High PSA: Prostatitis or Prostate Cancer?

The video features Dr. Mark Scholz discussing prostatitis and prostate cancer, and how they affect PSA levels. Prostatitis is inflammation of the prostate that can come from various causes, including infection and autoimmune reactions. The chronic low-grade form of prostatitis is common and causes high PSA levels. Diagnosis between prostatitis and prostate cancer can be challenging, and the PSA levels may bounce around. However, with better imaging techniques, such as PSMA PET scans, the possibility of metastatic cancer can be ruled out. Treatment for prostatitis involves trying different medications, and monitoring consists of periodic PSA testing. The video emphasizes the importance of discussing treatment decisions with a medical team to improve quality of life.

What Medications are Used to Treat Prostatitis?

There is no one specific medication or dose for prostatitis, as treatment can vary depending on the underlying cause of inflammation and the individual patient’s response to medication. However, some common medications that may be used for prostatitis include:
  • Antibiotics: In the case of acute bacterial prostatitis, antibiotics are often prescribed for several weeks. The specific type of antibiotic and duration of treatment may depend on the type of bacteria causing the infection and the severity of the symptoms.


  • Alpha blockers: These medications relax the muscles in the prostate and bladder neck, which can improve urine flow and reduce urinary symptoms. Examples of alpha blockers include tamsulosin (Flomax) and alfuzosin (Uroxatral).


  • 5-alpha reductase inhibitors: These medications reduce the size of the prostate by blocking the production of a hormone called dihydrotestosterone (DHT). Examples include finasteride (Proscar) and dutasteride (Avodart) (be careful with sexual side effects).


  • Anti-inflammatory drugs: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) or naproxen (Aleve) can help reduce inflammation and relieve pain.
The duration of treatment will depend on the individual patient’s response to medication and the severity of symptoms. It’s crucial to adhere to the doctor’s recommended course of treatment and report any negative side effects or deteriorating symptoms.

How to Decide What Antibiotic to Use if Prostatitis is Caused by an Infection

Determining the specific type of antibiotic and duration of treatment for prostatitis typically requires a urine test and possibly a culture of the prostate secretions or a blood test. These tests can help identify the type of bacteria causing the infection and its sensitivity to different antibiotics. The healthcare provider may also consider the patient’s age, medical history, and any other underlying health conditions when choosing an antibiotic and duration of treatment.In some cases, the healthcare provider may prescribe a broad-spectrum antibiotic initially to cover a wide range of potential bacteria, and then adjust the treatment based on the results of the urine test or other tests. It is important to follow the prescribed treatment plan and complete the full course of antibiotics, even if symptoms improve before the medication is finished, to ensure that the infection is fully treated and to reduce the risk of antibiotic resistance.

In this video, PCRI’s Alex and Dr. Mark Scholz discuss prostatitis, that is, inflammation of the prostate. Prostatitis can be symptomatic or asymptomatic, transient or chronic, and it can confuse PSA screening for prostate cancer by inflating PSA results. Here, they discuss how it is identified, if and when it is treated, how it is treated, and how it can potentially confuse PSA testing.

0:07 What is prostatitis and how is it interpreted and treated?

2:05 What causes prostatitis?

3:53 How do you tell the difference between prostate cancer and prostatitis when you are tracking PSA, for example?

5:52 If a person’s PSA is bouncing up and down from prostatitis, what is the range you would expect? In other words, how high can the PSA go from a prostatitis bump?

8:47 What are the treatments that are available for urinary function?