Originally published 12/25/2017
Since we posted the blog below, it appears that there hasn’t been much progress in diagnosing prostatis. According to the Prostate Cancer Foundation, the term itself is a “grab-bag” or “catch-all” for a condition that can present a variety of symptoms. The PCF puts it humorously: PCF Pain in the testicles? Prostatitis. Pain in the penis? Prostatitis. Pain in the bladder or rectum? You guessed it. Burning when you urinate or ejaculate? Prostatitis. It’s like the diagnostic Island of Misfit Toys from the classic TV special, ‘Rudolph the Red-Nosed Reindeer.’” However, for men with chronic pelvic pain, it’s no laughing matter. While there are several laboratory tests that are used to analyze urine and prostatic fluid, MRI can play a key role in identifying inflammatory prostate conditions. However, some of these conditions can be mistaken for prostate cancer (PCa).
Thankfully, our team can rely on Dr. Sperling’s expertise and our 3T multiparametric MRI to distinguish imaging-based features that characterize infective and inflammatory conditions and distinguish them from PCa. The global term prostatitis includes acute and chronic bacterial prostatitis, infective and noninfective granulomatous prostatitis, and a condition called malacoplakia. Thus, we are able to avoid what Shakur, et al. refer to as “common imaging pitfalls.”[i] If you experience sudden or chronic pelvic pain, put your prostate in good MRI hands at the Sperling Prostate Center.
One of the most troubling conditions for men is chronic prostatitis. It is estimated that 5-10% of men suffer from this inflammation, which can cause pain, urinary difficulties, sexual dysfunction, and psychological stress.
Difficult to diagnose
Measures to diagnose prostatitis often frustrate doctor and patient alike. In many cases, blood and urine tests, physical exam, and clinical history are inconclusive. Often, the doctor will prescribe a course of antibiotics in hopes that a bacterial infection is the source, in which case the problem should clear up. Sadly, this does not bring long term relief in the majority of cases. Many men also undergo a prostate biopsy to rule out prostate cancer. Rarely does the biopsy bring diagnostic enlightenment. The situation is further complicated because many of the symptoms that the patient describes could point to other conditions such as cancer, stones, other infections, etc.
Linked with Chronic Pelvic Pain System
To complicate matters, prostatitis is associated with chronic pelvic pain syndrome (CPPS) – even though prostatitis may not be the source of chronic pelvic pain. Both prostatitis and CPPS can negatively impact quality of life, but CPPS is even harder to get a handle on than prostatitis. If CPPS is suspected, more tests will be done, many of which circle back to the prostate as the culprit. In fact, the patient may be experiencing nerve pain resulting from tension in the pelvic floor –but the source of nerve pain can be elusive since where the patient feels the pain may be different from where the pain actually arises.
New diagnostic system covers 6 bases
Symptoms for both prostatitis and CPPS vary widely among patients. In an effort to arrive at better diagnostic precision, researcher have developed a 6-category system that covers all possible bases. It is called the UPOINT[ii] system, a word made up of the first letter from each category:
- Urinary symptoms
- Psychological dysfunction
- Organ-specific symptoms
- Infectious causes
- Neurologic (nerve) dysfunction
- Tenderness of the pelvic floor muscles.
The beauty of categorizing an otherwise vague condition is it guides the diagnostic process[iii], and ultimately allows treatment to be tailored to the individual. An interesting treatment note: A 2016 study demonstrated that simply treating prostatitis/pelvic pain with anti-inflammatories (and bypassing antibiotics) was effective in reducing inflammation, which you can read about in my blog.
mpMRI adds diagnostic information
At the Sperling Prostate Center, we are proud to offer 3T multiparametric MRI (mpMRI) of the prostate for cancerous and benign (noncancerous) disease conditions. In fact, our unparalleled imaging and expert readers can detect tissue changes that indicate prostate inflammation (prostatitis) or other changes in the pelvic bed that may be related to muscle tension or nerve damage.
Preventing worse conditions
If you or a loved one is experiencing long-term discomfort, pain, urinary or sexual problems and antibiotics or other medications have not been helpful, It is important to find out if inflammation is the root problem. We now know that inflammation can be a precursor to prostate cancer. 3T mpMRI can help clarify what’s going on with the prostate gland and other structures in the pelvic area. Don’t wait until the situation gets worse. Contact the Sperling Prostate Center for more information.
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.
[i] Shakur A, Hames K, O’Shea A, Harisinghani MG. Prostatitis: imaging appearances and diagnostic considerations. Clin Radiol. 2021 Jun;76(6):416-426.
[ii] Sandhu J, Tu HYV. Recent advances in managing chronic prostatitis/chronic pelvic pain syndrome. F1000Res. 2017 Sep 25;6. pii: F1000 Faculty Rev-1747. doi: 10.12688/f1000research.10558.1. eCollection 2017.
[iii] http://www.upointmd.com/
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
