Prostate Cancer and Prostatitis

[Phil Klezmer]

My last PSA went from 2.6 to 4.0 this gave my Urologist a reason to do a Biopsy which came back that I have Cancer in 2 cores out of 12 sampled.  I think the reason for the spike in my PSA was due to the inflammation of the Prostate.  I've had urinary problems (Prostatitis) for 3 years on and off.  |I guess I should be happy that a biopsy was taken and the cancer was caught in the early stages.  Now I have to decide how to treat it.  I think the only choice is Surgery.  I'd like to go with Proton Therapy Radiation but I fear that the cancer may be cured but the |||||||Prostatis may get worse.  Anyone out there with a similar case?  All help appreciated.  Thank you

[Arnon Krongrad, MD]

Others have had chronic prostatitis and prostate cancer. (another example). So in a general sense, sure, there others with somewhat similar cases.

 

To the best of my knowledge, and please let me know if you find to the contrary, there are no published cases of prostatitis being cured with prostate radiation. Conversely, there are thousands of cases of radiation causing prostatitis, cystitis, and proctitis. So instinctively one would not easily find a reason to embrace radiation as a two-birds-with-one-stone solution in a case like yours.

 

Not sure you're heading there, but for your interest here is a recent piece on proton beam radiation.

 

Incidentally, just fyi, a recent study found that prostatitis has no effect on PCA-3.

 

[Phil Klezmer]

Thank you for the quick reply and the links to the articles.  So in your opinion the only treatment I should have is surgery.  Again  if you had to place a number on the chance of  curing the protatitis or at least improving it by having you do the surgery  ( 1 being the worst and 10 being the best)  how would you rate it?   Thank you Phil K

[Arnon Krongrad, MD]

Let me clarify: I have not expressed an opinion about your preferred treatment for either condition, other than to suggest that there is no support for the idea that radiation cures prostatitis.

Prostate cancer and chronic prostatitis may be treated to variable effect by a huge array of possible approaches. To target them requires an examination of their possible pros and cons in the context of your detailed circumstances, which has not yet been done, at least not in this discussion thread. I just want to be careful to distinguish between the academic, generic points above and a specific treatment recommendation for a specific patient.

 

In the simplest of terms, in that I have not reviewed your records or examined you or even had a chance to see all the details of your case, it feels instinctively that the likelihood of curing both the prostatitis and the prostate cancer with surgery hovers around a 9.

[Phil Klezmer]

Thank you for your opinion.  I understand without examining me or reviewing my records it is hard to put a number on it.  Do you also do Robotic radical prostatectomy ?  Do you prefer laparoscopic

[Arnon Krongrad, MD]

Just to be clear, "robotic" surgery is laparoscopic surgery. To your question, I have used numerous "robots" in the laboratory setting and 3 different kinds of "robots" in surgery. Here is a recent story from one of my patients, an anesthetist, that specifies the daVinci "robot" that I used in his case. His cancer was a higher grade and stage, so we're not comparing "apples" to "apples" but this may still interest you.

[Phil Klezmer]

What percentage of patients for prostatitis also have prostate cancer?  How do you determine that a person has prostatitis?  Urologists that I've met with are very uncertain as to what it is.  Most of the time they call it UTI or sometimes BPH.  They prescribe Cypro, Flomax, drink lots of water and after a few weeks it goes away, only to return again.