What is the role of prostate biopsy in the workup of chronic bacterial prostatitis (CBP)?

Updated: Jan 15, 2019
  • Author: Samantha D Kraemer, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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This is the most definitive, but least practical, modality used to diagnose bacterial prostatitis. The biopsy sample can serve as a specimen for culture, which if positive provides a definitive diagnosis. Viewing the sample under microscopy can help to identify a focal infiltration of inflammatory cells into the prostatic stroma. Again, the finding of inflammation is not specific to CBP. Category IV prostatitis is sometimes diagnosed using prostate biopsy. Category IV prostatitis is asymptomatic but may be responsible for elevations in PSA levels, resulting in the need for a diagnostic biopsy to help exclude prostate cancer.

However, prostate biopsy carries a risk of complications, including bleeding, injury to surrounding structures, and infection. In the face of an active infection such as acute prostatitis, performing a biopsy could precipitate sepsis. Overall, prostate biopsy is not recommended as a diagnostic modality for CBP and should be done only if prostate cancer is suspected on the basis of PSA level and/or DRE findings.

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