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Acute and chronic prostatitis discussion. Arnon Krongrad, MD, moderator.

Hi Dr. Krongrad,
Thanks for the update on your work. Would you be able to provide us information on the Pathology Report of your patients? This may provide valuable infornation on the disease process and help researchers in the understanding of the pathophysiology of Prostatitis.
Once again thank you very much
Regards
AEF

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Hi Antonio,

This afternoon my secretary, Hope, came into my office with a funny look on her face. In her hand was the pathology report from the most recent patient who had LRP for five years of prostatitis. Like the two before, it showed Gleason 6 cancer. That is three for three in the clinical trial, for men aged 40 to 50. Otherwise, there appears nothing interesting in the pathology.

Three for three in the trial also have reported the next day that their prostatitis symptoms were gone. This happened with Ike, who posted his story on Free at Last, and the man yesterday too and the one before. Yes, in the frist days they have the typical post-LRP supra-pubic discomfort but all three have said, like Radford did, that the symptoms they had before surgery are no longer there.

PS: yet another surgeon has now approached me to report relief of prostatitis symptoms with radical prostatectomy. I am now aware of five such surgeons, including myself.
Very interesting Dr Krongrad. Dr Eden also had 4 out of his initial 5 prostatitis patients showing cancer on their pathology reports. I am beginning to really question many sources who say prostatitis is not linked to cancer. The importance of psa testing-better if its the new more accurate version, along with MRI scans for prostatitis can not be overstated.

Arnon Krongrad, MD said:
Hi Antonio,
This afternoon my secretary, Hope, came into my office with a funny look on her face. In her hand was the pathology report from the most recent patient who had LRP for five years of prostatitis. Like the two before, it showed Gleason 6 cancer. That is three for three in the clinical trial, for men aged 40 to 50. Otherwise, there appears nothing interesting in the pathology.
Three for three in the trial also have reported the next day that their prostatitis symptoms were gone. This happened with Ike, who posted his story on Free at Last, and the man yesterday too and the one before. Yes, in the frist days they have the typical post-LRP supra-pubic discomfort but all three have said, like Radford did, that the symptoms they had before surgery are no longer there.

PS: yet another surgeon has now approached me to report relief of prostatitis symptoms with radical prostatectomy. I am now aware of five such surgeons, including myself.
Hi Arnon,
Thank you again for sharing with us the pathology report. May I request that the histopathology report be included in your series of patients? I am sure many will benifit for the study.
It appears that the pathology report failed to document prostatitis? If so then what would be the final diagnosis based on the Pathology?
"Like the two before, it showed Gleason 6 cancer. That is three for three in the clinical trial, for men aged 40 to 50. Otherwise, there appears nothing interesting in the pathology".I woulad like to thank you in advance.
My very best regards,
AEF
Nik

One sure is tempted to associate prostatitis with cancer. However, a handful of cases in which clinical symptoms we call prostatitis are associated with histological cancer do not a rule make. We are merely at the stage of setting hypothesis, not testing it. Let us see what further experience brings us.

Antonio,

The final diagnosis has so far been cancer. This is not to say that the pathologist is not seeing inflammatory cells. As you know, these kinds of cells are very common in prostates and scattered findings do not trigger reactions in pathologists. Given that the three men we are discussing -- Ike is one of them -- all reported relief from symptoms, we really must distinguish clinical and histological prostatitis. In these three cases the clinical prostatitis appears to have been eliminated, regardless fo what the pathologist reported. This is good. After all, the clinical objective is the relief of symptoms. My gut feeling is that routine H&E pathology analysis, as picks up cancer and inflammation, will provide us with little if any clue about the etiology of the symtoms our patients describe. For now, severe chronic prostatitis and its origins remain mysterious to me.

Interesting, no?
Arnon Krongrad, MD said:
Hi Antonio,

This afternoon my secretary, Hope, came into my office with a funny look on her face. In her hand was the pathology report from the most recent patient who had LRP for five years of prostatitis. Like the two before, it showed Gleason 6 cancer. That is three for three in the clinical trial, for men aged 40 to 50. Otherwise, there appears nothing interesting in the pathology.

