In 2006, I had perineal pain, urinary frequency so bad that I had to carry around a 2lb protein powder container in my car so I could pull over to pee in it. Sometimes off to the side of the freeway. The urgency came with extreme pain that had me whimpering until I could relieve myself. This went on for months before I saw a urologist. I had seen a few nurse practitioners in the interim who took urine cultures, all coming back negative.
When I went to friends homes to visit they started asking me if I was doing drugs because of my frequent trips to the bathroom, even after explaining what was happening. I had to pee sitting down. Not only was my prostate enlarged, but it was inflamed, so there had been some obstruction happening for some time.
I was given antibiotics. One offered Cipro, which I didn't have filled. I used bromelain and quercetin capsules along with cranberry concentrate capsules. These alleviated it for a while. The pain went away. Then the pain came back. This time there was visible blood in my urine. I had a friend who knew a doctor whom he asked to refer me to a urologist. The urologist gave me a DRE, only this time he "milked" my prostate until pre-seminal fluid came out which he put onto a slide. He cultured it immediately in his office under microscope. This was something I've never heard of, but it was standard in his practice. There was no bacteria. He diagnosed me with non-bacterial prostatitis. Gave me antibiotics, Macrobid. This seemed to clear it up. Then it came back again so he gave me a cystoscopy. He didn't see anything suspicious. He did see irritation on the bladder wall. He told me I may have passed kidney stones because I also had flank pain on one side. He remarked that he saw indications of bladder cystitis, which again, non-bacterial.
More antibiotics, vicodin and AZO after the cystoscopy. Then it went away. In 2013, it came back, only this time I had no health insurance. So I couldn't afford to see the urologist. I had to go to a free clinic. I had a part-time job. They gave me a DRE, took a urine sample, all came back negative for infection. Diagnosis: non-bacterial prostatitis with possible cystitis. Antibiotics, Cipro. I went back to the bromelain and quercetin, vicodin, drank green tea only. It got to be so unmanageable that I had to leave the desk job. It went away. I went back to the NP, she did a DRE, she did not take a pre-seminal culture. "We don't do that here," she said. Macrobid and AZO.

Jump to Aug. 2022. Extreme fatigue, frequent urination, dizziness, high blood pressure and back pain.
After X-ray of the back came an ultrasound which showed bilateral hydronephrosis and a 99cc sized prostate. The prostate had been causing me to hold more urine that had backed up to my kidneys. I received a catheter.
The reason I point this out is that I was living with a time bomb. Part of it was my fault for not running to the doctor, however it was discouraging me to see any doctor because of the long wait. These tests were months between. Had I had an ultrasound of my abdomen back in 2006, they may have found something.
I believe that much of what provoked the flare-ups of the prostate were due to extreme prolonged stress, poor sleep due to nocturia, pain and diet and economic stressors. Consequently, the most recent enlargement may have been non-bacterial prostatitis which caused urinary retention- coupled with the enlargement- but that's my theory. I live in a foreign country, was filing for a divorce in a toxic marriage, my mother was dying of cancer in the States, the Covid problem- my cortisol levels must have been through the roof and I was in a constant state of anxiety and inflammation.
I have a urologist here, but they don't milk the prostate. It didn't occur to me to ask them! I may ask them if they do another DRE. I recently had an MRI with contrast of the prostate; still waiting for those results to come - the day before my 60th birthday, of course.
I'd like to thank you for your story about prostatic milking for culture analysis, it's something that they SHOULD know about, and be doing TODAY.