Chronic Prostatitis

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Chronic Prostatitis

Question:

I'm a 42-year-old man and have been suffering from prostatitis for the past two years, which seems to come and go. My doctor says this is not uncommon for men my age. I'm worried, though, that this increases my risk of eventually developing prostate cancer. Is there a link? And what can I do to prevent the prostatitis from coming back?

Answer:

First, there is no specific evidence that links having recurrent or chronic prostatitis — an inflammation of the prostate gland — directly leads to prostate cancer.

However, there are a couple potential reasons why prostate cancer may be found more often in men with prostatitis. Patients with prostatitis often are under the care of a urologist, where a blood test for prostate cancer, known as PSA, may be obtained and may lead to a prostate biopsy. The prostate biopsy might show an incidental cancer. If these men didn't have prostatitis, they may not have gone to a urologist and therefore never been tested for prostate cancer in the first place. Also, cells in an inflamed prostate sometimes show changes suggestive of a precancerous state. However, it isn't clear that the prostatitis causes these cellular changes.

Preventing prostatitis from coming back is problematic. In many men, prostatitis may recur over years. Whether it does depends, in great part, upon whether the prostatitis is caused by a specific bacterial infection.

If there is a bacterial infection, taking an antibiotic to kill the bacterial organism should help prevent prostatitis from coming back, assuming the prostate is otherwise normal. A doctor can tell if the prostatitis is caused by bacterial infection by massaging the prostate and examining the urine and secretions from the prostate gland before and after the massage. But bacterial infections as a cause of chronic prostatitis occur in only a minority of patients.

If the prostatitis is not associated with a bacterial infection, the disease can become chronic and is known as non-bacterial chronic prostatitis or chronic pelvic pain syndrome. Because we are not sure of the specific cause of nearly all forms of prostatitis, it becomes difficult to know how to prevent it.

In my own practice, I urge men with recurrent or chronic prostatitis to avoid activities that put pressure on their prostate gland, such as bike riding. Also I advise them to see a doctor at the first possible sign of a recurrence. So, if there is an infection, it can be treated early.

Some small medical studies have suggested that the same medications used to treat the symptoms of benign prostatic hyperplasia (called BPH — benign enlargement of the prostate gland) may be helpful in decreasing the incidence of prostatitis. These drugs include alpha blockers, finasteride and dutasteride. Unfortunately, larger randomized studies have not shown this to be the case. Nevertheless, if you have had multiple bouts of prostatitis, it may be useful to discuss this concept with your physician.

Last updated:	March 03, 2009