Is there a connection between prostatitis and prostate cancer (PCa)? No one knows for sure because there’s evidence on both sides of the question.

What is prostatitis?

Prostatitis is an inflammation of the prostate gland (think of swelling and irritation). Roughly 6-10% of men will have prostatitis at some time. There are two general types:

• Acute bacterial prostatitis is caused by a bacterium (single-cell organism). It can come on suddenly and produce symptoms like fever, aches, painful or bloody urination. It is cause for immediate medical attention, and it can be quickly diagnosed and treated with antibiotics.
• Chronic nonbacterial prostatitis is more difficult to diagnose and treat. Tests for bacteria are done to rule out infection, but establishing the cause is more difficult since nerves may be involved. In some men, it may cause a rise in PSA as well as discomfort, lower back or groin pain, and urinary or sexual symptoms that also suggest aggressive PCa.

Inflammation and prostate cancer

Most researchers today accept the theory that inflammation can act as risk factor for the initiation and progression of cancer. Stark et al. (2015) dig deeply into cellular biology to analyze the mechanisms by which prostate inflammation may foster PCa.^[i] From a research viewpoint, Jiang et al. (2013) reviewed
20 case control studies and discovered “a significant association between prostatitis and prostate cancer.”^[ii] Jung et al. (2022) conducted a powerfully persuasive demographic analysis of nearly 750,000 PCa cases matched with an equal number of control cases tracked for up to nine years.^[iii] Their data revealed that “the incidence of PCa was significantly higher in the group with prostatitis,” and “acute prostatitis is associated with higher risk of PCa than chronic prostatitis.”

Should prostatitis patients be worried?

Is there reason for prostatitis patients to worry that they may develop PCa? Well, there’s a difference between association and causality. Association means that one variable gives information about another, but not necessarily causation. In other words, prostate inflammation (prostatitis) is linked with prostate cancer, but we can’t say for sure that it causes PCa. For example, the link between the two might be attributed to an increase in PCa diagnoses in prostatitis patients because they visit the doctor more often. More frequent doctor visits can explain more testing, which in turn may lead to overdetection of insignificant PCa. In fact, the National Institutes of Health estimates that prostatitis accounts for about 2,000,000 visits to U.S. healthcare providers annually. So, where does this leave all those prostatitis patients? Is there reason for anxiety? The Jung paper offers this suggestion: “Clinicians should inform patients with prostatitis that they may have an increased risk of diagnosing PCa, and follow-up is needed.”^[iv]

If you were a prostatitis patient, would this alert or alarm you? Would you rather not know? This is a thorny dilemma, but the Sperling Prostate Center offers a solution thanks to multiparametric MRI (mpMRI). As far back as a decade ago, we have used our powerful 3 Tesla (3T) magnet and our high resolution imaging sequences or parameters to show “differences between prostatitis and PCa in both the peripheral zone and central gland.”^[v] For men who develop acute prostatitis, in addition to standard of-care urologic diagnostics and treatments, we recommend gaining a baseline portrait of their prostate gland by means of a 3T mpMRI scan.

If you or a loved one suffers with acute or chronic prostatitis, contact us to find out how we can put your mind at rest.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Stark T, Livas L, Kyprianou N. Inflammation in prostate cancer progression and therapeutic targeting. Transl Androl Urol. 2015 Aug;4(4):455-63.
[ii] Jiang J, Li J, Yunxia Z, Zhu H, Liu J, Pumill C. The role of prostatitis in prostate cancer: meta-analysis. PLoS One. 2013 Dec 31;8(12):e85179.
[iii] Jung G, Kim JK, Kim H, Lee J, Hong SK. The association between prostatitis and risk of prostate cancer: a National Health Insurance Database study. World J Urol. 2022 Nov;40(11):2781-2787.”
[iv] Ibid.
[v] Nagel KN, Schouten MG, Hambrock T, Litjens GJ et al. Differentiation of prostatitis and prostate cancer by using diffusion-weighted MR imaging and MR-guided biopsy at 3 T. Radiology. 2013 Apr;267(1):164-72.