Diagnosis of Prostatitis
Diagnostic Test list for Prostatitis:
The list of medical tests
mentioned in various sources as
used in the diagnosis of Prostatitis
includes:
Prostatitis Diagnosis: Book Excerpts
Diagnostic Tests for Prostatitis: Online Medical Books
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PROSTATIC MASS OR ENLARGEMENT:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The main consideration in diagnosing a prostatic mass is to rule out carcinoma. It is therefore wise to draw blood for PSA before proceeding in anyone that is suspected of prostate cancer. If the mass is located in the posterior lobes, there is further support for the diagnosis. Ultrasonography can be done for further localization before proceeding with a biopsy. Obviously, if the PSA is positive, referral to a urologist is mandatory, although false-positives can occur in this test. A large, boggy prostate suggests a prostatic abscess or prostatitis. If there is no urethral discharge, one can elicit a discharge by prostatic massage. However, this should not be done if the patient has fever and significant tenderness of the prostate. It is better to proceed with antibiotic therapy and reexamine the patient after the fever has subsided. A smear and culture of the discharge is made. If upon examining the discharge under high-power microscopy, four or more WBCs per high-power field are found, the diagnosis of prostatitis can be made. If benign prostatic hypertrophy is suspected, cystoscopy and retrograde pyelography can be done.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Benign prostatic hyperplasia:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Clinical features and a rectal examination are usually sufficient for diagnosis. Other findings help to confirm it:
❑ Excretory urography may indicate urinary tract obstruction, hydronephrosis, calculi or tumors, and filling and emptying defects in the bladder.
❑ Elevated blood urea nitrogen and serum creatinine levels suggest renal dysfunction.
❑ Urinalysis and urine culture show hematuria, pyuria and, when the bacterial count exceeds 100,000/µl, urinary tract infection (UTI).
When symptoms are severe, a cystourethroscopy is definitive, but this test is performed only immediately before surgery to help determine the best procedure. It can show prostate enlargement, bladder wall changes, and a raised bladder.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Prostatic cancer:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
A digital rectal examination that reveals a small, hard nodule may help diagnose prostatic cancer. The American Cancer Society advises a yearly digital examination for men older than age 40, a yearly blood test to detect prostate-specific antigen (PSA) in men older than age 50, and ultrasound if abnormal results are found.
CONFIRMING DIAGNOSIS A biopsy confirms the diagnosis of prostatic cancer. PSA levels will be elevated in all men with metastatic prostatic cancer. Serum acid phosphatase levels will be elevated in two-thirds of men with metastatic prostatic cancer.
Therapy aims to return the serum acid phosphatase level to normal; a subsequent rise points to recurrence. Magnetic resonance imaging, computed tomography scan, and excretory urography may also aid diagnosis.
Elevated alkaline phosphatase levels and a positive bone scan point to bone metastasis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Prostatitis:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Characteristic rectal examination findings suggest prostatitis. In many cases, a urine culture can identify the causative infectious organism.
CONFIRMING DIAGNOSIS A firm diagnosis depends on a comparison of urine cultures of specimens obtained by the Meares and Stamey technique. This test requires four specimens: one collected when the patient starts voiding (voided bladder one); another midstream; another after the patient stops voiding and the physician massages the prostate to produce secretions (expressed prostate secretions; and a final voided specimen. A significant increase in colony count in the prostatic specimens confirms prostatitis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Prostate Abnormality:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Benign prostatic hypertrophy
❑ Acute bacterial prostatitis
❑ Chronic prostatitis
❑ Adenocarcinoma
❑ Prostatic calculus
❑ Prostatic abscess
Diagnostic Approach
History helps in risk stratification: Men with a first degree relative with prostate cancer have a 2 to 3 fold increased incidence of prostate cancer. With 2 first degree relatives, this increases 5 to 8 fold.
