I recently posted a blog on the relationship between prostate inflammation (specifically, prostatitis) and prostate cancer. I opened with the question, “Is there a connection between prostatitis and prostate cancer (PCa)?” We still don’t have a conclusive answer, but experts do recommend that men with the uncomfortable or even painful condition called prostatitis be informed that they may have a higher chance of eventually being diagnosed with PCa.

In January, 2023 Dr. J Curtis Nickel (Queen’s University, Ontario) delivered an online presentation on the same topic. However, instead of asking, as I did, whether prostatitis can lead to PCa, he explores what happens when a PCa patient develops prostatitis at the same time as his cancer.^[i] He speaks with both knowledge and passion because this topic is close to his heart. I want to share his main points:

1. On slides of prostate tissue, prostatitis can be readily distinguished from healthy prostate tissue, PCa, and BPH. Rather than speaking about bacterial prostatitis (easy to diagnose, easy to treat), Dr. Nickel focuses on chronic prostatitis/pelvic pain syndrome (CPPS) which is harder to diagnose and treat because it entails complicated pathways leading to this inflammation.
2. Trauma can instigate the development of prostatitis, and some PCa treatments like radiation or ablation cause trauma to the prostate gland. In addition, other physiological systems such as the endocrine system, immune function, neurologic system, and psychological factors can modulate the progression of CPPS in susceptible patients.
3. Prostatitis can mimic other prostate conditions, especially BPH and PCa, and it does not necessarily predict symptoms, making diagnosis challenging. However, for patients already suffering with CPPS, the one thing that can be predicted is progression. This is particularly relevant for PCa patients who have existing CPPS prior to cancer diagnosis (see #7 below)
4. Situation: a PCa patient who reports bothersome CPPS symptoms like:
   • Nerve or other pain (chronic, episodic, dull, sharp, electrical) in the pelvic floor, penis, scrotum, pain with ejaculation)
   • Urinary symptoms
   • Impaired quality of life, activities and overall health perception
5. Administer the Chronic Prostatitis Symptom Index questionnaire; discuss with patient; examine patient; rule out infection (urine cultures); ascertain history (get a timeline); cystoscopy; imaging 6. Types of symptoms vary widely among patients. Standard treatments are dismal, and might be even worse for PCa patients
6. For PCa patients who already had CPPS before cancer diagnosis, diagnostic and treatment procedures (e.g., needle biopsy) can create prostate trauma that worsens their CPPS. Warn the patient this is a possibility, and take their CPPS into account in making PCa treatment decisions.
7. PCa patients at risk of developing prostatitis are those treated with radiation (beam, seeds or combination), those with previous TURP (“reaming out”), those with large glands, those with lower urinary tract symptoms. Radiation may worsen urinary symptoms. If these occur, treatment may include antibiotics, alpha blockers, anti-inflammatories, or simply wait to see if symptoms ease over time.
8. Prostatitis can even occur with no prostate! Some prostatectomy patients experience chronic pelvic pain symptoms after gland removal. They describe pain as stabbing, burning. Treatment should approach this as a neurological (nerve) condition.
9. Evolving minimally invasive PCa procedures (focal laser ablation, ultrasound ablation, cryotherapy, etc.) are now finding their way into the PCa + prostatitis space. Dr. Nickel does not have experience with these, and does not know if this will lessen or increase CPPS risks and symptoms. He imagines management strategies will be similar to those already mentioned.

CPPS impacts PCa patients significantly. Dr. Nickel notes that PCa patients with CPPS deserve the respect of their doctors. It’s still unknown territory, yet treatment is needed to manage their symptoms while taking into account urinary, psychosocial, organ-centric, and other symptoms.

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.
If you or a loved one has PCa or is at risk of PCa and also suffers with acute or chronic prostatitis, contact us to find out how our services can assist with treatment planning.
 

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] Nickel, J. Curtis. “When Men with Prostate Cancer Get Prostatitis.” January 2023, 2023. Accessed Oct 2023.
https://grandroundsinurology.com/when-men-with-prostate-cancer-get-prostatitis/

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.