Diagnostic Testing – the First Step towards Prostatitis Treatment
The first step for successful prostatitis treatment is getting the right diagnosis. For that, certain diagnostic tests must be done, so that the cause and nature of the problem can be understood. In this post, I want to talk about all the tests that have helped me in understanding my condition and dealing with it effectively. Some are lab tests, and some are imaging tests. If you have prostatitis and have not had these tests done, I would recommend you to do so to get an idea of the root cause of your condition. Once you know what is causing the problem, you can begin to address it, and take the next steps towards your prostatitis treatment. During my treatment, I repeated these tests every 4-5 months to monitor my progress and make sure that my treatment was on the right path.
Prostate Fluid Culture
The prostate fluid can be taken out by massaging the prostate. A culture of the prostatic fluid will show the bacteria that are in a state of overgrowth in the prostate and causing prostatitis. In my case, the bacteria that were cultured in the prostate fluid were Staphylococcus haemolyticus, Staphylococcus aureus and Streptococcus mitis.
Semen Culture
We all know what semen is. What we don’t know is that it is full of information regarding the health of the urogenital system. A semen culture should show bacteria causing epididymitis, or any infection in the testicular region. For me, Enterococcus faecalis grew in the semen culture. The first time it grew, I was told it could be contamination as it is normal bacteria for that region. However, it grew again in repeat cultures in medium to heavy quantities, so it was definitely a pathogen.
Urine Culture
A urine culture will show any urinary tract infection one might have. An important thing to note is that while urine is a good sample to test for infections in the urinary tract, bladder etc., it will NOT accurately show up a prostate infection. Many urologists recommend a post prostate massage urine sample. My experience is that unless your prostatitis is in a very acute phase, the post massage urine will not really show up the offending bacteria. In my case, every time I gave a urine sample, whether with a prostate massage or without it, it came out sterile – even during the worst phase of my infection.
Urethral Swab
If you have any discharge from your penis, getting it taken on a swab and getting it cultured is imperative to know what is causing your problems. It could point towards possible urethritis or other related problems. I did not have any discharge, but I have had a urethral swab culture done. Nothing grew in that culture.
Microscopy/Analysis
Microscopy is a study of the your fluid samples through a microscope. It captures a lot of relevant information like white blood cell/leukocyte count, which will be high if you have an infection or inflammation in the region where the fluid has come from; epithelial cells count, which is the number of epithelial cells your body is shedding, etc. When you give your fluid sample for culture testing, the pathologist at the lab should be able to do a microscopic analysis on the same sample.
Each fluid has different parameters for analysis. The normal value/range for each parameter should be mentioned in your report, and can also be found with a simple online search.
The websites I used to understand my results are:
- Semen analysis – https://www.webmd.com/infertility-and-reproduction/guide/what-is-semen-analysis#1
- Urinalysis – https://emedicine.medscape.com/article/2074001-overview
- Prostate fluid microscopy – this was only done at the phage clinic for me, and I compare the result to the normal values/ranges given in my report.
PCR (DNA Testing)
Polymerase Chain Reaction (PCR) is a test that looks for the DNA of bacteria in the fluid sample that you submit for testing. I believe PCR testing is significant when testing for certain bacteria that do not grow on cultures, like Chlamydia, Gonococcus, Ureaplasma, Mycoplasma, etc. Some labs have started offering a complete DNA profile test, in which the DNA of all the bacteria present in the fluid sample will show up in the report. I think the interpretation of such a test is difficult – not every bacterium is a pathogen, so how do you segregate pathogenic bacteria from normal bacteria in such a report? These complete DNA profile tests will even show a probiotic supplement that you might be taking to aid your digestion! The diagnostic value of such a test is not very clear.
TRUS
TRUS, or transrectal ultrasound, is an imaging test that is able to show the condition of the prostate fairly accurately. Through it, the radiologist is able to see the size of the prostate, and is able to check for any calcification in the prostate, any abscesses, scar tissues, lesions, fibroids, cysts, or any other signs of damage or infection.
