The Prostate Specific Antigen (PSA) blood test is a reliable indicator of prostatitis. In 118 men, PSA predicted the presence of prostatitis 100% of the time at a level of greater than or equal to 1 ng/ml. The expressed prostatic secretion, EPS, in this group was greater than or equal to 10 wbcs/hpf in all patients. It is recognized that the PSA blood test may also reflect benign prostatic hyperplasia (BPH) and prostate cancer. Given this data, PSA can reliably predict prostatitis. A significant drop off in predictability takes place when PSA is asked to identify BPH or prostate cancer. Voiding symptoms, while predictive of prostatitis may or may not be a clinical finding of significance in men with prostatitis. It is not uncommon for men with prostatitis to be asymptomatic. In 235 consecutive men evaluated and reported on at the 1999 NIH Prostatitis Collaborative, 81% of men less than 50 y/o, N=83, with any level of voiding symptoms, noted prostatitis using an EPS as the diagnostic test. In this same study cohort, 88% of men aged 50 and above, N=152, noted prostatitis if any level of voiding symptoms were noted. BPH is also commonly identified with voiding symptoms making this marker inconsistent to disease specific identification.

It is our belief therefore, that men with a PSA of greater than or equal to one should be treated as if they have prostatitis regardless of the presence or absence of other symptoms. Further research is encouraged in this very important diagnostic point of disease.

Respectively submitted by
Ronald E. Wheeler, M.D. 10/23/00
The Prostatitis and Prostate Cancer Center
www.theprostatecenter.com

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