Laboratory parameters of the 1st order – obligatory laboratory tests.
- Small blood count [leukocytes (white blood cells) ↑]
- Inflammatory parameters – C-reactive protein
- Urinalysis – urinalysis typically reveals bacteria as well as leukocytes (white blood cells) as an indication of existing inflammation.
- A germ culture (for pathogens (aerobic and anaerobic) and resistance should be created in the process
- Furthermore, a three- or four-glasses sample (3-glasses or 4-glasses sample, respectively) should be performed (gold standard for microbiological clarification of prostatitis-like symptoms). After collecting the first and second portions of urine, the prostate is examined, with some massaging (using a digital-rectal examination) to obtain prostate expression. Then the remaining urine is emptied into a third glass, together with the prostatic secretion. We speak of the four-glass test if the secretion has already drained through the urethra during the prostate massage and has been collected separately. By this method, bacterial involvement can be detected or excluded. Examined first stream urine, midstream urine, prostate expressate and postexprimaturin.
- However, in clinical practice, due to time constraints, often only the two-glasses sample (2-glasses sample) is performed, that is, collection of urine before and after prostate massage.
- Examined the presence of pathogenic bacteria and inflammatory parameters/inflammatory parameters (leukocytes/white blood cells).The examination allows a distinction of a chronic bacterial prostatitis (CBP; NIH type II) from a chronic abacterial prostatitis/ CPPS (NIH type III).
- Ejaculate analysis with determination of inflammatory mediators (a positive ejaculate culture is present at: > 103 germs/ml (relevant germ type) and leukospermia, that is, > 106 leukocytes/ml; synonym: > 106 PPL/ml, PPL = peroxidase-positive leukocytes) sperm pathogen detection from ejaculate (obtained by masturbation or prostate massage; bring fresh to the laboratory!):
- Common sperm pathogens: anaerobes, Chlamydia trachomatis, Escherichia coli, enterococci, mycoplasmas, Staphylococcus aureus, group B hemolytic streptococci, Ureaplasma urealyticum.
- Less common sperm pathogens: yeasts (eg, Candida), mycobacteria tuberculosis, Neisseria gonorrhoeae (gonococci), Pseudomonas.
- Urinary parameters – creatinine, cystatin C if necessary.
- Blood cultures – in febrile courses.
Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification.
- Urethral smear (smear from the urethra) for pathogens – in men with risky sexual behavior:
- Gram preparation – method for differentiating staining of bacteria for microscopic examination.
- Bacteria and fungi, possibly mycoplasma (M. genitalium), Ureaplasma urealyticum T. vaginalis and Chlamydia trachomatis and Neisseria gonorrhoeae; if necessary, also Chlamydia trachomatis DNA detection (Chlamydia trochmatis-PCR) or Neisseria gonorrhoeae DNA detection (Go-PCR, gonococcal PCR).
- Urine for chlamydia, mycoplasma and gonococci – in men with high-risk sexual behavior.
- Antibodies to chlamydia, Neisseria gonorrhoea.
Other notes
- Asymptomatic prostatitis (prostatitis without symptoms) is associated with PSA elevation in many cases.
- Acute prostatitis is usually accompanied by a (severe) PSA elevation, which may persist for up to two months after the prostatitis has healed. Note: If after the healing of prostatitis after two months no drop in PSA in the normal range, a prostate carcinoma (prostate cancer) is to be excluded!
