Originally published November 3, 2014
Diagnosing prostatitis can be challenging. The symptoms often overlap with symptoms of prostate cancer (PCa) and benign prostatic hyperplasia (BPH). According to the Cleveland Clinic, a wide range of symptoms including painful urination, frequent urinary urgency, a urine stream that stops and starts, blood in pee or semen, and pain (genital, lower abdomen, lower back) could also mean PCa. Also, prostatitis may cause a rise in PSA, making it even harder to tell if cancer is present.[i]
Standard diagnostic tests don’t always clearly identify prostatitis. Unfortunately, if prostate cancer is suspected, an invasive needle biopsy may be done to rule cancer out. Thankfully, multiparametric MRI (mpMRI) is a noninvasive way to distinguish between the two conditions. A study of 138 patients (94 with prostate cancer, 44 with prostatitis) found that quantitative information from two mpMRI sequences (Diffusion Weighted Imaging, Dynamic Contrast Enhanced) specifically pointed to prostatitis, not PCa. The authors wrote, “Quantitative analysis of mpMRI differentiates PCa from prostatitis with high sensitivity and specificity, appears to have significant potential, and may improve diagnostic accuracy. In addition, evaluating these parameters does not cause any extra burden to the patients.”[ii]
Prostatitis is an inflammation of the prostate gland that affects as many as 50% of men at some point during their lives. It is not a life threatening condition, but chronic prostatitis can make life miserable. The four main symptoms are pain, difficulty urinating, sexual dysfunction, and general health concerns such as fatigue, flu-like feelings, and depression. In addition, as with most irritants to the prostate, it’s common to have an elevated PSA.
This irritation of the prostate gland can be caused by a number of different factors, and because it’s not always clear what the cause is, it is difficult to treat. Causes include
- Bacterial infection
- Viral infection
- Sexually transmitted disease
- Stress
- Irregular sexual activity
- Irritation or injury to the pelvic bed
Treatment is sometimes a process of ruling a cause in or out. For example, if fever or achiness is present, a bacterial infection will be suspected, and if an antibiotic is helpful, then the cause was clearly bacterial. But it’s not always that easy. Some men try different treatments over a long course of time, only to get little or temporary relief.
The symptoms of prostatitis can mimic a few signs of later stage prostate cancer: elevated PSA, urination problems, erectile difficulties, painful ejaculation. Before jumping to conclusions, it’s a good idea to have a 3T multiparametric MRI and an experienced reader to interpret it. This high-tech imaging is generally accepted as the best way to distinguish anatomy within the prostate gland. Many kinds of prostatitis confound less experienced radiologists, who may misread normal (but inflamed) anatomic structures as suspicious lesions.
At the Sperling Prostate Center, we unite sophisticated technology and the expert ability to interpret our prostate images that comes with both experience and collaboration with global authorities. If prostatitis is troubling you, or you’re worried you may have prostate cancer, consider coming in for a consultation and learn what we can do to make your life easier.
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] Uysal A, Karaosmano?lu AD, Karcaalt?ncaba M, Akata D et al. Prostatitis, the Great Mimicker of Prostate Cancer: Can We Differentiate Them Quantitatively With Multiparametric MRI? AJR Am J Roentgenol. 2020 Nov;215(5):1104-1112.
[ii] Ibid.
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.
Leave a Reply
You must be logged in to post a comment.