Acute and chronic prostatitis discussion. Arnon Krongrad, MD, moderator.
The question every chronic prostatitis sufferer asks. Why doesn't his urologist want to treat him?
There are many reasons. The cruel fate of c.p. sufferers is that their illness falls between 2 stools: Urology and sexual transmitted disease. And this is central in understanding why urologists don't want to treat you. Why his shoulders sag as soon as you enter the room.
1) Status. A urologist doesn't want to be associated with STDs. In every profession, there is a "pecking order", and medicine is no different. Heart surgeons, brain surgeons, are at the top. Urologists are not. But within urology, and amongst urologists, there is also a pecking order; and any urologist worth his salt doesn't want to be associated with treating STDs. It's not status enhancing.
2) Ego. Which is closely related to the first reason, but with a subtle twist. There is no glory in treating chronic prostatitis. Nobody cares about the illness. There is no "pyschological payback" for the urologist, or from his patient for that matter. Conversely, if the urologist manages to cure somebody with bladder cancer, or prostate cancer, then he is going to be glorified by the patient and his family. This feeds the doctor's sense of self. His ego. After all, cancer is perceived as far more important than prostatitis.
3) Diagnostic Testing. Almost all the tests to identify prostatitis and to successfully treat it, are either unpleasant, tedious, or need to be repeated over long periods of time. In some cases--years. If not to cure the illness (and many are cured), then to keep the illess under control. This requires stamina on the part of the physician; but when progress is slow, or non-existent, and yet more tedious and unpleasant tests are required, the urologist gives up, or loses heart. or passes the patient on to somebody else, or accuses the patient "it's all in his head".
4) These Unpleasant Tests. If infection is suspected, bacteria has to be removed from the prostate gland via massage. The key to an early cure. If bacteria is found, it can be taken to the lab, tested, and an effective antibiotic prescribed. But most urologists refuse to do this basic test. Why? It's a simple test, which if done correctly, lasts no longer than 60 seconds--yet very few urologists can obtain fluid by massage. So what do they do? They tell you that these tests don't work, or your urine is clear, or it's the wrong day of the week, etc, etc. But the truth is, they don't want to do the massage. Why? Because the test is disgusting--that's why, to both doctor and patient. It's unnatural. It's against Judeo/Christian teachings. It's not what the doctor came into medicine for. It's not what he wants to discuss with his wife over dinner when she ask him, "Has he had a nice day?". The test has homosexual overtones. Sticking your finger up another man's rectum is what homosexuals do. It's not something any "normal" person would do, or want to have done. So the doctor shakes his head, says no massage for you, then hands the patient a sackful of antibiotics which won't work. By now, the patient has moved from the acute stage of prostatitis, to the chronic stage. His chances of a cure have diminished substantially.
5) Money. There's more money in treating prostate cancer.
I can think of more reasons. But it's getting late. Feel free to add more reasons if you wish.
The argument implies that the science exists with which to eradicate the symptoms of prostatitis the first time any patient walks through the doctor's door. This implication has no basis in fact. As such, it unfairly maligns doctors who try to do the best science allows for their patients, and there are many such doctors.
Bringing an unrealistic expectation through the door is a recipe for poor physician-patient relationship. And the obligation to be fair rests on both parties.
Yes, you're right. In some cases, antibiotics resolve the symptoms of prostatitis, especially with acute and febrile cases such as those most commonly seen in young men.
However, in many cases, antibiotics have no role to play. Many patients, including many on this site, have been treated repeatedly but uselessly with anbiotics that are not effective.
Keep in mind that most men have bacteria in their prostates and that most men do not have the symptoms of prostatitis. In other words, bacterial alone are not a finding specific to prostatitis. So the question is if the finding of specific bacteria in prostatic massage specimens can help to select antibiotics that more effectively than an empirical choice unguided by specific bacteria get rid of the symptoms.
This is where there seems to be a general lack of evidence. Does a specific antibiotic driven by massage findings really work better in a first case than an empirical prescription for ciprofloxacin? If so, could we have access to and review this evidence? Where is it?
