So, Dr. Scholz, today we're talking again about prostatitis, and I have to apologize to
our viewers. Obviously, we've covered prostatitis before, but there are so many different variables
and obviously, with its effect on PSA, I think we need to bring even more clarity to the situation.
So, my first question is, "Why does prostatitis matter in regard to prostate cancer?"
Well, you sort of mentioned it with the allusion to PSA. So, we rely on PSA so heavily
for screening, and tracking, and diagnosing, and the wonderful thing would be if PSA only
changed when the cancer changed and sometimes people assume that's the case and it's not.
The PSA can jump around due to non-specific inflammation from prostatitis, from big prostates,
recent sexual activity, and I'd say prostatitis is the most confusing one. People
understand how PSA can be high from non-cancer reasons when the prostate gets big, and of course,
that relates to the old PSA density calculations that we do all the time. The rule of thumb is
that if you take the size of the prostate which is measured with an ultrasound or an MRI, let's say
it's 40ccs—that's the average size prostate—the average PSA for someone with no cancer is going
to be around 4.0. If their PSA is 8.0 but the prostates 80ccs, that's a normal PSA. So,
we're using the PSA for screening and one patient aptly suggested to look at the PSA like a check
engine light, and that — it's not real precise, but it tells you if there's a problem. Well,
when does a check engine light go on? It goes on when the PSA density is abnormal. That's when
the 10 to 1 ratio I just described becomes 15 to 1. In other words, if a man has a 40cc prostate,
but the PSA is above 6, the check engine light just went on—and we're talking about
for screening or for active surveillance. We use PSA to try and determine if cancer is present
and we also try and detect higher grade cancers in men on active surveillance. But
people shouldn't get concerned about their PSA if it's less than 1.5 of what we would expect.
Now, the exception, of course, is that with prostatitis—that's inflammation of the
prostate—you can see the PSA rise above that normal range. The check engine light is on;
the PSA is higher than it should be for that size prostate, but it's not because of cancer.
It's because of prostatitis and that's why we're covering this today. "The prostatitis conundrum"
is taking a really good test, PSA, and injecting a lot of confusion and muddying the water
and making it more difficult to use this tool, this wonderful PSA tool due to the
inflammation that can happen so frequently in men who are under monitoring conditions.
So, you had mentioned that prostatitis is an infection of the prostate. First of all,
can you expand on that a little bit—like how does one get an infection? And also, is it dangerous?
I tend to think of prostatitis in two categories—it's not one thing—but a chronic form
that's not really well understood, it may be sort of an autoimmune thing like asthma or a skin rash
like eczema, and it causes inflammation in the gland probably the immune system is overactive,
and then there's another type of prostatitis, bacterial prostatitis,
an actual infection of the gland like a urinary tract infection and it responds to antibiotics
and oftentimes men feel ill when they get that type of acute prostatitis, bacterial prostatitis.
So, the chronic form oftentimes doesn't really have much in the way of symptoms—maybe some
mild discomfort, maybe a little burning with urination that comes and goes—but
the chronic form is very difficult to eradicate. People may try dietary things, herbal products,
anti-inflammatories to try and reduce its impact but it's and for the most part, I hate to be
pessimistic, but it's not really curable; whereas,
acute prostatitis—bacterial prostatitis—where someone might feel sick or feverish
does respond to antibiotics. That's less common and is generally fixable with antibiotics.
Thank you so much for watching if you would like more information,
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