Prostatitis laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2], Usama Talib, BSc, MD [3]

Overview

Laboratory tests used in the diagnosis of prostatitis may include a CBC, urinalysis, serum PSA (prostate-specific antigen) level, urine culture, postvoid residual volume levels, 2-glass pre- and post-prostatic massage test, Stamey-Meares four-glass test, and a semen analysis.[1][2][3] Laboratory findings consistent with the diagnosis of acute prostatitis include increased leukocytes on CBC, bacteria seen on urine culture, elevated C-reactive protein, and transiently elevated PSA (prostate specific antigen) levels. [4] Laboratory findings consistent with the diagnosis of chronic bacterial prostatitis include negative pre-massage urine culture results, more than 10 to 20 leukocytes per high-power field in both the pre- and the postmassage urine specimen, bacteriuria in the postmassage urine specimen, and lower leukocyte and bacterial counts in voided bladder urine specimens as compared to bacterial count in post-prostatic massage voided urine or expressed prostatic secretions. In most prostatic syndrome patients pathogen is not detected.[5][3][6] The absence of bacterial growth on cultures is diagnostic of chronic nonbacterial prostatitis.[3][7]

Laboratory findings

Laboratory Tests

Laboratory tests used in the diagnosis of prostatitis may include:[1][2][3] [8]

  • CBC
  • Urinalysis
  • Serum PSA (prostate-specific antigen) levels
  • Urine culture
  • Postvoid residual volume levels (a tense bladder or symptoms after voiding may be suggestive)
  • 2-glass pre- and post-prostatic massage test
  • Stamey-Meares four-glass test
  • Semen analysis

Laboratory Findings

Laboratory findings consistent with the diagnosis of acute prostatitis include[2]

Laboratory findings consistent with the diagnosis of chronic bacterial prostatitis include:[6]

  • Negative pre-massage urine culture results
  • More than 10 to 20 leukocytes per high-power field in both the pre- and the postmassage urine specimen
  • Bacteriuria in the postmassage urine specimen
  • Lower leukocyte and bacterial counts in voided bladder urine specimens as compared to bacterial count in post-prostatic massage voided urine or expressed prostatic secretions[3]

Postvoid Residual Urine

Post void residual urine is an important investigation done in case of a suspicion of obstruction. Obstruction by BPH or kidney stones can lead to episode of acute prostatitis or may also cause chronic prostatitis.[2][9]

Stamey-Meares Method

The Stamey-Meares localization method is used to differentiate between chronic nonbacterial prostatitis and other types of prostatitis. The absence of bacterial growth on cultures is diagnostic of chronic nonbacterial prostatitis. Leukocytosis may be present in the prostatic secretions. The premassage urine specimen contains <10 WBCs per high-power field, while the postmassage urine specimen has >10-20 WBCs per high-power field.[3][10]

Prostatic Massage

The prostatic massage can be helpful in diagnosing some types of prostatitis[11][12]

  • Chronic inflammatory prostatitis or asymptomatic inflammatory prostatitis can be differentiated by the appearance of leukocytes in expressed prostatic secretions which previously did not show leukocytes.
  • Chronic bacterial prostatitis is diagnosed if the cultured organisms increase 10 times in a urine sample taken after prostatic massage or in expressed prostatic secretions.

Differentiation on the basis of laboratory findings

The following table can help in differentiating prostatitis on the basis of laboratory findings:[13][14][15]

Type of Prostatitis Urinalysis Expressed Prostatic Secretions
WBCs Bacterial

Culture

WBCs Bacterial

Culture

Acute Bacterial
Chronic Bacterial
Chronic (abacterial) / CPPS Inflammatory - - -
Non-

