What is the most appropriate initial test for a patient suspected of having acute prostatitis?

For a patient suspected of having acute prostatitis, the most appropriate initial test is urinalysis and urine culture. This choice is crucial because acute prostatitis often presents with symptoms such as fever, dysuria, pelvic pain, and urinary frequency, which can be indicative of a urinary tract infection or bacterial involvement of the prostate.

Urinalysis provides valuable information about the presence of white blood cells, bacteria, or blood in the urine, which can support the diagnosis of prostatitis. Additionally, urine culture is vital for identifying the specific causative organism, if any, allowing for targeted antibiotic treatment. This approach aligns with clinical guidelines that prioritize identifying and treating infections promptly in cases of suspected prostatitis.

In contrast, while other options might provide useful information about the patient's condition, they are not the best initial tests for suspected acute prostatitis specifically. Scrotal palpation and urine culture may provide some clinical information, but a focused approach directly assessing the urinary system is more appropriate initially. Prostate-specific antigen (PSA) is typically not indicated in the acute setting since it can be elevated due to inflammation or infection rather than solely indicating prostate cancer. A complete blood count with differential (CBC with Diff) can indicate systemic infection or inflammation but does not