Chronic prostatitis: Q&A

My dad (he's 60) was recently diagnosed with chronic prostatitis. It all started about a month or two ago with the typical symptoms—frequent, painful urination. He spent a few weeks on antibiotics and the symptoms cleared up, but his prostate remains enlarged at about 26 grams. I haven't been able to look over his full medical history because, for obvious reasons, he’s being pretty tight-lipped about it. I suspect he's just embarrassed. There's also a possibility he’s dealing with some epididymitis, maybe some inflammation in the scrotum.
Anyway, the next step is for him to get a PSA test. I know it's standard protocol for an enlarged prostate and that men his age really should be getting these checked regularly, but I can't help feeling anxious about it. Especially with my old man; he's acting like a nervous wreck. He’s never been seriously ill before, and he’s stuck in that old-school mindset where he thinks once you start seeing specialists, you're basically finished.
Okay, enough rambling. I wanted to ask anyone who actually knows about this or has gone through it themselves: what should we realistically expect? My guess is that his PSA levels will come back elevated due to the recent inflammation, so hopefully, that won't raise any major red flags.

Yeah, it’ll be slightly elevated. But if it's a significant jump—then we're talking about needing much more detailed testing.

Michelle Cook83 said:Yeah, it’ll be slightly elevated. But if it jumps significantly, they're going to need to run more detailed tests.

I'm assuming "more detailed" means jumping straight to a biopsy, or is there some middle ground I'm missing?

Look, there's zero point in testing PSA while an infection is still raging. Prostate enlargement is just part of the territory once you hit a certain age; it’s usually what triggers those bladder issues and leakage, which then spirals into full-blown systemic infections—especially if you're dealing with kidney stones on top of it. If the levels come back high, a biopsy might be the next move, but that's for the urologist to call. It’s typically an outpatient thing.

Ryan Vaughn7 said:I'm assuming this means they're looking closer at the biopsy—basically, there's nothing else going on in between?

A transrectal ultrasound before the biopsy, plus a CT scan of the lower pelvis.

PSA levels can be quite tricky. They aren't particularly reliable, especially in cases involving clinical prostatitis. Many people suffer from asymptomatic inflammation without knowing it, leading to elevated readings that cause unnecessary panic... As Michelle Cook83 mentioned, I am somewhat uncertain about the necessity of a CT scan, particularly if a biopsy confirms simple BPH paired with inflammatory infiltration. Since you are already seeing a physician, it might be worth suggesting a colonoscopy. If one hasn't been performed recently, it’s certainly time, given that standard guidelines typically suggest a follow-up every two years provided the previous results were clear.

I would like to ask a physician—perhaps a urologist if they happen to be reading this—to clarify something for me. Is a total prostatectomy truly the only definitive solution for an enlarged prostate of this size (92mm), regardless of whether the condition is benign or malignant? Additionally, I am wondering if hyperplasia is an irreversible process. My sincere thanks.