inflammatory

- - - -
Asymptomatic Inflammatory - - -

References

  1. 1.0 1.1 Prostatitis: Inflammation of the Prostate. NIDDK 2016. http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/prostate-problems/Pages/facts.aspx. Accessed on February 25, 2016
  2. 2.0 2.1 2.2 2.3 Sharp VJ, Takacs EB, Powell CR (2010). "Prostatitis: diagnosis and treatment". Am Fam Physician. 82 (4): 397–406. PMID 20704171.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Lipsky BA, Byren I, Hoey CT (2010). "Treatment of bacterial prostatitis". Clin Infect Dis. 50 (12): 1641–52. doi:10.1086/652861. PMID 20459324.
  4. Shahana Sarwar, Mohammed Abdul Majid Adil, Parveen Nyamath & Mohammed Ishaq (2017). "Biomarkers of Prostatic Cancer: An Attempt to Categorize Patients into Prostatic Carcinoma, Benign Prostatic Hyperplasia, or Prostatitis Based on Serum Prostate Specific Antigen, Prostatic Acid Phosphatase, Calcium, and Phosphorus". Prostate cancer. 2017: 5687212. doi:10.1155/2017/5687212. PMID 28168057.
  5. Dino Papes, Miram Pasini, Ana Jeroncic, Martina Vargovic, Viktor Kotarski, Alemka Markotic & Visnja Skerk (2017). "Detection of sexually transmitted pathogens in patients with chronic prostatitis/chronic pelvic pain: a prospective clinical study". International journal of STD & AIDS: 956462417691440. doi:10.1177/0956462417691440. PMID 28120647. Unknown parameter |month= ignored (help)
  6. 6.0 6.1 Stevermer JJ, Easley SK (2000). "Treatment of prostatitis". Am Fam Physician. 61 (10): 3015–22, 3025–6. PMID 10839552.
  7. Domingue, Gerald J., and Wayne JG Hellstrom. "Prostatitis." Clinical microbiology reviews 11.4 (1998): 604-613.
  8. J. Curtis Nickel, Daniel Shoskes, Yanlin Wang, Richard B. Alexander, Jackson E. Jr Fowler, Scott Zeitlin, Michael P. O'Leary, Michel A. Pontari, Anthony J. Schaeffer, J. Richard Landis, Leroy Nyberg, John W. Kusek & Kathleen J. Propert (2006). "How does the pre-massage and post-massage 2-glass test compare to the Meares-Stamey 4-glass test in men with chronic prostatitis/chronic pelvic pain syndrome?". The Journal of urology. 176 (1): 119–124. doi:10.1016/S0022-5347(06)00498-8. PMID 16753385. Unknown parameter |month= ignored (help)
  9. J. Curtis Nickel (2003). "Recommendations for the evaluation of patients with prostatitis". World journal of urology. 21 (2): 75–81. doi:10.1007/s00345-003-0328-1. PMID 12684835. Unknown parameter |month= ignored (help)
  10. J. Curtis Nickel, Daniel Shoskes, Yanlin Wang, Richard B. Alexander, Jackson E. Jr Fowler, Scott Zeitlin, Michael P. O'Leary, Michel A. Pontari, Anthony J. Schaeffer, J. Richard Landis, Leroy Nyberg, John W. Kusek & Kathleen J. Propert (2006). "How does the pre-massage and post-massage 2-glass test compare to the Meares-Stamey 4-glass test in men with chronic prostatitis/chronic pelvic pain syndrome?". The Journal of urology. 176 (1): 119–124. doi:10.1016/S0022-5347(06)00498-8. PMID 16753385. Unknown parameter |month= ignored (help)
  11. Wein, Alan (2016). Campbell-Walsh urology. Philadelphia, PA: Elsevier. ISBN 978-1455775675.
  12. E. M. Meares & T. A. Stamey (1968). "Bacteriologic localization patterns in bacterial prostatitis and urethritis". Investigative urology. 5 (5): 492–518. PMID 4870505. Unknown parameter |month= ignored (help)
  13. J. N. Krieger, L. Jr Nyberg & J. C. Nickel (1999). "NIH consensus definition and classification of prostatitis". JAMA. 282 (3): 236–237. PMID 10422990. Unknown parameter |month= ignored (help)
  14. A. Doble (1994). "Chronic prostatitis". British journal of urology. 74 (5): 537–541. PMID 7827813. Unknown parameter |month= ignored (help)
  15. Geoffrey M. Habermacher, Judd T. Chason & Anthony J. Schaeffer (2006). "Prostatitis/chronic pelvic pain syndrome". Annual review of medicine. 57: 195–206. doi:10.1146/annurev.med.57.011205.135654. PMID 16409145.

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