A Holistic and Scientific Approach to Chronic Prostatitis
Chronic prostatitis is a collection of complaints that seriously impairs men's quality of life, often plunges the patient into a psychology of helplessness, and whose exact cause cannot be fully explained. In this article I will try to describe the experience I have gained from more than 1,000 patients whom I have diagnosed and treated over 9 years of urological practice, and the innovations I have learned from the latest papers by the most authoritative scientists on this subject. (Links to the scientific papers can be found at the end of the article.)
First of all, to diagnose this disease one must know it well. Unfortunately, because the disease is not well known, its diagnosis can be missed for years. According to a study by Krieger and colleagues, this disease is present in 2% to 16% of men under 50 (1). Another problem is that because the disease is not fully recognised, the average time to diagnosis is 7 years (2). In my experience a diagnosis can only be made after at least 6 months to 2 years. The reason for this confusion is that the disease presents differently in every person and affects every patient to a different degree. Some patients have persistent burning when urinating, testicular pain on ejaculation, frequent urination, leg pain, itching and an unpleasant feeling inside the penis, pain and a feeling of fullness behind the testicles and in front of the anus, inability to sit on hard surfaces, constantly thinking about that area and feeling restless, reduced or absent erections, tingling at the tip of the penis, unexplained aggression and irritability and, most importantly, a feeling of helplessness. Some patients are so desperate that they contemplate suicide and may even want to have their prostate surgically removed to get rid of these complaints.
Diagnosing a disease that presents in so many different ways is genuinely difficult. First of all, a patient suspected of having prostatitis must be listened to seriously and without interruption, because before coming to you this patient has consulted at least two urologists.
Shoskes et al. from the Cleveland Clinic, who have conducted serious research on this subject, explained the possible causes of prostatitis in the World Journal of Urology as follows (3):
Infection, trauma, allergy or drug use, excessive stress and depression, which can cause tissue damage in the prostate and bladder.
One or several of these may occur at the same time. According to a widespread belief, which in my experience is very likely wrong, most cases are caused by a sexually transmitted disease. But in the classification of prostatitis the most common type is non-bacterial prostatitis, i.e. prostatitis not caused by bacteria. That is why in most cases no bacteria grow from the urine samples taken from patients. What is known for certain is that there is an inflammatory process in the prostate, and inflammation does not always require a bacterium: the body's immune system, for example, activates chemokines and cytokines in a state of excessive stress or trauma and causes inflammation in that area. That is why the patient feels pain during prostate massage, since the prostate is inflamed, and when the fluid from the penis is examined under the microscope leukocytes are seen. A count of 10 leukocytes or more favours prostatitis. Again, in my clinical experience, deciding whether prostatitis is present or absent on the basis of leukocytes alone is not a sufficient criterion for diagnosis. It is of course a valuable finding, and taking a sample of that fluid immediately afterwards and testing it by PCR for 14 different sexually transmitted microbes helps us plan treatment. When the PCR result shows a bacterium our job is relatively easier, because we can give antibiotics according to that result. Even if the result is negative, antibiotics should be given for at least 6 weeks. Shoskes writes that antibiotics can reduce inflammation in the prostate even in the absence of bacteria, so giving antibiotics even when the result is negative is not a wrong approach.
When evaluating and diagnosing a prostatitis patient, these 7 criteria should be examined:
- Is there a voiding disorder? (a feeling of incomplete emptying, relief after urinating, burning when urinating)
- Is there a psychological impact? (a feeling of helplessness, the thought that this disease has affected their whole life, or signs of depression)
- Organ-specific findings (prostate tenderness, blood in the semen, frequent urination)
- Infection (positive culture of the prostatic fluid despite a negative urine culture)
- Neurological/systemic symptoms: pain that may occur outside the pelvis
- Tenderness (tenderness and pain in certain muscle groups, especially the perineal region — the area behind the testicles and in front of the anus)
- Sexual dysfunction (erectile dysfunction, loss of libido).
At the diagnostic stage a transrectal ultrasound should be performed to check for prostate stones, and if necessary prostate massage should be added to the treatment plan.
After the diagnosis is made, the patient's condition should be explained in detail and the treatment stage should begin. When planning treatment: “Just as one size of suit does not fit everyone, the treatment of this disease must be tailored and adjusted for each person”, because the disease manifests differently in everyone.
Before starting treatment one must KNOW THE DISEASE WELL. Every patient should complete the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) form, and a treatment plan should be arranged according to the score. For example, for a patient with a voiding disorder, muscle tenderness and bacteria growing in the prostatic fluid or a high leukocyte count, treatment should be planned as a prostate medication or an anticholinergic bladder medication to correct the voiding disorder, Kegel exercises to strengthen the pelvic muscles and 6 weeks of antibiotic therapy. Antioxidant treatments used in chronic prostatitis (quercetin, pumpkin seed oil, bee pollen, green apple peel, nettle) help treatment by reducing the chemokines and cytokines that cause inflammation in the prostate. Vitamin supplements such as Liqone complex should be used for about 3 months. Even if no bacteria are detected in the urine culture or prostatic fluid culture, a weekly antibiotic course should be recommended for its anti-inflammatory properties.
If the patient's psychology is severely affected, seeking psychological support is not a wrong approach, and the medications recommended for a period should be used.
Changing one's lifestyle is helpful in coping with chronic prostatitis.
Foods that aggravate prostatitis: hot and spicy food, caffeine consumption, alcohol.
Foods that relieve prostatitis: bicarbonate, drinking plenty of water, low-fat milk.
In prostatitis, injection treatment into the prostate with a so-called antibiotic cocktail, or burning the tissues from inside with heat via a catheter, are practices with little place in the literature.
Finally, if you have understood and accepted the disease in every sense, there is no need to fear it and you are not helpless. When a prostatitis attack occurs, with the appropriate multiple treatment (at least 2 different groups of drugs plus vitamin support, according to the results of the tests performed) you can cope with this disease easily and live through the attacks without your quality of life being impaired. Catching a chill, being under stress, consuming fermented alcoholic drinks and acidic drinks (orange juice, tangerine) flare up the disease; warm sitz baths and apple cider vinegar can reduce your complaints.
References:
1. Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999;282:236–7.
2. McNaughton Collins M, Pontari MA, O'Leary MP, Calhoun EA, Santanna J, Landis JR, et al. Quality of life is impaired in men with chronic prostatitis: The Chronic Prostatitis Collaborative Research Network. J Gen Intern Med. 2001;16:656–62.
3. Shoskes DA, Nickel JC. Classification and treatment of men with chronic prostatitis/chronic pelvic pain syndrome using the UPOINT system. World J Urol. 2013 Aug;31(4):755-60.
