Prostatitis Forum & Social Network

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

Does anybody here know of anyone who has been "permanently" cured by prostate massage with antibiotics? I attach a paper by Dr Shoskes & Zeitlin on the subject. If I am not mistaken, it seems as if 40% had a complete and durable resolution of symptoms, many of whom were long standing chronic sufferers.

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I tried it for a considerable length of time (months) with multiple antibiotics and paying weekly for a Dr massage.
Symptoms always got better for 2-3 days - then come back.
Its a lot like chiropractic care - it helps symptoms but doesn't cure you.
At least that was my experience.

There is no harm in trying it thougj - no risk and maybe it will work.
Your experience is similar to everyone else's that I have talked to, that have tried it. It seems a little strange to me that as many as 40% in this study were basically cured. It's not the type of treatment I could see myself doing on a regular basis for the rest of my life unless relief lasted for at least a month at a time per massage.
1) To further complement the general knowledge about massage, have a look at
Role of Repeated Prostatic Massage in Chronic Prostatitis. Its conclusion: The evidence for a role ... is at most "soft." 2) The attached study (posted above by Nik) selected 73 out of 195 men. How were they selected? Why were the other 122 men not selected? 3) The responders were much more likely to have had successful previous antibiotic treatment. Were these responders the kind of patients we commonly encounter who have failed repeated antibiotic treatments? If not, how relevant are the observations to men who have failed repeated antibiotic treatments? Are we even comparing "apples" to "apples?" 4) How do we compare the observations to those made in other studies? For example, in
this study of Cipro, the study relied upon CPSI symptom measure. However, the study about massage did not use the CPSI. Rather, it used a crude measure that seemingly was invented for this study. Again: Are we even comparing "apples" to "apples?" 5) The authors conclude: "In this study, we have shown that the combination of antibiotics with regular prostatic massage is effective for a proportion of men with longstanding CPPS refractory to other therapies." Um, really? Based upon what is reported would it not be more correct to conclude that "in this study it was shown that massage and antibiotics were much more associated with symptom reduction in men who previously had shown response to antibiotics?" 6) There was
no placebo group and no dissection of antibiotics vs. massage. How much of the self-reported relief was placebo effect? Don't patients routinely report oscillations in symptom severity? See
this discussion for an illustration. Also
this discussion. What if patients enrolled at the peak in symptom severity, just before a spontaneous remission? The absence of a control/placebo group makes it impossible to assess the role massage and antibiotics in the amelioration of the symptoms. Maybe it was just time passing by? 7) As to "no harm in trying," you'd think so, kind of like with chicken soup. However, patients have most emphatically reported that massage has triggered symptomatic flare-ups, not to mention the many patients who have reported that they simply do not work.Plus massage is inconvenient, uncomfortable, and costly. And antibiotics can certainly be associated with some nasty side effects, from bad allergic reactions to disruption of intestinal function. So massage and antibiotics, which have a dubious upside in chronic cases, are not without any downside. Overall, in chronic cases antibiotics have stopped working and the case for massage is at best weak.
Hence why we are here in this forum in the first place...sadly....
Yes. We are here to share what we know and to carefully dissect the scientific literature. As a related matter, it does seem that this forum, like others, can have a constructive role to play in the realm of advocacy and support.
I have just seen a urologist at the local hospital where I live. We went through my history and he agreed that the only thing I had not tried was prostate massage. As I am so close to considering LRP for this condition, we agreed that I should at least give it a try to see if it helped, and if it did, how long would it help for. I still have to wait 6-8 weeks though before it is done-that's the British NHS for you LOL...!!! After that I can at least know in my heart that I tried everything (except the dubious stanford protocol) before doing the nuclear option. As pointless as it seems, I might as well use the opportunity to get a prostate fluid culture at the same time.
I was impressed with the urologist I saw, he did not freak out that I was considering LRP and actually was interested about the trial, its always nice to meet an open minded urologist. I told him about your website, so hopefully he will at least pay a visit.
Thanks, Nik. He should use the http://ProstatitisSurgery.com link. I'll be pleased to communicate with him.

There is only one randomized trial of massage that I know of, a 2006 study of antibiotics +/- massage. This was in "virgin" prostatitis patients, the group most like to respond. That study showed partial relief of symptoms (CPSI dropped from 25 to 13, if memory serves). More to the point: Massage made absolutely no difference to response. This was a response to antibiotics.

Other studies are case series, not randomized trials. They also include antibiotics, so it's absolutely impossible to infer that massage added anythining.

You are right: Massage is worth trying because it's cheap and safe. If it works, great. If not, as is likely to be the case, then at least you can sleep knowing you tried.

As for LRP, not sure "nuclear" is a useful adjective, other than perhaps in describing your feelings. Are you scared? Intimidated? If so, why? What do you believe are the logistical and functional implications of LRP?

PS: Am traveling this week, so will be slower to respond than usual.
Hi Arnon. Yes the word "nuclear" is only my way of expressing my personal feelings and was intended as a bit of an analogy along with some dark humour!

My analogy is with that of a battle. In a war where every other weapon has been tried and failed and the last option is using a nuclear weapon or to perish..!!!! In my battle with prostatitis where all other treatments have failed, the LRP is likened to the weapon of last resort.

Yes I am scared and intimidated of any major surgery (a fear of the unknown), but I am even more scared of the thought of continuing indefinitely in my current state of health, especially with the responsibilities of fatherhood approaching rapidly.

The main functional implication is permanent impotence, but then I already avoid sex as much as possible due to pain so my fear is not fully justified-its a play on the mind. I am also aware that impotence is highly treatable so long as the desire remains. I have faith that continence will return so I am only concerned with dealing with temporary leakage, so I am not too fearful of that, and I know pads are well designed these days. I guess my biggest fear would to still be in permanent pain after the surgery.

I know that the actual event will probably be nowhere as bad as my somewhat over active imagination portrays it to be. To experience fear itself is often worse than the event you are fearing.
So: The nuclear disease, the nuclear reaction, and the nuclear treatment. The bad, the worse, and the ugly.

Based upon your photos you look young: In your 30s? Assuming you have good overall health and good erections and given you are motivated, the likelihood of erectile dysfunction is low.

Let's segregate the logistics and statistics from your coping style and emotional reaction. It's important. That "nuclear" is a sign of distress, which is a problem apart from prostatitis. And no wonder given your protracted illness and imminent parental obligations. You need some resolution. Your wife and baby need you to have resolution.
I am 39 (photo a few years ago!) and Chris Eden like you also believe long term erectile dysfunction risk is low-I find that comforting. My erections have always been good, even on medication that can effect erections negatively so I see that as a big plus. Erections aside, I would still consider myself better off just to be out of pain and continent.

Its twins so my wife and babies will certainly be needing me....!!! I will be playing a primary role as my wife is the one earning a living right now and I will literally be "left holding the babies" after her maternity leave expires.....!!!!
A number of patients have reported improved sex life after LRP, because of resolution of pain.
Here's hoping I will be one of them when the time comes.!!

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