The normal prostate is heart-shaped with a median raphe and a mass of 20 to 25 g. Carefully examine the posterior surfaces of the lateral lobes because this is where most prostate cancer originates. In screening for prostate cancer, digital rectal examination (DRE) looking for nodules, induration, or asymmetry may help to calibrate PSA values in the “gray zone” of 4 to 10. For example, a large gland may offer an explanation for a mildly elevated PSA, but a small gland or one with induration or asymmetry should heighten suspicion of prostate cancer. The positive predictive value for prostate cancer of an abnormal finding on DRE is 15% to 30%, increasing odds 1.5- to 2-fold. Because of low sensitivity, the value of a negative DRE to rule out prostate cancer is low. Men with an abnormality on DRE and a PSA ,4 still have a probability of prostate cancer of 12%, so biopsy is usually recommended. Examination followed by biopsy of any prostate nodule is the appropriate tactic because the clinical examination alone is not accurate enough in distinguishing benign causes from adenocarcinoma.
New suspicious findings on DRE in a patient with an initial negative baseline helps to select for aggressive tumors. Cancer found based on the first DRE has a 5 year prostate cancer mortality of 3% and 10 year mortality of 14%. Cancer found on a subsequent DRE has mortalities of 19% and 43% respectively.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Benign prostatic hyperplasia:
Diagnosis
(Handbook of Diseases)
Signs and symptoms and a rectal examination are usually sufficient for a diagnosis. Other test findings help to confirm it.
❑ Excretory urography may indicate urinary tract obstruction, hydronephrosis, calculi or tumors, and filling and emptying defects in the bladder.
❑ Elevated blood urea nitrogen and serum creatinine levels suggest impaired renal function.
❑ Urinalysis and urine culture show hematuria, pyuria and, when the bacterial count exceeds 100,000/µl, urinary tract infection.
With severe symptoms, a cystourethroscopy is definitive, but this test is performed only immediately before surgery to help determine the best procedure. It can show prostate enlargement, bladder wall changes, and a raised bladder.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Prostatic cancer:
Diagnosis
(Handbook of Diseases)
A digital rectal examination that reveals a small, hard nodule may help diagnose prostatic cancer. The American Cancer Society advises a yearly digital examination for men older than age 40, a yearly blood test to detect prostate-specific antigen (PSA) in men older than age 50, and ultrasonography if abnormal results are found.
Biopsy confirms the diagnosis. PSA is produced by the normal neoplastic ductal epithelium of the prostate and secreted into the lumen; its concentration in the blood is proportional to the total prostate mass. PSA levels will be elevated in all patients with prostatic cancer, and serum acid phosphatase levels will be elevated in two-thirds of men with metastatic prostatic cancer. Therapy aims to return the serum acid phosphatase level to normal; a subsequent rise points to recurrence. Magnetic resonance imaging, computed tomography scan, and excretory urography may also aid the diagnosis.
CLINICAL TIP: Elevated alkaline phosphatase levels and a positive bone scan point to bone metastasis.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Prostatitis:
Diagnosis
(Handbook of Diseases)
Although a urine culture can usually help identify the causative infectious organism and rectal examination findings may suggest prostatitis, firm diagnosis depends on a comparison of urine cultures of specimens obtained by triple-void urine specimens. This test requires three specimens:
❑ one collected when the patient starts voiding (voided bladder one [VB1])
❑ another specimen collected midstream (VB2)
❑ another specimen collected after the patient stops voiding and the physician massages the prostate to express prostate secretions.
A significant increase in colony count in the prostatic specimens confirms prostatitis.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
PROSTATIC MASS OR ENLARGEMENT:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The main consideration in diagnosing a prostatic mass is to rule out
carcinoma. It is therefore wise to draw blood for prostate-specific antigen
(PSA) before proceeding in anyone who is suspected of having prostate
cancer. If the mass is located in the posterior lobes, there is further
support for the diagnosis. Ultrasonography can be done for further
localization before proceeding with a biopsy. Obviously, if the PSA test is
positive, referral to a urologist is mandatory, although false-positives can
occur in this test. A large, boggy prostate suggests a prostatic abscess or
prostatitis. If there is no urethral discharge, one can elicit a discharge
by prostatic massage. However, this should not be done if the patient has
fever and significant tenderness of the prostate. It is better to proceed
with antibiotic therapy and reexamine the patient after the fever has
subsided. A smear and culture of the discharge is made. If upon examining
the discharge under high-power microscopy, four or more white blood cells
(WBCs) per high-power field are found, the diagnosis of prostatitis can be
made. If benign prostatic hypertrophy is suspected, cystoscopy and
retrograde pyelography can be done.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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