Andrew John Rynne, MD  
Male, 79
Dublin, Ireland

Specialties: sexual dysfunctions, reverse vasectomy

Interests: sexual medicine, Testosterone Therapy
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Prostatitis or Chronic Pelvic Pain Syndrome - CPPS

Jun 09, 2014 - 4 comments



chronic pelvic pain


chronic pelvic pain syndrome


pelvic pain


Raised PSA




acute prostatitis


chronic prostatitis

Prostatitis – the little understood condition.

When the medical profession is unsure about the causes, symptoms or treatment of a condition they often say of it that it is “poorly understood”. Prostatitis is a great example of a medical condition that is “poorly understood”. This makes it all the more difficult for the patient to come to terms with their illness, find answers to their research or to find ways of dealing with it.

Of necessity then, when it comes to writing about Prostatitis, it is not possible to give definitive or precise advice or guidelines. Here I will attempt as honest an overview as our present ignorance will permit. Furthermore, you may find it of some comfort to realise that we are all in the swim here, doctors and patients alike.

Prostatitis can be divided into two, sometimes overlapping categories:

Acute Prostatitis: This is an acute, usually bacterial, infection of the prostate gland. It is manifest by fever, malaise, rigors, ***** penile discharge and painful urination. It should not be difficult to diagnose and can be treated successful with antibiotics. It can recur or it may go on to become chronic prostatitis. It is often misdiagnosed.

Chronic Prostatitis: This may arise from acute prostatitis though more usually it gradually develops over time without any acute episode. In the main, when we speak of chronic prostatitis we mean a non-bacterial chronic inflammation of the prostate gland. The condition is also referred to as Chronic Pelvic Pain Syndrome or CPPS. The symptoms of chronic prostatitis are many and varied but will include at least some of the following:

• Chronic recurring low level pelvic pain. This is the worst manifestation of some chronic prostatitis because the pain is very difficult to control and indeed may not be associated in the physicians mind with the prostate gland at all. The diagnosis may be missed. Diagnosis is further complicated by there being no bacteria to identify or culture. Microscopic examination of semen, urine or even prostate biopsy will usually yield negative results.
• Urinary frequency. This is similar to that experienced by sufferers of Benign Prostate Hyperplasia (BPH) though often in a younger man without prostate enlargement as such.
• The PSA will usually be raised but a normal PSA should not be allowed rule out chronic prostatitis or Chronic Pelvic Pain Syndrome.

A word about PSA:  PSA means Prostate Specific Antigen and is a blood test used to screen for prostate cancer. And while the test is specific to the prostate it is NOT specific to prostate cancer. We have just seen that chronic prostatitis can raise PSA levels. So too can Benign Prostate Hyperplasia (BPH) raise PSA. If you are discovered to have a raised PSA of say 10 mm/L it is important to bear this in mind and to not be panicked into agreeing to undergo prostate biopsy. Take your time and check PSA again in 3 months time. Prostate biopsy carries a 1% mortality rate and that is too great a risk for too little reward.

Treatment of Chronic Prostatitis: The treatment of Chronic Pelvic Pain or prostatitis is, in the main, symptomatic management. The most important thing is to have a health care professional who understands your symptoms your pain and is not dismissive or worse, suggesting that this is all in your mind.

If you are worried that you may have chronic prostatitis and are not happy with the care you are receiving then please get in touch with us here. We would be delighted to try and help you.

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Avatar universal
by tnt1984, Mar 08, 2015
Hi im suffering from some symptoms my urologist and pcp cant seem to figure out.  Ive had 3 std tests, and 3 cultures. Tested for chlamydia gonorrhea ureaplasma Mycoplasma hiv syphilis all neg. Cultures neg as well. Blood test for diabetes, prostate exam also neg. For about 6 weeks my symptoms have been constant urge to urinate, feeling of full bladder, about 4 times ive had small amount of clear discharge. The urge has calmed down quite a bit. It actually seemed to go away for about three days then started up again. Now it is back to calm, almost completely gone. I believe in this time my urethra got irritated from all the peeing ive been doing.  I thought i had NGU, becuase of urge, frequency, discharge, and a slight irritation in my urethra.  I have no burning pain bumps or lesions. Someone on here pointed me to chronic pelvic pain syndrome. Seems plausible. My urologist said he thinks its from havig the flu and the virus is escaping my body through the bladder and said im fine, but i don't feel fine. Symptoms are urge, frequency, feeling of full bladder, urethra irritation , occasional small clear discharge. Any thoughts? Could this be prostatitis or cpps?

Avatar universal
by tnt1984, Mar 08, 2015
Also pcp put me on flomax (alphablockers) whih seemed to help a great deal but bad side effects. I am 30 yrs old

1667242 tn?1487950547
by AndrewRynneMD, Mar 09, 2015
Were you ever on Propecia?

Avatar universal
by 6316jon, Apr 26, 2016
Hello, your post is very clear.

I am booked for a biopsy next week. I have had PSA 3.97 and 4.44 -- 6 weeks apart. I am 58. DRE by UK NHS urologist found smooth, slightly enlarged and firm on RHS and explained side effects of a biopsy but did not mention any risk of mortality. I am probably going to go ahead with this biopsy and have already had an MRI scan.

  I do have CPPS symptoms with lower back RHS low level chronic pain and RHS  night tremors (probably connected with intestine) and occasional sweating at night -- ongoing for months. These are seen as unconnected by my GP and urologist.

Would you recommend that I go ahead with the biopsy, and is your mortality risk as stated, bearing in mind my age the MRI and present UK practice?

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