An emailed newsletter I received today from Johns Hopkins said the
following about prostatitis:

"Nearly 95 percent of men with prostatitis (inflammation of the
prostate) are believed to have the chronic nonbacterial form -- also
known as chronic pelvic pain syndrome, or CPPS. Chronic nonbacterial
prostatitis may last for several weeks or longer, only to disappear and
then flare up again. The pain of CPPS can wax and wane; it is much worse
on some days than on others. There's no good explanation for the
variation in intensity."

(See: http://tinyurl.com/3rba36r)

If that's true, then when a urologist prescribes antibiotics to "rule
out prostatitis as the cause of the PSA rise", he and the patient have
only a very, very small chance of learning anything.

95% of prostatitis patients cannot be cured by antibiotics. Antibiotics
will do nothing if there is no bacterial infection. Of the 5% who can
be cured, some percentage probably won't be because the particular
bacterium they have is resistant to the particular antibiotic or for
other possible reasons.

So who are we kidding when we take antibiotics to avoid a biopsy? We
clearly aren't "ruling out prostatitis" if the PSA fails to come down.
And if the PSA does come down, it's more likely to have come down
because the prostatitis "can wax and wane" in the words of the Hopkins
author, and in the 28 day course of antibiotics the prostatitis "waned"
enough to produce a lower PSA.

I would suggest that we'll get almost as much benefit from just
retesting PSA a month later as we'll get from taking antibiotics and
then retesting, and we'll have no antibiotic side effects.

Furthermore, if the urologist were to query the patient about the
possibility of prostatitis, he'd be more likely to find out if
prostatitis is involved than if he prescribed antibiotics. Yet how many
urologists actually bother to ask the patient any questions about any
history of discomfort in the prostate region that might indicate
prostatitis?

What have I got wrong here?

I would suggest that any patient with an elevated PSA ask his doctor
about just waiting a month and testing again, and maybe another month,
and maybe even another month if the PSA is jumping around. We may be
able to avoid some unnecessary biopsies and make better use of "active
surveillance" than we do.

Alan