you a form to fill out, called the National Institutes of Health Chronic Prostatitis Symptom Index. Your doctor can then take your answers to help determine a diagnosis before performing other tests for prostatitis.
Here’s an idea of the questions on the Prostatitis Symptom Index:
- During the past week, have you experienced any of the following, and if so, how often (daily, how many days per week):
- Pain or discomfort in the perineum (region between the rectum and testicles)
- Pain or discomfort in the testicles
- Pain on the tip of the penis (not related to urination)
- Pain or discomfort in your pelvic area or bladder
- Pain or burning feeling when urinating
- Pain or discomfort during or after ejaculation
- How would you rate each of the symptoms named above on a scale from 1 to 10 (10 being the most painful or most discomfort)?
- During the past week, how often did you feel like your bladder was not empty even though you had just finished urinating? (never, 1 time in 5, half the time, more than half, always)
- During the past week, how often did you need to urinate again less than two hours after urinating? (never, 1 time in 5, half the time, more than half, always)
- During the past week, how often did your symptoms prevent you from engaging in your normal activities or make it difficult? (never, occasionally, frequently, a lot, always)
- During the past week, how often did you think about your symptoms? (never, occasionally, frequently, often, always)
- If you had to live with the symptoms that you experienced during the past week for the rest of your life, how would that make you feel? (No problem, slightly annoyed, mostly annoyed, dissatisfied, very unhappy, terrible)
(Adapted from the NIH Chronic Prostatitis Symptom Index)
The DRE is used to check for abnormalities in the size, shape and structure of the prostate and is considered the “gold standard” for determining prostate disorders including prostatitis diagnosis tests. Read more on the DRE procedure
Your doctor may undertake an analysis of the urine to determine bacteria and presence of infection in the prostate.
For this procedure, the doctor inserts a gloved, lubricated finger into your rectum and pushes against your prostate, expressing fluid into the urethra and out the tip of the penis. The fluid is examined for the presence of white blood cells, bacteria, or other signs of infection or inflammation. If your doctor has any reason to suspect acute bacterial prostatitis, he or she may also take a blood sample to check for signs of infection.
One of the Prostatitis diagnosis tests often overlooked (because it is expensive and time-consuming) is the Meares-Stanley Four Glass Test, which can determine the type and extent of infection and inflammation in the lower urinary tract of men who are experiencing symptoms of chronic prostatitis.
You will be asked to produce urine samples in four “glasses”: a sample from the beginning of a urination, one from the middle (midstream), a sample of prostatic secretions (the “milking” test above), and a urine sample following the milked sample. Your doctor will have the four specimens examined and cultured for bacteria or white blood cells, pus cells, or other signs of inflammation. The idea behind this test is that it is possible for these signs to escape detection in a single test, but they will have a real hard time avoiding all four tests.
A PPMT (pre and post massage test) is also one of the Prostatitis diagnosis tests and is the least expensive and less time-consuming version of the Meares-Stanley test that is used for men who have symptoms of chronic prostatitis. For the PPMT, the clinician collects urine samples before and after the prostate is massaged and the samples are analyzed for signs of infection or inflammation. It is accurate 90 percent of the time.
If your doctor has reviewed your symptoms, done a physical exam, and conducted a DRE, PSA test and prostate “milking,” this may be all that’s necessary to make a diagnosis of prostatitis. However, in many cases, more tests are necessary to identify the cause of the symptoms as it is important to rule out other conditions that can have symptoms similar to those of prostatitis, such as bladder or kidney infections or stones, BPH, and bladder or prostate cancer. These tests may include:
- MRI and ultrasound: This one of the Prostatitis diagnosis tests can help clinicians visualize the structures in the pelvic area. More on ultrasound imaging of the prostate
- Cystoscopy: This procedure involves “peeking into the penis” to determine any infection.
- Uroflowmetry: This is the “long and strong” test. The results will help your doctor evaluate the condition of your lower urinary tract.
UPOINT: A New Way to Classify Chronic Prostatitis/Chronic Pelvic Pain Syndrome
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a difficult condition to treat because men who suffer with the syndrome often have very different causes for their symptoms and they respond to different therapies. To help doctors make more effective treatment decisions for men with CP/CPPS, Dr. Daniel Shoskes, a urologist at The Cleveland Clinic Glickman Urological and Kidney Institute, developed a system to classify these patients. The system is called UPOINT (Urinary, Psychosocial, Organ specific (prostate or bladder involved), Infection, Neurologic/systemic, and Tenderness (muscle) and groups men according to these six clinically defined domains. Most men can be categorized into more than one UPOINT domain and thus require more than one type of therapy (see Figure).
For each of the six domains, a patient is classified as yes/no. Each domain is associated with treatments shown to be effective for that specific problem. For example, if a man is positive for Urinary, Organ specific, and Tenderness domains, the doctor may prescribe an alpha-blocker, pollen extract or quercetin, and prostate massage— a treatment choice for each of the domains. A man who is positive for Infection and Tenderness domains may be prescribed antibiotics and physiotherapy, such as biofeedback or myofascial trigger release therapy.
Use of UPOINT Prostatitis diagnosis tests allows clinicians and patients make better treatment decisions when symptoms of chronic pelvic pain syndrome appear and to also customize therapy based on each man’s needs based on his response to different treatments in the past, any allergies, other health conditions, and known drug interactions.