Testing for Non-Bacterial Prostatitis

Medically reviewed by Dr. Paul Song M.D

Article at a Glance

Non-bacterial prostatitis makes up the majority of all prostatitis cases—90 to 95% of all cases—but testing for it can be challenging because it can present in different ways and stem from a number of different causes. Commonly known as chronic pelvic pain syndrome (CPPS), non-bacterial prostatitis is the hardest and most frustrating type of prostatitis to treat. The process of testing for non-bacterial prostatitis is significantly more involved than testing for bacterial types of prostatitis. One of the reasons for this is that its many causes originate elsewhere in the body and outside of the prostate—often having nothing to do with the prostate itself.

One of the main treatments for bacterial prostatitis, antibiotics, does not work for CPPS because it is not caused by bacteria. If your doctor prescribes antibiotics without finding any bacteria, find out why—you could be doing more harm than good if you do not have an infection and you take antibiotics.

For this reason it is important to look at the whole patient and correctly diagnose CPPS and find its causes when testing for non-bacterial prostatitis.

Testing for Non-Bacterial Prostatitis

The following may be involved in testing for non-bacterial prostatitis:

• fill out The National Institutes of Health Chronic Prostatitis Symptoms Index (NIH-CPSI)—a symptom scoring questionnaire to evaluate the severity of current symptoms
• physical examination of abdomen, external genitalia, prostate, and perineum
• Meares-Stanley “Four Glass Test” or even a 2-glass pre- and post-massage test (PPMT)
• urodynamic evaluation of urine flow rates, post-void residual volume, and pressure flow (if you have urinary voiding problems)
• screen for psychological problems (depression, coping problems, or poor social support)
• digital rectal exam (DRE)—the doctor may apply pressure
• discussion of dietary issues, allergies, food intolerances

The DRE can help help to identify the location of pelvic pain and any myofascial trigger points. It is normal to feel your pelvic pain get worse during the DRE, and noting the areas with an increase in pain can help pinpoint the problem. You doctor may also find any possible musculoskeletal dysfunction of your pelvic floor or pelvis during this exam, and this may help guide treatment as well.

The following tests are not recommended because they have not been found helpful in diagnosing CPPS:

• semen culture
• cystoscopy
• transrectal ultrasound
• CT scan
• MRI
• PSA test