The normal size of the prostate varies from person to person, but anything above 24-25 cc is considered higher than normal. My prostate size at the peak of my infection was 24 cc. As my infection has been eradicated with phages, and by following a strict dietary and exercise regime, I have been able to maintain my prostate size in the range of 14-16 cc over the last 6 months.
Scrotal Doppler
This is an ultrasound of the scrotum. It is usually done for epididymitis, not for prostatitis. The ultrasound should show any inflammation, calcifications, abscesses, scar tissues, lesions, fibrosis, cysts or anything else that might be causing your pain.
The Doppler test is to check for vascularity, or blood flow, in the region. Higher blood flow is indicative inflammation, often caused by an infection.
PSA
The PSA, or Prostate Specific Antigen test, is a blood test that measures the level of the antigen present in the prostate that is indicative of prostate health. It is more commonly used to detect or corroborate cases of prostate cancer or tumors, but might be somewhat useful for prostatitis if you track its trend. Generally speaking, if you are in an acute or a flare-up phase of your prostatitis, then you PSA will probably be higher than the PSA value at a time when your prostatitis is settled down. My PSA at the worst phase of my prostatitis was 0.75 and post phage treatment and elimination of my bacterial pathogens, is currently at 0.54. I see that as a sign that my prostatic inflammation has reduced and the prostate tissue is in a healthier state compared to the acute phase of my condition.
Once you have these tests results, you can approach your prostatitis treatment in a targeted way, armed with answers. Before I knew of these tests, I was stuck in a cycle of getting the same test – urine culture – done over and over again as recommended by various urologists, in the hope of finding some answers. The results were always negative (showing no growth), and it would flummox me that I was suffering so much and there was nothing concrete for me to base my treatment on.
After months of repeated testing with negative results, I decided to take matters in my own hands and got my testing done based on my own research into this problem. The tests I have written here are a result of that extensive research, and my own experience of finally getting answers when I got them done.
If you are trying to figure out the right tests to identify the root cause of your prostatitis/epididymitis and have any questions, feel free to reach out to me and I would be happy to help.
Great stuff Pranav. Thank you!
So I have a few questions. Did you have to get the DNA testing done to reveal the bacteria in your prostate? Do they perform such a test in the Eliava institute? If they don’t, do they have other means to catch chlamydia, gonococcus, ureaplasma etc..?
You mentioned in another post that you had 12 months of phages, why so long? From what I’ve gathered, it should be like 2 weeks for the treatment. Also, do you have to pay the 4000€ fee for each bacteria or do you get all bacteria killed for one price and can it be done at one time?
Sorry it’s a lot of questions but it’s a puzzling subject and I really want to be sure what I’m getting myself into. Thank you so much for keeping this blog, great information! I’m happy you are healthy and I hope I get there too.
I have had DNA tests done for chlamydia, gono, ureaplasma, mycoplasma etc on my prostate fluid, and it was all negative. As far as I know, they don’t do DNA testing at the Eliava lab.
2 weeks of phage treatment is completely inadequate to eliminate pathogens from the prostate. I have made 3 visits to Georgia for my treatment in the last 16 months. Each visit is 3 weeks long and I return with phages to take for another 2-3 months. I had 4 bacteria and one was resistant to all the standard phages, thats why my treatment took time. Some guys with simpler infections get cured in one visit itself.
Merhaba taner. İletişime geçebilir miyiz. Mail veysievis@gmail.com
Selamlar
And by catching bacteria I mean detecting of course 😀
I have been suffering from prostatitis since 5 years and I tried everything possible in India for its treatment. I took antibiotics for months and I took intravenous antibiotics too but nothing worked out. I tried Homeopathy,Ayurveda also for months.
It gave me some symptomatic relief . Through internet I came to know about phage therapy and on YouTube I found one video of Pranav expalning his experience regarding phage therapy treatment. I reached Georgia on 14 may for my prostatitis treatment . In my prostate fluid test only one bacteria found i.e E coli and it was sensitive to their standard phages . I am taking phages orally and through instillation and just in few days I started feeling improvement in my symtoms . On 28 may again my prostate fluid taken for testing and in preliminary report found reduced WBC and low growth of bacteria . Inflammation of prostate also got reduced in just two week of treatment as first time while having prostate massage I had huge pain but this time I had very little pain. Hoping all my infection will be eliminated after finishing phage therapy. Thanks Pranav for all these valuable information and help.
