The key step in diagnosing prostatitis is a urine test, which is done in three parts (and which sounds much more complicated than it is; actually, it doesn’t take long—less than five minutes). In what’s called a three-glass urine collection method, you will be asked to collect your first ounce of urine in one container, then to take a midstream sample in another. (The first urine to come out contains fluid from the urethra; urine collected in midstream comes from the bladder.) Next, continue urinating in the toilet until your bladder is almost empty. Now is the time for the prostate massage, and your doctor will collect on a glass slide any prostatic fluid that’s expressed. Finally, in the third container, you will collect the remaining urine, which contains fluid from the prostate.
An examination of expressed prostate fluid by itself is not enough to make a good diagnosis. Comparing the urine samples with the prostatic fluid enables the doctor to determine the site of infection (the urethra, bladder, or prostate), if there indeed is an infection. And cultures of this urine will show the type of bacteria that’s causing it. Then, having pinpointed the bacteria, the doctor can identify the drug that best targets that particular kind of infection.
In chronic bacterial prostatitis, the digital rectal examination may be normal, but white blood cells and bacteria will be spotted in the urine or prostatic fluid. In nonbacterial prostatitis, the expressed prostate fluid contains high levels of white blood cells, and shows other signs of inflammation, but the cultures are negative. In prostatodynia, however, this fluid is normal on microscope examination and culture. Signs of inflammation then, are the litmus test for ruling out prostatitis.
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