Prostatitis is one of those medical conditions that is hard to pin down and even more difficult to cure. According to the Prostatitis Foundation, “Prostatitis is an inflammation of the prostate gland, often resulting in swelling or pain. Prostatitis can result in four significant symptoms: pain, urination problems, sexual dysfunction, and general health problems, such as feeling tired and depressed.” Urologists estimate that at any given time, 5-10% of men suffer from prostatitis. When patients come in complaining of pain in the pelvic bed, they will be asked about the history of the symptoms, and diagnostic tests will be done. These may include blood, urine and prostate fluid analysis as well as a digital rectal exam. There is no standard treatment, but most men with symptoms of prostatitis (for which no other cause can be found) will be given a course of antibiotics. Sometimes this helps, but in most cases the same symptoms will continue or return after a temporary let-up.
An August 2016 article on using only anti-inflammatories with no antibiotics had some promising results. For study purposes, patients with PSA greater than 4.0 ng/mL were diagnosed with prostatitis based prostate biopsy samples; none of them were found to have prostate cancer (PCa) on initial biopsy. The goal of the study was to determine if treatment using only anti-inflammatories (no antibiotics) would be well-tolerated and effective in lowering PSA.
The authors enrolled 140 participants who were divided into two equal groups of 70:
- Group 1 consisted of men found to have inflammation on biopsy (no PCa)
- Group 2 were those who were not.
Both groups were given a three month protocol of anti-inflammatories that included nimesulide (not available in the U.S.), saw palmetto, bromelain (derived from pineapples, it reduces inflammation), and quercetin (a plant pigment found in many foods, it is an antioxidant and can help reduce inflammation).
At the end of the trial period, PSA blood draws and repeat 16-core biopsies. The results are interesting:
|Group 1 (initial inflammation)||Group 2 (no initial inflammation)|
|PSA||Average baseline PSA of 7.3 dropped to 4.6||Average baseline PSA of 7.2 dropped to 7|
|2nd biopsy||20% (14/70) diagnosed with PCa||18.5% (13/70) diagnosed with PCa|
Study participants whose PSA was below 4 in both groups were cancer free on the repeat biopsy, but the rate of picking up PCa was almost equal in both groups, only slightly higher in Group 1. Inflammation is thought to be a possible precursor of cancer, but despite the small sample size, there is no evidence for that in this study. Also, the drop in PSA was greater in Group 1, and practically nonexistent in Group 2, suggesting that the treatment reduced inflammation but had no negative effects on men who did not have prostatitis.
Perhaps nonsteroidal, over-the-counter anti-inflammatories and commonly available supplements (saw palmetto, bromelain and quercetin) have the potential to help men who suffer from nonbacterial prostatitis. However, it is important to avoid self-diagnosis and self-treatment. If you have any of the symptoms of prostatitis, see a doctor for professional evaluation. Also, multiparametric MRI on a 3 Tesla magnet can tell the difference between healthy prostate tissue vs. inflammation. Imaging before taking antibiotics or undergoing a biopsy can be very helpful in diagnosing prostatitis. If you are interested in image-based analysis, contact our Center to learn if multiparametric MRI is right for you.
Copyright by Dan Sperling, MD. Reprint permission courtesy of Sperling Prostate Center (New York, Florida), the leading U.S. center for multiparametric detection, diagnosis and image-guided focal treatment of prostate cancer.
Read more in our Prostatitis Health Center.
Gallo L. The effect of a pure anti-inflammatory therapy on reducing prostate-specific antigen levels in patients diagnosed with a histologic prostatitis. Urology 2016 Aug; 94:198-203.