Thanks for sharing your experience Aditya. I am happy that phage therapy has worked well for you. I hope your E.coli will be cleared completely by the time you finish your phages. Good luck man!
How do you fell Aditya, did the phage treatment work?
Hello Alex. I am feeling very good and Phage therapy worked well over me. I am almost 90% fine now. Initially I had E.coli bacteria and its growth rate was 10^8 in my first prostate fluid test report. After taking 2 week of phage therapy again my prostate fluid culture test done and in its report E.coli bacteria got reduced to less than 10^3 and 3 more bacteria appeared as Bio films would be broken. I am taking phages orally now and when my phages will be finished , I’ll again get tested and update regarding it.
Hi Aditya, what were your symptoms at the very first time when Prostatitis started for you and what are your symptoms today?
Hello Charlie. At the very first time around 4 years ago I had all the time low grade fever and pain while ejaculation. Gradually it got worsen and I started having burning while urination , urine urgency . After ejaculation I used to go to urinate again and again for half an hour . These were my main symtoms . Now after taking phages, I am almost fine. Only very few times I feel very little burning after ejaculation. Today is my last day of taking phages . After 3 weeks from now I will get tested of my semen culture test and I am hopefully that all my bacteria would have been finished.
Hi Aditya, I am glad the phage therapy worked for you. Did you take antibiotics combined with phages or just phages alone?
Hi Alex , I took only phages alone.
Hi this is phaniraman. I am in UK from so many years, but three months back never I got anal burn while sitting on the leather chairs or sofas, so I consult my GP regarding this issue and he told me that it might anal fissure/pile and at that time he was verified my prosatate and it looks good.but after three weeks still I am suffering with same burn in anal and also in UK it will take more time to consult further consultants, so I decided to go India and now I am in India from last two months. I went for the colonoscopy procedure to verify whether there is any anal fissure/hamarriod, but it was found only tiny anal fisure and low grade pile and also doctors suggested me no need of any medication because of low grade. After two weeks my sysmpomts were worsened with anal burn pain/continue urine burn and again I went to doctor and he told me that it might be prostatis. My symptoms are anal burn/pain, urine pain continously some times. The urologist found entrococci bacteria in my prostate fluid by pressing the prostate and collecting the fluid from penis, but the antibiotics what they found in fluid culture is not working that much,but reduce the pain and still I cannot sit on chIars due to inflammation of prostate, that is what doctors are saying. So please suggest me what is phase therapy and the good side is I don,t need visa to go Georgia as a British citizen.
Pranav/Aditya ..if possible could your phone no or contact me my India no 6302757567..I never forget your help because I am in deep furstation. Thanks
Hello Guys, My Semen Culture test done and for the first time it is not showing growth of any bacteria. My quality of life has been improved drastically . For that I am very much thankful to Eliava clinic and Pranav.
I am glad that phages have worked out well for you Aditya. It takes courage to go for a treatment that is not well known, and that too in a foreign country. I am happy that you are seeing the benefits of it.
Hello Everyone . I have good news . After my Phage treatment , For the first time my prostate fluid test done and today i got report and it is not showing growth of any bacteria. All my bacteria have been eradicated .
Congratulations, I’m planing to go by the end of the year 2018, I had this problem since last July.
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Hi Pranav,I was wondering if you ever came across this article concerning Chronic Prostatitis ,Its a few years old,But has a drug once used for kidney infection : https://www.mdedge.com/familypracticenews/article/103425/infectious-diseases/old-drug-new-treatment-chronic-prostatitis
Dear Pranav,
Thank you for your excellent website. I wanted to know your thoughts on what test would be needed to better identify the root cause of my prostate issues. Thank you in advance for your advice!
Over the past year, I have had three urinary tract issues. Twice it was a burning sensation while peeing, and the other time more frequent urination, including getting up at night. I am 39 years old, btw. My doctors always tested me for sexually transmitted diseases and did urine cultures- all tests came back negative.
