Prostate Removal

[mike]

Can prostate removal for prostatitis really offer a cure for suffering men?

[Arnon Krongrad, MD]

There is no question that it can. The case of
David Radford makes that as plain as can be. In whom is surgical removal most effective? For any man what is the likelihood of success? Which variables -- age, symptom type -- signal success?

[mike]

Dr krongrad.. How many prostatitis patients have you treated with surgery to date? What are the results so far. I read you treated a case last week? Should be interesting to see if surgery can work in the majority of sufferers. Is there something that can be done medically to determine if the prostate is the cause of the patients symptoms before surgery. I would think a Dre or ultrasound would be first used in determining.

[soso]

Dr Krongrad, how is David Radford doing now? Does he have any symptoms now?

[Arnon Krongrad, MD]

Soso

David is about 18 months out. No symptoms. Complete relief. No incontinence. Erections back. It could not have turned out any better for him. You can read his story in his words on the link I posted above.

You ask all the right questions. They are the questions I am asking too. With time, we will identify the tests and parameters that will tell us which man will do how. With one clear case in the inventory, we have not begun this task, let alone completed it. The case of David Radford does clearly illustrate that for some men minimally invasive prostatectomy can be an effective remedy to years of misery.

Yes. I did another case last week. The man is only four days out from surgery. So far so good in that he is reporting responses that remind me of the early days for Radford. It's only four days. We will see how he does.

Thank you for joining. This is important.

[Antonio E. Feliciano,Jr.MD]

Prostate removal for Prostattis will do more harm than good specially in a young sexually active man

[soso]

???

[soso]

can you explain why?? If you have a damaged organ and it doesn't get better and it causes pain and suffering how can that be better than pain free. Unless you want to have kids and then I can see That.

[mike]

Umm did you not read the success story Feliciano,? There are others found on the internet too

[Arnon Krongrad, MD]

Mike, I think the point is that we have not yet fully identified the variables that correlate with improvement, as seen so vividly with Radford and now another patient who seems to be headed in the same direction, or with deterioration, as suggested by Dr. Feliciano. The idea of surgery has indeed been associated with improvements but it has not been well studied.

Keeping that in mind, we are not yet in a position to quantify the likelihood of improvement. Given this, Dr. Feliciano brings up an important caveat, even if it's overstated ("will do more harm than good" is absolute and is defied by Radford's case). I would add that if surgery is done poorly then patients could wind up with complications and worse off. So ... and especially since we cannot yet fully quantify the likelihood of benefit ... any man who considers have lap prostate removal really owes it to himself to have it done by a surgeon with tons and tons of experience. In this, it's the same principle as with prostate cancer surgery.

[Bob]

Dr. Krongrad;

My doppler TRUS shows infection in both lobes and the seminal vessels. I guess it is safe to assume that all the gentiourinary nerves and tubes are infected as well. By removing the prostate, do the infected gentiofemoral nerves, spermatic cord, epididymis and all other associated nerves heal as well? I hope this makes sense. Sorry, for any misspelled words.

[Antonio E. Feliciano,Jr.MD]

Can anyone in this forum ddiscuss the pros and cons of total removal of the prostate in the presence of Prostatitis?

soso said:

can you explain why?? If you have a damaged organ and it doesn't get better and it causes pain and suffering how can that be better than pain free. Unless you want to have kids and then I can see That.

[Arnon Krongrad, MD]

Dr. Feliciano,

I don't get the sense that any of us has a large experience with prostatectomy for prostatitis, although the others may know something that I have missed. I will wait for them to answer.

The literature offers basically nothing scientific on this question. The best I can find -- please let me know if you have other references -- is a paper dating to 1982 about "radical TURP" that showed some improvement in some patients. I don't have the original paper and don't know how improvement was characterized, measured, and followed.

Other than this, we have anecdotal reports. I am aware of several places where radical prostatectomy was reported to have eliminated symptoms of prostatitis. I am not party to the clinical cases and cannot provide you detail.

My personal experience is as I have written here. Mr. Radford was sent to me by a surgeon at the Cleveland Clinic. He had had eight years of misery and failed treatments. His situation was completely remedied by a laparoscopic radical prostatectomy. Eighteen months out he is pain free, continent, and reporting normal erections.

I believe based upon this case that some men will find relief with prostatectomy. I cannot quantify the likelihood. I would stress again, as I did above, that for any man who is considering such a move it is absolutely imperative that he go with a surgeon whose focus is radical prostatectomy and who has a lot of experience.

If we initiated a clinical trial of laparoscopic radical prostatectomy for chronic prostatitis, would you collaborate? Would you work with me to design the study? Would you refer patients to it?

Thank you.