The prostate is an internal organ, so the physician cannot look at it directly. Because the prostate lies in front of the rectum, just inside the anus, the doctor can feel it by inserting a gloved, lubricated finger into the rectum.
This simple procedure, called a digital rectal examination ( or just 'recta'l), allows the physician to estimate whether the prostate is enlarged or has lumps or other areas of abnormal texture. While this examination may produce momentary discomfort, it causes neither damage nor significant pain.
Because this examination is essential in detecting early prostate cancer, which is often without symptoms, the American Urological Association recommends a yearly prostate examination for every man over age 40 and an immediate examination for any man who develops persistent urinary symptoms.
The test that must be performed when
prostatitis is suspected is prostate massaging, during which prostatic fluid is collected. While performing the digital rectal examination, your doctor may vigorously massage the prostate to force prostatic fluid out of the gland and into the urethra. Although prostate massage is not comfortable, we need to be able to examine the fluid to accurately diagnose your condition. If no fluid is expressed after massage, we may ask you to give us another urine specimen so that we might be able to examine the washout of the prostate channel from the first part of urination. For this urine specimen we do not want the middle of the stream, but the first few teaspoons that are urinated. The prostatic fluid is then analyzed under a microscope for signs of inflammation and infection.
When the diagnosis of prostatitis is not clear we will do a three glass urine collection with prostate massage. The three-glass urine collection method with prostate massage is used to separately measure the presence of white blood cells and bacteria in the urine and prostatic fluid. You will be asked to collect two urine samples separately: the first ounce of the urine you void (urine from your urethra) and then another sample of flowing, midstream urine (urine from your bladder). You will then almost empty your bladder by urinating into the toilet. At this point, your doctor will massage your prostate (prostatic fluid) and collect on a slide any secretions that appear. If no fluid is retrieved from the massage (about 50% of the time) you will then collect in a third container the first ounce of urine that remains in your bladder. All of these specimens will be examined and cultured separately.
Examination of these samples will help your physician determine whether your problem is an inflammation or an infection and whether the problem is in your urethra, bladder, or prostate. If an infection is present, your doctor will also be able to identify the type of bacteria involved so that the most effective antibiotics can be prescribed.
