Diagnosis of chronic prostatitis: overview and update

Symptoms and signs are unhelpful in the diagnosis of chronic prostatitis which in many cases continues to rest on comparison of white cells and organisms in urine samples collected before (VB2) and after (VB3) prostatic massage to express prostatic secretion (EPS), and particularly in the EPS itself, if this is obtained. A series of 195 patients is reviewed, 38 with chronic bacterial prostatitis (CBP), 66 with chronic non-bacterial prostatitis (CNBP), 55 with prostatodynia, and 31 with a history of recurrent urethritis without prostatitis. Demographic characteristics and history of recurrent urethritis were similar in all groups indicating that recurrent urethritis alone does not predispose to prostatitis. The upper limit of normal for the EPS while cell count was taken as 1000/mm3 in line with other reports. With this, the upper limit of normal for the estimate of white cells by simple microscopy appeared to be about 5/high power field (hpf) rather than the figure of 10 often quoted; with the latter figure, a number of cases of CNBP would have been missed. All microscopy was undertaken with the same microscope using a x 40 objective. Culture results showed a predominance of enterococci, and cultural and cytological findings in EPS and VB3 were comparable. On microscopy, clumping of white cells was associated with increased numbers-mentioned previously in the literature but not supported by data. Ejaculation just before examination was associated with reduced rather than the increased numbers of cells previously reported. Individual investigators should assess their own methods in determining upper limits of normal for cells. In a separate series of 8 patients with symptoms compatible with prostatitis, transrectal ultrasound scanning showed a prostatic cyst; aspiration was associated with relief of symptoms. It is concluded that transrectal ultrasound scanning (TRUS) should precede prostatic investigation by prostatic massage as this may save the prolonged treatment often necessary for prostatitis.