Hi, I’m Dr. Scholz.
A common question we get at the PCRI is “What’s the difference between BPH and prostatitis?”
BPH stands for “benign prostatic hypertrophy.” What it essentially means is the prostate
is getting bigger—enlargement of the gland.
“Prostatitis” signals inflammation of the prostate. “-itis” means inflammation.
So you have “pneumonitis” that would be inflammation of the lung; “colitis” inflammation
of the colon; “prostatitis” inflammation of the prostate.
So essentially, prostatitis is inflammation of the prostate. BPH is enlargement of the
prostate.
So what are the implications of these conditions?
Well both forms prostatitis and BPH can occur either in a symptomatic form (that means they’re
causing some sort of a problem) or an asymptomatic form—in other words, they’re present but
they’re not causing any pain or discomfort. In the prostate world when we’re talking
about asymptomatic prostatitis or asymptomatic BPH we’re really talking about an issue
with rising PSA levels. PSA is used to try and detect prostate cancer, and when prostatitis
or BPH is present the PSA levels may rise and create some sort of a concern that prostate
cancer is lurking in the background. So BPH and prostatitis can confuse the situation.
Can prostatitis and BPH occur together? Absolutely, yes. In fact, there are some suspicions that
BPH is a result of prostatitis. That’s not confirmed and it’s interesting that after
all these years the true cause of prostatitis and the true cause of BPH is not entirely
clear.
We do know that some forms of prostatitis—particularly symptomatic prostatitis, that’s where men
get frequent urination, pain, or maybe even a fever—often will be coming from a bacterial
infection and it will respond and it will respond generally to an antibiotic such as
Cipro or Levaquin. Those forms of symptomatic prostatitis are relatively uncommon. Most
men may have some vague symptoms or no symptoms at all, and the primary issue is trying to
sort out what a high PSA is coming from.
What about symptomatic BPH (enlargement of the prostate)? Big prostates seem to be blamed
for everything bad that happens to urinary function. A lot of these issues are related
to the bladder. As you know, women can have problems with urination and they don’t have
any prostate at all. But big prostates can cause urinary flow to occur at a very slow
rate; big prostates can cause blockage of urinary flow.
So there are a variety of different treatments implemented on a selective basis depending
on how serious the situation is using pills or various other interventions. The common
pills—just for your information—are Flomax, Rapaflo, Proscar, Dutasteride, and then there’s
a lot of herbal products like saw palmetto for example. So the interventions that are
used transurethral resections (in the old days called roto-rooter jobs) with laser or
knives. They also have new interventions with steam called Rezume, and a way to pin the
prostate open with the methodology called Urolift.
So in summary, prostatitis and BPH are both afflictions of the prostate some of them are
symptomatic, some are totally asymptomatic. Interventions recommended are selected on
the basis of the underlying cause. An accurate diagnosis has to be made to distinguish between
prostatitis and BPH. Treatment is generally very effective.
So in summary, prostatitis is inflammation of the gland. BPH is enlargement of the prostate.
They are two distinct processes, but there may be a relation as some experts suspect
that inflammation is causing the enlargement. As of yet, that hasn’t been proven and the
exact etiology of these conditions is still not clearly known.