How many cured so far over the past two years

[mike]

Hey all,

This question is for Dr K. It has been at least 2 years now that you have been performing LRP for prostatitis suffers. To date, how many LRP procedures have you performed on prostatitis suffers? How many men found partial/total relief from the procedure?

[Jon]

Further to the above question: At what point do you have enough data to publish a research paper?

[Arnon Krongrad, MD]

Mike. Long time. How are you doing? How are you defining "cure?"

Jon, one can publish any time a publisher cooperates. The question is when do you have things worth saying.

You may find interest in this related discussion, btw, which provides some more recent feedback from a few of the patients who have had LRP.

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[mike]

Hi Dr Krongrad,
I am doing very well. Diet change really helped my condition. Avoiding acid foods really reduced my symptoms for the time being.

Anyway. My question is, how many surgeries to date have you done for prostatitis. What is the rate of post surgery cure as of now.??

I define cure as a dramatic improvement in the condition post surgery.

Thanks!!

Arnon Krongrad, MD said:

Mike. Long time. How are you doing? How are you defining "cure?"

Jon, one can publish any time a publisher cooperates. The question is when do you have things worth saying.

You may find interest in this related discussion, btw, which provides some more recent feedback from a few of the patients who have had LRP.

Admin note: We're starting to develop a critical mass and the site is becoming increasingly active. Please try to fit new discussions into the groups listed on the right. If there is a need for a new topic-focused group, let's talk about developing one. Following group structure will help us classify discussions, search discussions, and participate. Also group members are notified about new activity, whereas general forum discussions like this are not noticed to anyone. This discussion, for example, would have fit neatly into the Treatment group. Thank you.

[Arnon Krongrad, MD]

Mike,

That's good news. If you're up to it, why not start a discussion in Treatment on diet? I think others will find interest and it's something we could really use. Just find the Discussion Forum, scroll down, and click on +Start Discussion.

One of the issues in all search for knowledge, and this absolutely true of medical knowledge, is language and standardization. The word "cure" is not always operationally clear, especially with a disease whose symptoms vary over time. Do we mean complete eradication of all symptoms? And for how long: a minute, a month, a year, longer? Same goes for "dramatic," in that one man's drama is another's non-drama. Moreover, given that some of the symptoms of prostatitis, e.g. urinary urgency, are nonspecific and can be common to other situations, e.g. overactive bladder, and may or may not be bothersome, we are faced with the question of what our treatment objective is; this can be highly personal. What I'm saying is that, with your permission, I prefer to let patients speak for themselves and let you judge the meaning.

Let's take a look at examples to get at the practical implications of all this. Ike has reported that as measured by his CPSI, which is one possible measure of prostatitis symptoms, he has none as of a year after surgery. Rich, on the other hand, has a one-year CPSI that has a few points registered on it; I am not in the office but as I recall his score was something like 8, having dropped from the high 30s preop. Ike and Rich comment on some of this in related narrative form, not CPSI, on this discussion. So would you say Ike is cured and Rich is not? Which, if either, meets the criteria for "dramatic" improvement? This is subjective. So leaving aside words like "cure" and "dramatic," we can see that these two men had symptomatic relief as captured quantitatively by the CPSI, although not to the same exact degree, and as captured in their narratives. My perspective is that both did well with surgery (and they might agree), even as they did not reach exactly the same quantitative level. I prefer the quantification and narratives to the labels: Letting data and patients speak for themselves.

I have done something on the order of 25 LRPs, starting with Radford, who btw recently joined this network on his 3rd anniversary. Many are in early recovery. Leaving aside the methodological points raised above about the usefulness of words such as "cure," the fact is that early symptom assessment is of obviously limited value. Nobody really cares if somebody feels great a week after surgery because among the questions is: Did the relief endure? It has with Radford up to 3 years. But this does not mean that all will endure.

Having said all that, I will share that there appear to be different kinds of early recoveries, at least as measured by the CPSI (as well as subjective narrative reports from patients), and that sometimes the early recoveries are misleading. For example, some report instant relief, with CPSI plunging within a month from as high as 40 to as low as 2. Others show a 2-3 point worsening in the first month, presumably from symptoms related to surgery itself, and then marked declines in the coming weeks. So again, early reports are potentially misleading and should definitely be treated with caution. This is why numbers of patients and long term followup will permit us to really characterize the symptomatic variations associated with surgery so that future patients will be able to make more informed decisions. With time, we hope to also develop markers of success: Patient characteristics that can tell us before surgery if they will succeed. We're not there yet.

Like all treatments for essentially all conditions, be they antibiotics or radiation, surgery will not work for all patients. How likely will it be to work? To what degree of symptomatic relief? How quickly? For how long? These are among the critical issues upon which with time the study will shed some light.

I hope this helps.

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