Differential Diagnosis Issues

You should always make sure you’ve seen at least one urologist before deciding that you have chronic prostatitis/CPPS. Here’s why. Patients with supposedly “classic” prostatitis symptoms may turn out to have IC (bladder pain syndrome) or any number of other conditions, including invasive bladder cancer, prostate cancer (with a normal PSA), varicoceles (pain disappears after repairing them), congenital seminal vesicle obstruction, entrapped nerve pain after inguinal hernia repair and primary bladder dysfunction (complete response to pharmacotherapy aimed at bladder muscle and bladder neck problems). That’s why seeing a urologist is essential as a first step.

For completeness, here is a list of some of the afflictions to which the prostate is prone (in no particular order):

  • a granulomatous condition of the prostate accompanying Wegener’s Granulomatosis
  • allergic granulomatous prostatitis
  • allergic prostatitis (Lopatkin, NA et al 1990)
  • amyloid deposits in the prostate during amyloidosis
  • atypical prostate stromal lesions (e.g. extramedullary hematopoiesis in the prostate)
  • autoimmune pancreatitis-associated prostatitis (IgG4-related autoimmune prostatitis)
  • eosinophilic cystitis (can affect the prostate)
  • fistulae from adjacent organs
  • fungal infections of the prostate (e.g. Aspergillus prostatitis, blastomycosis, coccidioidomycosis, phycomycosis etc), usually seen in the immunocompromised
  • malakoplakia/malacoplakia of the prostate
  • melanosis of the prostate
  • prostate stones (calculi)
  • prostatic sarcoidosis
  • prostatic telangiectasia in von Willebrand’s disease
  • prostatic urethral strictures (relatively common)
  • sclerosing adenosis of the prostate
  • seminal vesiculitis may cause prostate symptoms
  • the prostatitis accompanying Reiter’s Syndrome
  • tuberculosis of the prostate
  • various abscesses and cysts (e.g. utricle, Mullerian duct cyst, hemorrhagic prostatic cyst, emphysematous prostatic abscess, hydatid cyst, histoplasma prostatic abscess)
  • various benign and malignant tumors found in the prostate
  • various other forms of Granulomatous Prostatitis (polytetrafluoroethylene (Teflon)–induced prostatitis, silicone-induced prostatitis, and giant cell arteritis).

For frequency and urgency, which are not necessarily part of CPPS, Campbell’s Urology 2002 Edition lists these as some of the causes:

  • Urinary tract infection
  • Bladder pain syndrome/interstitial cystitis (BPS/IC) (now seen as part of CPPS)
  • Upper motor neuron lesion
  • Habit
  • Large fluid intake
  • Bladder calculus
  • Urethral caruncle
  • Radiation cystitis
  • Large postvoid residual
  • Genital condyloma
  • Diabetes mellitus
  • Periurethral gland infection
  • Chemical irritants
  • Detrusor instability
  • Diuretic therapy
  • Bladder cancer
  • Urethral diverticulum
  • Pelvic mass
  • Chemotherapy
  • Bacterial urethritis
  • Renal impairment
  • Diabetes insipidus
  • Atrophic urethral changes