Is antibiotic treatment necessary to treat prostatitis?

Hi doctor,

I am consulting you about a prostate gland problem. I am having a problem in passing urine, and there is a pain in the lower abdomen up to the scrotum and the testicles, but no fever yet. I saw the doctor a few days back, and he prescribed a blood test and my PSA level has been > 8 ng/dl. I have symptoms of prostatitis. Around five months back, a urologist did sonography and found a gland that was swollen, with scars on it (from older prostatitis) and a "harder" outer shell consistency. The doctor suggested that I take Ciprofloxacin 500 mg thrice daily for three weeks to avoid a full-fledged infectious syndrome and to drive the PSA value down. I was told that eventually, I should go for a biopsy too. My question is do I need to take the antibiotics treatment? What would be the criteria to apply to the decision? Can a urologist go for a biopsy under the present high PSA levels? Is there a chance that the PSA value will go down again, with or without antibiotic therapy? What is an evidence-based approach (best conduct) in this case?

Thank you for your guidance.

Hi doctor,

Thank you for your assessment and advice.

Just to add two more concerns. Can I practice biking under these circumstances, is there any risk? Can I use real lavender oil in my humidifier? Are there any adverse interactions of concern with the prostrate gland hormone system?

Thank you doctor for the reply,

In the search for indications of carcinoma of the prostate gland, an MRI exam was conducted, and below are the translated findings from the prostate report:

1. There is a discrete enlargement of the prostate (1.57 x 1.77 x 2.16 inches; volume - 51 cm²) with an inhomogeneous internal structure, indicative of prostatic hyperplasia.

2. An oval-shaped focal point is observed in the posterior region on the right side (9:00 AM position), measuring 0.39 x 0.19 inches. This focal point appears hypointense in T1 and T2 weighted images, mesointense in DWI, and ADC. It is not distinguishable from the normal prostate structure in the lower part. Prostate evaluation (PE) is recommended in this regard. Seminal vesicles appear normal, and the urinary bladder is adequately filled with fluid and has a smooth wall contour. No pathological enlargement of lymph nodes is observed in the imaged area. The inguinal region on both sides is unremarkable.

Evaluation: Prostate hyperplasia with suspicious focal point in the posterior right floor area, categorized as PI-RADS v.2.1 - 3.

It is worth noting that back in the 90s, I experienced prostatitis, possibly due to intensive biking. At that time, the urologist identified a scar on the surface of the prostate gland. I am curious whether the hyperplasia detected by the MRI could be linked to this unevenness or scar on the gland's surface. Regarding sharing the MRI images with you, could I provide screenshots or send the file to facilitate visualization on your end?

Thank you for your help and support. Kind regards.

Thank you doctor for the reply,

I have successfully completed a new PSA test, and the results are presented in the attached documents. Could you please confirm the nature of the tumor identified by the multiparametric MRI on the prostate gland? Should I arrange for additional PSA tests every three months? Also, considering that the MRI was conducted without a contrast agent, how dependable is the PIRAD score?