Sure, there are unscrupulous doctors, just as there are unscrupulous patients. But this fact alone does not negate the sad reality that we understand painfully little about the causes and optimal treatments of prostatitis.
There seem to be several discussions here rolled into one. Let's tease them out:
1) Does prostate massage help to relieve symptoms? This is reviewed here.
2) Does prostate massage better target antibiotics such that symptoms are relieved? Is massage-targeted treatment choice better than empirical treatment? If so, how much more often? Has this been quantified? I have not seen an answer to this.
3) Case reports versus scientific evidence. Single cases can generate hypotheses about treatment effect. Clinical trials and research can test these hypotheses about treatment effect. A case in which symptoms were relieved by massage-directed antibiotics may mean that the massage made the critical difference; or not.
4) Feelings versus findings. We all have feelings. These feelings can blur judgment. Anxiety can cause a symptomatic patient to interpret that his doctor is not really trying to help him. We have to be careful not to let feelings blur our judgment and/or erode constructive communication with people who may really be trying to help us.
There is generally a poor scientific framework with which to target prostatitis treatments. The prostatitis community is generally disorganized (compared with the breast cancer community, for example) and has few good informational resources. Prostatitis research funding is generally not great (compared with prostate cancer research funding, for example). The only path forward is through better communication between patients and between doctors, as well as through more research.
Blake, you keep assuming that all prostatitis patients need to be sorted out by docs on the very first appointment. How is that possible? Do you realize that many insurance providers will not cover extensive test - such as infectious disease testing - on the very first appointment? Of course docs will try a more conservative approach. Do I always agree with it? No, but sometimes there needs to be more than one appointment to isolate a potential problem.
As for targeting Dr. Krongrad; I cannot disagree more. Dr. Krongrad is trying to help men who are suffering with these dreadful symptoms. The forums he has provided, as well as professional research/thoughts, have helped many of us stay level-headed about what prostatitis is, or could, be.
Well done, Blake. Finding a urologist who will listen to you and then perform a simple prostate massage, is like finding buried treasure.
Make sure the path lab conduct sensitivity tests on the organism from your prostatic fluid, so that the correct antibiotic can be prescribed. Otherwise your uologist will be guessing. You write that the urologist has put you on 4 weeks supply of pills. If you've had this for a number of months, then you will need a longer period on antibiotics. The Cleveland Clinic, a highly respected clinic in the US who have a big reputation in treating this illness, say a period of between 4-12 weeks for chronic prostatitis. The Mayo Clinic say a minimum of 8 weeks.
Your life isn't over. Calm down and think logically.
White blood cells are what your immune system uses to fight infecion with. Pus is (mainly) the remains of dead white blood cells.
The fact that the infection hasn't shown in the lab results is due to any number of possible reasons. The infecting bacteria can be lodged behind or inside a blocked duct. You may have hidden chambers inside your prostate (I had 2 congenital hidden chambers) where infection can hide. You may have a build up of calcification in certain areas of your prostate--yet another perfect place for bacteria to hide.
The list is endless. That's why you need to go to a specialist clinic who deal with this illness on a daily basis. Before you consider any further treatment options, you need a correct diagnosis. Once your illness has been accurately assessed, it should then be treated by doctors with inter-disciplinary skills. There are 3 or 4 such clinics in the USA who have a good record in treating this illness. The Cleveland Clinic, the Arther Smith Institute in New York, the Mayo Clinic to name but a few.
We have none in the UK.
WBCs are nonspecific findings. They can be a reaction to bacteria, viruses, fungus, chemicals, trauma ... So if the culture focused specifically on bacteria and it's negative (even in the face of WBCs), then it may be for the reasons Chris outlined or because the WBCs are not a reaction to bacteria in the first place, that there's something other than bacteria afoot.
Prednisone is sometimes prescribed for reactive arthritis, a multi-organ illness of unclear origin that can affect the eyes, large joints, and urethra and cause the kinds of symptoms at times seen with prostatitis. You may want to ask your doctor(s) if the prednisone was prescribed on suspicion of reactive arthritis.