Most prostatitis symptoms are not caused by the prostate gland

Most prostatitis symptoms are not caused by the prostate gland

Approximately ninety five percent (95%) of what is called prostatitis is not prostatitis. Most men diagnosed with prostatitis have no pathology of the prostate gland that can account for symptoms of urinary frequency, sexual and sitting pain and internal pelvic pain among other symptoms.

Historically, the conventional medical viewpoint has explained most cases of what is typically diagnosed as prostatitis as an infection and/or inflammation of the prostate gland. Indeed, that’s what the name prostatitis indicates, namely, an “itis” of the prostate. The conventional advice of many urologists to men they diagnose as having prostatitis related to increasing sexual activity derives from the idea that there is inflammation or infection in the prostate gland and more frequent ejaculation will empty it of these noxious critters.

Unfortunately, many doctors make a diagnosis of prostatitis and prescribe antibiotics without verifying that there is any infection present in the prostate

When a man comes into the physician’s office and complains about pelvic/urinary/rectal/genital pain and/or urinary symptoms like frequency, urgency, dysuria (pain during urination), sitting pain or ejaculatory discomfort, where there is no evidence of structural disease, the doctor typically treats the patient as if the cause of the problem is an infected or inflamed prostate gland and routinely gives antibiotics.

Prostatitis, which means an infection or inflammation of the prostate gland, is often diagnosed without the doctor doing any tests at all to establish the validity of such a diagnosis. As we have seen in a study of physicians in Wisconsin, a large majority of doctors view prostatitis as an inflammation or bacterial infection, and almost all prescribe antibiotics as a treatment. Most urologists know from their own experience that antibiotic treatment for prostatitis without evidence of infection routinely fails to help the patient’s symptoms and yet almost 100% of the cases of this kind of prostatitis receive antibiotics. We are always troubled to hear this routine diagnosis and antibiotic treatment in the patients who come to see us, when the patient’s doctor made no attempt to establish the presence of infection.

We always check for evidence of infection and inflammation in the prostatic fluid with men who complain of pelvic pain and urinary dysfunction. As we will discuss, antibiotics can have serious side-effects, especially taken long-term. And we have had more than a few men suffer the consequences of inappropriate long-term antibiotic treatment.

We want to emphasize that the antibiotic treatment of bacterial prostatitis has been an achievement of modern medicine. If you have bacterial prostatitis, antibiotics are a very good treatment—certainly the only treatment. Viewing all conditions of pelvic pain and dysfunction in men, however, as acute or chronic bacterial prostatitis is an error in therapeutic judgment.

Despite the clear scientific evidence to the contrary and almost every urologist’s clinical experience of the ineffectiveness of antibiotics for nonbacterial prostatitis, it is amazing that giving antibiotics routinely for nonbacterial prostatitis is the common practice. This is very important to understand, particularly if you have been diagnosed with prostatitis and it has not been determined whether infection or inflammation is present. We would consider it quite appropriate for a patient diagnosed with prostatitis to ask his doctor if there is clear evidence of bacteria, should the doctor prescribe antibiotics.

It is not difficult to determine whether the prostatic fluid is inflamed or infected

The urologist does a prostate massage, expels some fluid which comes out of the penis and then puts the fluid on a microscope slide where he examines it microscopically. Alternatively, the sediment of an immediate post-massage specimen of urine can be examined.

When there is infection or inflammation, white cells are visible through the microscope and their numbers are counted in a conventional way per high-powered field, referred to as ‘x’ number of white cells per high-powered field. A few white cells are not uncommon in the prostatic fluid of normal men and in some studies men who have no symptoms have more white cells in their prostatic fluid than men who are symptomatic. Studies have shown that in the prostate fluid of men whose prostates show no evidence of infection, inflammation in the form of white cells in the fluid can come and go. Most important, in these men there is no evidence that inflammation has any relationship to symptoms. It is most likely that the symptoms of what is variously called abacterial prostatitis, non-bacterial prostatitis, prostatodynia, pelvic floor dysfunction or chronic pelvic pain syndrome are not caused by inflammation.

When there are large numbers of white cells, it is appropriate to send the prostatic fluid specimen to a laboratory to be cultured to see if any bacteria grow. If there are bacteria that grow in culture, then a diagnosis of bacterial prostatitis is appropriate, and antibiotics are an appropriate treatment. Some bacteria are problematic and some are not. Some bacteria require longer incubation times to identify and some require elaborate culturing techniques to identify accurately.

Patients with pelvic pain that doctors cannot help have to become their own advocates and navigate their way through the bewildering world of treatments for pelvic pain using their common sense and intuition

Pharmaceutical and medical equipment companies, who happen to comprise a significant source of funding for medical research in America, obviously tend not to favor supporting alternative non-drug or non-surgical treatments for pelvic pain. The focus of their research efforts lies in developing new drugs and medical equipment, the sale of which will allow their companies to financially prosper. This economic reality supports the continued use of the traditional methods of treatment and perpetuates the paradigm that only drugs or surgical procedures are the answer to chronic pelvic pain disorders.

Dr. Lawrence True, a pathologist at the University of Washington Medical School, was part of a team that took multiple biopsies of the prostates of 97 men who complained of pelvic pain and symptoms of prostatitis. He found that in 95% of the cases, there was no evidence of clinically significant infection or inflammation. In this key study there was no evidence of significant infection or inflammation in 95% of cases of men diagnosed with prostatitis

Furthermore, he found there was no correlation between evidence of inflammation or infection in the prostatic fluid and any inflammation or infection in the tissue of the prostate. He concluded that the evidence suggested that researchers look elsewhere to determine the cause of prostatitis symptoms.

In our experience at Stanford, we found that symptoms were most severe with prostatitis patients who had no evidence of infection or significant inflammation.

Symptoms typically helped by the Wise-Anderson Protocol