So, in regard to treatment, now, there's obviously with the PSA, there's so many things affecting the
PSA when it comes to now getting to the process of having prostate cancer and also prostatitis.
So, let's just go down the list of treatments when it comes to prostatitis and prostate cancer.
So, will radiation treatment make symptomatic worse or better?
So, well you've injected another variable. So, we've talked about acute prostatitis, we've talked
about chronic prostatitis, and you're referring to something called radiation prostatitis. So,
radiation prostatitis, again, is inflammation of the prostate. It can cause PSAs to go higher,
and it also comes in two forms. An acute form, which is something that's ongoing during or
immediately after radiation, an inflammatory reaction to the radiation that may last
6-8-10 weeks, and then tends to get better. And then a more chronic type of prostatitis that can
drag on, thankfully, not very commonly, but maybe for a year or two. There's even a third type of
radiation prostatitis that we call the radiation bump which is where someone had radiation 2-3
years ago, and now, all of a sudden the PSA is going up due to delayed radiation in the gland.
We call the PSA bump. So, to answer your question, if someone has pre-existing chronic prostatitis
and now had radiation in addition, it's variable. Sometimes the radiation over time will
actually settle the prostate inflammation down. So, if someone has chronic prostatitis,
has it radiated (the prostate), it may temporarily get worse, and then over time may improve
as the radiation kind of zaps the prostate. So, there's not a real clear guaranteed outcome if
someone has pre-existing chronic prostatitis, has some radiation,
but the general rule of thumb is that short-term it will get worse, long-term, it will get better
I mean, is there any specific treatments that you would do for somebody who has
experienced either of those types of prostatitis
after radiation treatment? Anything in the meantime to get the symptoms down?
There's a long list of things that are used. Probably the most common
are the alpha-blockers like Flomax and Rapaflo.
Standard anti-inflammatories like Aleve and Celebrex are definitely useful. In men that
have a really acute form of radiation prostatitis, in desperate situations, sometimes some cortisone
will be administered. There are other things too: antispasmodics and a long list of things,
and whenever you have a long list of treatments available, it usually means none of them are super
great, and oftentimes men have to kind of suffer through the process until it resolves on its own.
This is really talking about when a man has prostatitis before he gets into radiation.
How will his PSA be affected after treatment?
Right, so when someone has a radiation treatment—when
they have prostate gland, sometimes men get radiation to,
you know, they've had previous surgery, and you're not going to see much impact on the PSA—but
if someone is undergoing radiation and you check the PSA within a month or two, the PSA will often
be higher because of the additional inflammation caused in the gland by the radiation itself,
and then over time, as that radiation effect dissipates the PSA will then settle down.
Is there any data to show that patients with
asymptomatic prostatitis would do better or worse after they've had treatment.
Well, historically, men that have big prostates and a lot of urinary
symptoms as a result of the large prostate (not really prostatitis per se) who are going to get
a bigger dose of radiation because they have a big target—a big prostate—there have been
concerns that those men are going to be at greater risk for long-term urinary problems
after the radiation. So, sometimes doctors will recommend a course of hormone treatment to shrink
the size of the prostate. So, lingering effects of radiation treatment is finished
(lingering meaning, say, more than a year or so) they're probably more related to the genetic
makeup to the human that is getting the treatment. It appears that about 2% or 3% of the general
population has a different type of genetic makeup that doesn't heal very well after radiation.
Some work is ongoing. I had an interview with Joanne Weidhaas, MD, who is doing studies at
UCLA looking at the genetic profile of people before they have radiation to see if they can
predict who these relatively rare patients are. The 2-3% of the population that have slow healing
after they undergo radiation. And so, those people are the most prone to having long-term
problems with ongoing prostatitis type symptoms after they undergo radiation.
So, the presence of symptomatic prostatitis ever affect the treatment decision?
Well, if people are really struggling, then, of course, at least in the short-term,
when they undergo radiation those symptoms will get even worse. So, one of the fears, when people
have radiation, is if their prostatitis gets so serious where they start to obstruct their urine
flow, they might need to have a catheter placed until all the problems blow over,
and that's unpleasant. I mean, if someone's got an inflammatory condition going on and
it's very painful when they urinate or if the urine flow is blocked due to the inflammation, to
have to have a catheter in for a month or more is very undesirable, and so that is one of the risks
that people with pre-existing prostatitis have to count when they think about doing radiation.
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