The Value of EPS, Semen and Urine Cultures

Are expensive and complex cultures warranted?

The bacterial form of chronic prostatitis, called Category II prostatitis, is a relatively rare phenomenon with completely different symptoms to CPPS. Men with category II prostatitis usually have no pain on a day to day basis, but then once or twice a year they’ll typically develop a cystitis-like condition (painful urination), which quickly succumbs to antibiotics. Here’s a description by the usual chronic bacterial prostatitis patient:

My doctor will express some prostate fluid and run a culture to determine the bug and prescribe an appropriate antibiotic. My bug has consistently been shown to be E. coli. My symptoms usually start with increased frequency of urination, burning and pain on urination, and pus discharge. But no pain other than that and it usually goes away after a few days on the antibiotics. I continue the antibiotics for 30 days which is well after the symptoms have disappeared. I can usually expect a relapse in 6 to 12 months. … This has been going on for more than 30 years. …. My worst experience a number of years ago was when I thought I would tough it out and see what happened. The pain got excruciating, testicles inflamed, bloody discharge, high fever. But this responded well to antibiotics and I haven’t tried to tough it out again after that experience. I know when it starts and go on antibiotics right away.

So if that’s not your profile, you probably do not have chronic bacterial prostatitis and if you ask for extended “7 day” cultures on your excretions and secretions, you’re wasting your money.

EPS cultures are a waste of time and moneyNevertheless, there are still many CPPS patients who have been convinced by inaccurate and outdated information on the internet, including at some major medical websites unfortunately, that long cultures of secretions are warranted. However, there is no robust science supporting this view. Indeed quite the opposite, with quality studies showing that men with chronic pelvic pain syndrome have less bacteria in their prostates than normal men!

Your money is far better spent on books like A Headache in the Pelvis, phytopharmaceuticals like Prosta-Q, and physical therapy.

Here’s the opinion of an American urologist with a special interest in prostatitis:

My experiential numbers in a clinical practice once with a heavy emphasis on CP/CPPS with a policy of doing a form of Stamey-Meares localization cultures in a setting of “all men with CP/CPPS symptoms get them” showed NO indisputable positive cultures in over 200 men. I did have one man with negative EPS cultures who showed up subsequently 2-3 times with a positive urine culture, and typical symptoms of a UTI, so MAYBE he had cat II, but not a single man with the standard, garden variety syndrome was ever shown to have X bacteria and thus responded to Y antibiotic. Some men with “non-bacterial CP” as it was called at the time I was doing all this responded to antibiotics, others did not. Ergo, I found that in a clinical setting of “everyday practice” the EPS cultures did the following:

  • Did not alter therapeutic decisions (because even after the negative cultures, they insisted on antibiotics anyway)
  • Cost a lot
  • Created confusion when “commensals” were detected…were these pathogens or innocent urethral bugs?
  • Created anxiety during the 7 day wait
  • Attracted a bunch of hypervigilant hypochondriacal types who drove me batty and out of the business of a CP/CPPS focused practice.

So, I do not speak off the cuff, I speak from experience. In a research setting or perhaps a tertiary center performing clinical research these studies may still be of value. I found them not to be so.

For what it’s worth, when I was a resident we used to do a VB3 and I never recall any of those being positive back then, either.