Medically reviewed by Dr. Paul Song M.D
Because there are so many causes of prostatitis and also many similar conditions, it can be challenging to properly diagnose prostatitis. The majority of prostatitis cases are not due to a bacterial infection, with only about 5 to 10% of prostatitis cases being bacterial in nature. If no bacteria are present (which is usually the case with chronic pelvic pain syndrome—CPPS), doctors usually look for different causes of prostatitis symptoms. These causes can stem from a variety of triggers that include inflammation, chronic tension disorders, stress, autoimmune disorders, food intolerance, genetics, pelvic floor spasm, and many more. That is why it is also a good idea to look at a patient’s lifestyle and habits to get a complete picture when diagnosing prostatitis.
Because the majority (about 90 to 95%) of prostatitis cases are CPPS, diagnosing prostatitis is challenging for doctors. Even once they narrow down the type of prostatitis, it can take some time to figure out the causes. Complicating things even further, there is no single treatment for CPPS, and treatment usually involves trying many different therapies. This multimodal approach (along with a healthy dose of patience) and some possible long-term lifestyle changes are what it takes to eventually cure the problem.
If your doctor has determined that your prostatitis symptoms are due to bacteria or an infection then he or she will prescribe antibiotics. That may solve the problem, but even most bacterial cases are not that simple. If you have chronic bacterial prostatitis your doctor may need to prescribe longer courses of antibiotics (from two to four to sometimes even six weeks!). In addition, treatment may include some natural prostatitis treatments.
Sometimes antibiotics make a patient feel better (temporarily) even if there are no bacteria present, and this can be misleading. If you feel better while taking antibiotics but then begin to feel worse after you stop taking them, it is possible that you do not even have a bacterial infection. Commonly prescribed antibiotics such as quinolones, macrolides, and tetracyclines are also powerful anti-inflammatory drugs. These drugs directly block cytokines—substances secreted by immune system cells involved in cell communication and generating an immune response.
So let’s say your case of prostatitis is caused by an unknown pelvic muscle dysfunction. The doctor may prescribe antibiotics, as so many of them do, for prostatitis. You might start to feel better, thinking the drugs are killing the bacteria. But the drugs are temporarily fighting just the inflammation and not relieving the problem. Then after you finish the course of antibiotics your symptoms come back. It is not a reinfection because there was no infection to begin with—it is just that you haven’t properly diagnosed or treated the problem. You see, CPPS diagnosis and treatment is tricky that way. Taking antibiotics when they are unnecessary is also not good for your body and immunity because they kill off beneficial bacteria as well as the bad kinds. Some antibiotics have dangerous side effects as well, so they should be avoided unless necessary.
Tests for Diagnosing Prostatitis
When your doctor is working to diagnose the condition, he or she will perform some different tests. Your physician should take a complete medical history at the time of the evaluation and have you answer questions from the Chronic Prostatitis Symptoms Index (CPSI). The CPSI is a test that looks at the scale of your symptoms. It is important to be honest and thorough with your doctor, sharing any past medical problems, surgeries (especially urologic), trauma, medications, and allergies. Your doctor should ask about the location of your pain and its severity, location, and duration. He or she will ask you about lower urinary tract symptoms and other symptoms such as fever or other pain syndromes such as sexual pain and health. Be prepared to discuss how your symptoms have had an impact on your life including your sex life and function.
The doctor should perform a complete examination of your abdomen, external genitalia, perineum, and prostate. You will most likely be asked to provide a urine culture. There are some tests and imaging that your doctor may order to help diagnose your prostatitis.