prostatitis, muscle tension, infection, psychosomatic pain or something else?

I am a 28 yr old male. I have had 8 months of consistent pelvic, perineal, lower back and penile tip pain/inflammation. I have also had a clear mucous like discharge. I have been throughly tested for stds, uti's and anything else that my doctor thinks may cause my symptoms.  all of which were negative aside from a count of 10 white blood cells in my urine. i have been on noroxin, keflex, azithromycin, diflucan and doxycycline. I have had a psa test of 2.3 which i know is high for my age. I have had ultrasounds, ct scans, xrays and a bone scan. all of which were fine. i have visited a urologist, dermatologist, immunologist and psychologist. Had a DRE on three occasions and it wasnt enlarged or inflamed. it was not tender or painful to touch and  my urine flow is fine and frequency is fine. my doctor is at a loss with what to do. In one hand he said the clear mucous discharge, the fact that there are white blood cells in my urine, and my psa being 2.3 is all suggestive of an infection. My doc would have said prostatitis, but he said given my prostate size is normal, its not inflamed, my flow is fine, erections and ejaculation are fine and there is no pain during a DRE,  it doesnt add up for prostatitis.  Do you know what could be causing the clear mucous discharge? It happens during times of stress, after urination and when im in more pain. Do you think i have prostatitis? My doc has offered drugs like lyrica and valium but im hesitant going down that track. im also getting osteopathic treatment to relieve muscular tension in the pelvis. I have an appointment with sydneys leading sexual health professor on thursday and i am getting a semen analysis done. i also have a appointment with a top urologist later this month. is a prostate biopsy a viable option to diagnose prostatitis? i have purchased the book "A headache in the pelvis".im in constant dull pain 24/7, its made worse by stress and i just need to know whats going on and what i can do to alleviate this.

[Stephen Liroff, MD]

PSA is not an absolute indicator of anything. Your value may be higher than expected, but that certainly does not make a diagnosis. Your urologist is your guide. He may get serial PSA's to look for trends, but bear in mind that PSA values may vary day to day.
I am pleased to learn that you are so improved.
S.A.Liroff, M.D.

[Concerned_guy786]

Update: I visited sydneys best Sexual Health Physican yesterday, Professor Basil Donovan. He thinks that my pain is muscular and he could not see the penile tip inflammation. He believes that muscles around my pelvis are chronically tight through stress and that this tension is putting pressure on the prostate and is possibly the cause of the clear mucous discharge. He is sceptical of prostatitis as a diagnosis. He thinks i would have had pain during a DRE if my prostate was inflamed. And obviously its not enlarged as i have no problem with flow and no enlargement was seen in ct scans or ultrasounds. He said another explanation for the discharge is a simple low grade infection and that a count of 10 wcc is not significant. He does not think its any form of STD but he is doing his own round of urine tests for mycoplasma, adenoviruses, herpes, chlaymida and gonohrea. He also did another PSA test and a semen analysis. I will get the results for these in about a week or so. I have my urologist appointment in two weeks. my main goal is to rule out bacteria and viruses and find out if the prostate is inflamed or not. If i can verify all of this. I will concentrate on physio for my muscles and therapy for my anxiety to get over this problem.

What do you make of the professors opinion?
I have never heard of herpes being tested in urine. is it possible?
can the urologist tell if my prostate is inflamed?

[Stephen Liroff, MD]

I think that Professor Basil Donovan’s assessment makes great sense. He is diligently ruling out everything else again, but he has a clinical feeling with which I totally agree. I am not familiar with urine testing for herpes. I certainly do not think that there is an indication for doing a prostate biopsy as you mentioned earlier. I do think that you may benefit from a mild tranquillizer for the short term while you are working on muscle relaxation, but you are seeing an individual who obviously has experience in this area and knows your individual situation much better than I.
Your urologist can tell from your symptoms and culture whether there is  clinically relevant prostatic inflamation (inflammation).
Good luck!
S.A.Liroff, M.D.

[Concerned_guy786]

Thanks for your reply. Just one further question. I recieved my psa and semen results today. My semen analysis showed no bacteria and my psa was 2.0 (my psa in march was 2.3). As my psa is still high for my age does that mean prostate cancer is a possibility? I take comfort in the fact that is lower then my previous test and would think that if prostate cancer was involved then my psa would be increasing and not decreasing. As for the muscle relaxants go, i have taken up my gps offer on these. Since taking them, i feel great. I am in no pain whatsoever and i have only taken them twice thus far. I would think that if there was a prostate problem, then i would still be in some form of discomfort regardless of the muscle relaxants. So im starting to believe that i dont have a prostate problem. I am also taking the Lyrica now, but i only intend to take one course of that. I feel that i am doing all the right things here. Taking the necessary medications along with specialist advice and therapy. but anyway if you can answer my question above regarding prostate cancer that would be appreciated.

[Stephen Liroff, MD]

Prof. Donovan is the person to really address this first hand, it seems to me.
Prostate cancer is way down on the list of possibles. If your anxiety persists in this matter, ask the professor about  a repeat PSA after not having an orgasm or rectal exam, rectal sex, for three days or more and see if that result isn't still lower (as you implied, downward trends are reassuring). Also, a percent free PSA may give you some additional indication of the likelihood that your PSA value is or is not related to cancer.
S.A.Liroff, M.D.