Prostatitis is inflammation of the prostate gland that can affect PSA and cause symptoms such as urinary frequency and urgency, fever, and pelvic pain. Prostatitis can be difficult to identify and hard to treat. This episode discusses diagnosing prostatitis, treating prostatitis, and how it can affect prostate cancer treatment decisions.
Dr. Scholz: [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls. I'm your host, Dr. Mark Scholz.
Liz: [00:09] And I'm your cohost, Liz Graves.
Dr. Scholz: [00:13] Welcome to the PROSTATE PROS podcast.
Liz: [00:16] Prostatitis is inflammation of the prostate, which can have a huge negative impact on quality of life. This episode, we're going to talk about diagnosing prostatitis, treating prostatitis, and how it can affect prostate cancer treatment decisions.
Dr. Scholz: [00:31] The real reason this topic comes up is because PSA goes up in men that have inflammation in their prostate, which is what we're calling prostatitis. There are many causes, we're going to go into that, but the confusing factor is that we're using PSA to diagnose prostate cancer, to monitor prostate cancer for treatment effect, and for relapse. If inflammation in the prostate intervenes and causes the PSA to go up, everyone gets frightened about the possibility of prostate cancer being out of control. So this podcast will cover trying to make a distinction between a high PSA from prostatitis and a high PSA from prostate cancer.
Liz: [01:17] So prostatitis is inflammation of the prostate, and there can actually be no known cause of this, or it can be due to bacterial infection and it can also manifest in many different ways.
Dr. Scholz: [01:31] There's so much confusion about what really is prostatitis. It may be sort of an autoimmune phenomenon, the way people get asthma or eczema on their skin, some sort of over activity of the immune system, but it's quite common and it's often asymptomatic. So that means that the PSA goes up, but men may not be feeling any urinary irritation. At the other end of the spectrum, of course you have the people that have real discomfort and pain with urination and are getting up at night a lot. When men have these symptoms, it doesn't necessarily mean that it is prostatitis, it could be a large prostate, it could be an irritable bladder, it could be a urinary tract infection, but prostatitis certainly is on the list of possibilities.
Liz: [02:19] So you mentioned asymptomatic prostatitis, which still has an effect on PSA. Can you distinguish a rise in PSA from prostatitis from a rise from prostate cancer?
Dr. Scholz: [02:32] Actually, PSA is very nonspecific. So when we see a PSA rise, we have to start doing all kinds of tests. The most popular one in the community of course, is to do a prostate biopsy. Our policy has been to do MRI testing, and there are certain blood tests and urine tests like OPKO 4K and SelectMDx that can help sniff out whether prostate cancer is really the problem. But many times, we are left with an ambiguous situation; an elevated PSA without a clear cause. And that's when people start calling it prostatitis.
Liz: [03:12] For people who do have symptoms, there are two or three different types. There's acute bacterial, chronic bacterial, and chronic prostatitis.
Dr. Scholz: [03:23] Years past when this problem was encountered, the reflex reaction was just to give some antibiotics. If the PSA would drop after a couple of weeks of antibiotics, then it must be prostatitis. The problem with that is that the antibiotics have potential bad effects. Secondly, they're not always effective because the many types of prostatitis are not bacterial. Thirdly, the problem with prostatitis is it