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.
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.
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.
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 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, 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.
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.
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.