Three for three in the trial also have reported the next day that their prostatitis symptoms were gone. This happened with Ike, who posted his story on Free at Last, and the man yesterday too and the one before. Yes, in the frist days they have the typical post-LRP supra-pubic discomfort but all three have said, like Radford did, that the symptoms they had before surgery are no longer there.

PS: yet another surgeon has now approached me to report relief of prostatitis symptoms with radical prostatectomy. I am now aware of five such surgeons, including myself.
Hellow Arnon,
Thank you for the reply. Your work may disprove the pelvic muscle theory. The mere fact that when the prostate gland is removed the pain dissapears.
Please continue to update us with your work.I suspect that we will learn from your study.
Regards
AEF
My gut feeling is that it will disprove the pelvic floor theory. I believe the pelvic floor trigger point therapy to be nothing more than a temporary symptom reliever. I do believe the muscles tighten in response to prostate pain, but believe firmly at this point that the prostate is the cause. Just my humble opinion..!!

Antonio E. Feliciano,Jr.MD said:
Hellow Arnon,
Thank you for the reply. Your work may disprove the pelvic muscle theory. The mere fact that when the prostate gland is removed the pain dissapears.
Please continue to update us with your work.I suspect that we will learn from your study.
Regards
AEF
We really do not know what causes the symptoms we call prostatitis. If indeed there is an association of prostate and muscle etiologies, which has not been tested, we still would have no idea if such an association is causal and which caused which. We have to be very careful not to overinterpret what is no more than a handful of cases. All we really can say now is that a handful of surgeons, Dr Eden and me included, have reported results that are really well captured by Ike's story: relief of years of symptoms with prostatectomy.
Ultimately, this is all that matters!

Arnon Krongrad, MD said:
We really do not know what causes the symptoms we call prostatitis. If indeed there is an association of prostate and muscle etiologies, which has not been tested, we still would have no idea if such an association is causal and which caused which. We have to be very careful not to overinterpret what is no more than a handful of cases. All we really can say now is that a handful of surgeons, Dr Eden and me included, have reported results that are really well captured by Ike's story: relief of years of symptoms with prostatectomy.
. Dr krongrad,
The Stanford protocol led by Dr Wise in California http://www.chronicprostatitis.com/spasmtx.html is strongly against surgery for prostatitis. They even claim to have treated patients not cured through prostate removal. It would be great if you and Wise could exchange thoughts and conversation. The Stanford team charges 5 k for 1 week of relaxation and pelvic floor pt. I personally think pt does nothing more them give a temp symptom relief if anything. What are your thoughts on the pelvic floor causing prostatitis symptoms? If it is the pelvic floor, how could prostate removal offer a full cure? It would be great if you and Dr wise could exchange notes..

mike
Mike,

Can you please provide us with data about the protocol you describe? A published reference?

Thank you.
Hi Doc,
Well i think there theory is that the prostate has little to do with prostatitis. They feel that the pelvic floor and the surrounding nerves cause the problems. I never understood how the pelvic floor can cause fevers and bloody urine. In the prosatitis world there seem to be two theory’s that have been at war with each other for years. The pelvic floor vs. the prostate.

As far as the Stanford protocol. There treatment is basically relaxation, yoga and having a trained pelvic floor pt give daily internal and external massages. Apparently they feel that tight pelvic floor muscles cause prostatitis symptoms. They think the prostate is not involved in a nutshell..It seem like rubbish to me. Yet some men get some relief. My guess is the massage helps relax some inflamed nerves. The treatment is http://www.pelvicpainhelp.com/ all info can be found on there site. The book headache in the pelvis is very popular in the prostatitis world. The book focuses on lifestyle changes, massages, yoga, and diet mods to cure the illness. Only problem is it doesnt really work in the real world. What are your thoughts on the link i posted? It seems your study so far is contradicting what these top prostatitis guys are saying.

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