This past month during the third episode, I did a CT scan as well as finally went to a urologist. The CT scan showed that the prostate looked enlarged and the bladder wall was thickened. The urologist thought I might have an early onset of benign prostatic hyperplasia and gave me a muscle relaxant to deal with the frequent urination. But today, I got the test results back from the prostate fluid and it showed streptococcus mitis. My urologist was not alarmed about that and did not suggest more therapy. But now, upon reading your website, I am thinking that the enlarged prostate (and the symptoms I have been suffering from over the past year) could stem from prostatitis caused by streptococcus mitis.
What other tests would you recommend me doing to have more certainty? Also, are there other therapies to attack streptococcus mitis other than phage therapy?
Thank you!
Hey Niko, it’s good that you have already got the prostate fluid cultured. Did the test result also give you the colony count of the Streptococcus mitis, and the WBCs in the prostate fluid?
Did you also get your semen cultured? Doing that would help you get a more complete picture of the infections that might be causing your symptoms.
As for treatments other than phage therapy, I personally have tried antibiotics for months, homeopathy, some natural remedies, but nothing cured me of my infections other than phages.
If you would like to know more about phage therapy, let me know.
Huh, I also have Enterococcus faecalis in my semen. What was your colony count?
Because mine is only 1.11 x 10³ and my urologist argues that that’s normal and so he doesn’t think that my problems are of bacterial nature.
Did you have the prostate fluid culture done by a local urologist or only when you went to the phage therapy center? (I’m asking because I’ve been to about 5 different urologists where I live and while 3 of them ordered semen cultures, none of them ordered prostate fluid cultures)
Congratulations to Pranav and Aditya and thanks to Pranav for this website. I hope your symptoms are gone or remain in remission forever.
It seems like Phage therapy has been around for 80 years, so why is it that it is not available widely in Europe, US , Japan, etc? Is it regulatory impediments from FDA etc?
Thanks Raj, I am glad you find this blog to be helpful. It’s been three years now that I have been free of symptoms, so fingers crossed!
Phage therapy has been around for almost a century now, though it is getting recognized globally only in the last 2 decades. There are many reasons for this, impediments from regulatory authorities being one, the pharmaceutical lobby being another. Even geopolitics had a role to play in this – after WW2 and the start of the Cold War, the West and the Soviet Union blocked their technologies from being shared with each other. Since phage therapy was being developed and practiced extensively in the Soviet block countries, this technology was “hidden” from the West. It is only after the fall of the Soviet Union and the rapid rise in antibiotic resistance that phage therapy is now being globally recognized as the most promising alternative to antibiotics for treating bacterial infection. Countries like Belgium have recently put in place regulatory frameworks to make phage therapy more accessible and available to their citizens.
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Hi Pranav. I am struggling to find the cause for my prostatitis, I have symptoms but tests come back negative. You wrote that semen culture shows pathogens only in testicles, but I have come across articles saying it has excellent diagnostic value in bacterial prostatitis as prostate liquid is a component of semen. And you skip the discomfort of a prostatic massage, especially when acute.
What do you think?
I am also looking to do a Next Generation Sequencing out of a semen sample. Not sure though of how easy it can be interpreted. Any new developments on that?
Thank you.
Hi SS,
Do excuse my late reply to your comment and questions. While semen sample does contain some prostate fluid, prostatitis causes inflammation which seals off some of the ducts and sacs of the prostate gland. That results in fluid from those inflamed parts of the prostate fluid not getting captured in semen. While semen is an excellent sample to test to diagnose epididymitis or orchitis, to get a complete picture for prostatitis, it is best to test the prostate fluid. In cases of acute prostatitis, when it is not recommended to administer a prostate massage for fear of spreading the pathogenic bacteria, semen and urine samples should be able to identify the infection.
NGS sequencing can give results which have to be carefully interpreted, because not every bacteria identified in a NGS test is pathogenic. Any culture or NSG testing must be accompanied by a microscopic analysis, which measures the leukocyte count in the semen sample to indicate the level of infection.