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Prostatitis or Chronic Pelvic Pain Syndrome

When the medical profession is unsure about the causes, symptoms or treatment of a condition they often say of it that it is “poorly understood”. Prostatitis is a great example of a medical condition that is “poorly understood”. This makes it all the more difficult for the patient to come to terms with their illness, find answers to their research or to find ways of dealing with it.

Of necessity then, when it comes to writing bout Prostatitis, it is not possible to give definitive or precise advice or guidelines. Here I will attempt as honest an overview as our present ignorance will permit. Furthermore, you may find it of some comfort to realise that we are all in the swim here, doctors and patients alike.

Prostatitis can be divided into two, sometimes overlapping categories:

Acute Prostatitis: This is an acute, usually bacterial, infection of the prostate gland. It is manifest by fever, malaise, rigors, pussy penile discharge and painful urination. It should not be difficult to diagnose and can be treated successful with antibiotics. It can recur or it may go on to become chronic prostatitis. It is often misdiagnosed.

Chronic Prostatitis: This may arise from acute prostatitis though more usually it gradually develops over time without any acute episode. In the main, when we speak of chronic prostatitis we mean a non-bacterial chronic inflammation of the prostate gland. The condition is also referred to as Chronic Pelvic Pain Syndrome or CPPS. The symptoms of chronic prostatitis are many and varied but will include at least some of the following:

  • Chronic recurring low level pelvic pain. This is the worst manifestation of some chronic prostatitis because the pain is very difficult to control and indeed may not be associated in the physicians mind with the prostate gland at all. The diagnosis may be missed. Diagnosis is further complicated by there being no bacteria to identify or culture. Microscopic examination of semen, urine or even prostate biopsy will usually yield negative results.
  • Urinary frequency. This is similar to that experienced by sufferers of Benign Prostate Hyperplasia (BPH) though often in a younger man without prostate enlargement as such.
  • The PSA will usually be raised but a normal PSA should not be allowed rule out chronic prostatitis or Chronic Pelvic Pain Syndrome.

A word about PSA:  PSA means Prostate Specific Antigen and is a blood test used to screen for prostate cancer. And while the test is specific to the prostate it is NOT specific to prostate cancer. We have just seen that chronic prostatitis can raise PSA levels. So too can Benign Prostate Hyperplasia (BPH) raise PSA. If you are discovered to have a raised PSA of say 10 mm/L it is important to bear this in mind and to not be panicked into agreeing to undergo prostate biopsy. Take your time and check PSA again in 3 months time. Prostate biopsy carries a 1% mortality rate and that is too great a risk for too little reward.

Treatment of Chronic Prostatitis: The treatment of Chronic Pelvic Pain or prostatitis is, in the main, symptomatic management. The most important thing is to have a health care professional who understands your symptoms and your pain and is not dismissive or worse, suggesting that this is all in your mind.

If you are worried that you may have chronic prostatitis and are not happy with the care you are receiving then please get in touch with us here. We would be delighted to try and help you.


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