Prostatitis is inflammation of the prostate gland which can cause symptoms such as urinary frequency, pain with urination, elevated PSA, and pelvic pain. While symptomatic prostatitis can have a huge negative effect on quality of life, it is difficult to diagnose and treat.
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Diagnosis
A prostatitis diagnosis usually must be made by a diagnosis of exclusion, meaning that the diagnosis is made by ruling out other potential causes. In the case of prostatitis this means ruling out prostate cancer, high PSA, enlargement, etc. until the only remaining possible diagnosis is prostatitis. One method of attempting to identify prostatitis is through urinary or semen analysis to check for bacteria that may be causing the inflammation.
Another potential way to differentiate prostatitis from prostate cancer is that inflammation ebbs and flows, so if you are keeping close track of your PSAs and your PSA is fluctuating regularly vs rising steadily it might indicate that you are dealing with prostatitis instead of prostate cancer.
Treatments
Prostatitis is notoriously difficult to treat. There are several different types of prostatitis: acute bacterial, chronic bacterial, and non-bacterial chronic prostatitis/pelvic pain syndrome.
Bacterial prostatitis is typically treated with over the counter anti-inflammatories like Aleve or Celebrex. It can also be treated with antibiotics like Cipro or Levaquin. While antibiotics can cure acute bacterial prostatitis and provide temporary relief for chronic bacterial prostatitis, there is always a chance that the prostatitis will return later.
If the PSA doesn’t drop or symptoms don’t improve while on the antibiotics it might indicate that the prostatitis isn’t caused by bacteria. If symptoms aren’t resolving after trying several different methods, sometimes the only advice is to just wait until symptoms improve. Occasionally if urinary symptoms are causing a lot of discomfort and issues, alpha blockers like Flomax and Rapaflo may provide relief.
Prostatitis and Prostate Cancer Treatment
If you have prostatitis and prostate cancer it is important to consider the effect prostate cancer treatment might have on prostatitis symptoms and PSA.
- Surgery: Radical prostatectomy may seem like the best option– by removing the prostate the inflammation and symptoms that come along with it will dissipate; however, that is not necessarily the case. Prostatitis and pelvic pain can persist even after the prostate is removed. Keep in mind this means that surgery is not necessarily a curative option for all men with prostatitis, though it may improve symptoms in some.
- Radiation: Radiation therapy usually causes worse short-term prostatitis symptoms but better long-term symptoms. PSA is usually higher immediately following radiation due to inflammation of the prostate but it will lower with time as inflammation decreases. Another cause of inflammation from radiation can occur either directly following or up to several years after radiation therapy, this is a non-cancerous rise in PSA due to inflammation called a PSA bump. It is important to distinguish a PSA Bump from a rise in PSA due to cancer growth. The newly FDA approved PSMA PET scan will help determine the cause of a high PSA after radiation.
- TIP: While hormone therapy or TIP shrinks the prostate, it unfortunately doesn’t have a huge effect on relieving prostatitis symptoms. However, some men find relief using Proscar or Avodart, both of which tend to have fewer symptoms than other hormone medicines like Lupron.
Prostatitis and Prostate Cancer
There is no proven link between prostate cancer and prostatitis. While they both have an effect on PSA, it is important to note that they are two separate conditions. PSA is nonspecific and can be an indication of anything from prostate cancer to recent sexual activity, BPH or prostatitis.
Listen to the PROSTATE PROS Episode: Do I Have Prostatitis?
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