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

Is it more a case of WHEN we have an LRP than IF?

When we look at the figures so far of around 60-70% having early cancer found upon prostate removal, surely its mostly a case of when we go for LRP than if. Many of us may already have early, gland confined carcinoma undetected by PSA, DRE or ultrasound etc.

Lets see what our choices are:

1.) To go on suffering for years more with prostatitis, watching and waiting until cancer becomes detectable, then doing LRP when we are older and our level of recovery possibly becomes reduced (erectile nerve bundles affected by cancer etc).

2.) Opt for radiation treatment to kill the cancer, not knowing how it will affect our prostatitis symptoms-better or worse-we just don't know? If it makes our prostatitis worse we then loose the option for LRP, as it is not done after radiotherapy due to severe side effects. Also with the continuing inflammation from the prostatitis, how long will it be before the cancer returns in an untreatable form?

3.) Opt for cryotherapy which remains unproven in cancer treatment, also not knowing how it will affect our prostatitis symptoms. I don't know what our options for LRP are after this treatment-I'm sure somebody will help me here...???  

4.) Do we just stop procrastinating and get the gland removed, hoping we will join the majority of men so far that have had relief, then put all this behind us and get on with our lives with whatever side effects we may or may not incur? Even if we were in the minority for whom the pain remains or gets worse, at least the cancer will be gone, so at least we could be grateful for that and continue with increased pain control.

If anyone knows of any other realistic options (injections dont work for many) to add then please help me out here guys?

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I will take option 4 for $500, Alex. (ok sorry, the "Jeopardy" reference may be poor comedic choice on my part!)

Seriously, though, if I were diagnosed with cancer I would certainly go with 4. I have lost someone close to my family due to cancer and saw that radiation was pretty ineffective. Does that mean it is in all cases? Certainly not, but if it were isolated, or have a good chance of being isolated to the prostate, I say remove it.

Nik, have you ever considered physical therapy? I wonder if this is not bacterial, then could it be a structural/muscle/trigger-point/stress issue?

Thanks,

Mike
I believe the equivalent program here in the UK is called "Who wants to be a millionaire?" LOL...!!!!
Can I choose "phone a friend?" ....!!!

I have considered PT but where I live is a long way from any therapists with any experience in this condition.
Also I have had an ecoli urine infection just before all this got really bad and every urologist who has examined me (At least 6) has confirmed that my pain is always located to my heavily calcified prostate and left seminal vesicle-just where a large calcification/stone sits at the neck (hi res scan) where it joins the prostate. Along with my regular nightsweats, often burning urethra & very occasional fever's, I am 99% convinced mine is bacterial or at least prostatic in origin.
When a Dr applies pressure during the DRE directly to the prostate, my urethra burns and I experience urinary urgency. When he pushes my left SV, I scream out in pain...!!!

I would not hesitate in suggesting PT for anyone with less obvious symptoms to mine, to at least see if it helps and as a diagnostic measure, as its non invasive and might give some men temporary symptom relief.
Interestingly I just found this link:

http://pain.about.com/od/treatment/a/CPP_treatment.htm

This is of particular significance to me as its the first web page I have ever found (after 1000's hours research) that actually includes radical prostatectomy as a possible treatment for chronic prostatitis. Not only that, but its listed under common treatments. I wonder where they got that conclusion from, considering the very first trial for this is still under way. Interesting.
Yes, PT, while not invasive can take a lot of time/patience/dedication to work through. I think I am going to give it a shot and see how it works out. It is tough, though, because I get somewhat confused by reading the web. I even have some people telling me I have IC instead of prostatitis. I guess because of the urinary frequency and pain/burning in the urethra. It is not that my bladder necessarily hurts, but the burning pain in the urethra makes me feel like I have to go quite often. Do you ever get that pain? Then again, I was diagnosed with a "mildly enlarged prostate that has a mass effect on my bladder." Could be getting irritated by the prostate as well. Uggh, frustrating.

Nik said:
I believe the equivalent program here in the UK is called "Who wants to be a millionaire?" LOL...!!!!
Can I choose "phone a friend?" ....!!!

I have considered PT but where I live is a long way from any therapists with any experience in this condition.
Also I have had an ecoli urine infection just before all this got really bad and every urologist who has examined me (At least 6) has confirmed that my pain is always located to my heavily calcified prostate and left seminal vesicle-just where a large calcification/stone sits at the neck (hi res scan) where it joins the prostate. Along with my regular nightsweats, often burning urethra & very occasional fever's, I am 99% convinced mine is bacterial or at least prostatic in origin.
When a Dr applies pressure during the DRE directly to the prostate, my urethra burns and I experience urinary urgency. When he pushes my left SV, I scream out in pain...!!!

I would not hesitate in suggesting PT for anyone with less obvious symptoms to mine, to at least see if it helps and as a diagnostic measure, as its non invasive and might give some men temporary symptom relief.
Wow, interesting. Thank you for posting.


Nik said:
Interestingly I just found this link:

http://pain.about.com/od/treatment/a/CPP_treatment.htm

This is of particular significance to me as its the first web page I have ever found (after 1000's hours research) that actually includes radical prostatectomy as a possible treatment for chronic prostatitis. Not only that, but its listed under common treatments. I wonder where they got that conclusion from, considering the very first trial for this is still under way. Interesting.
Your right Mike, its extremely confusing. There are a lot of treatments, none proven yet for prostatitis/male pelvic pain. It puts us in the position of almost having to become our own Dr's, jumping from one unsuccessful treatment to another. My "personal opinion" right now (until some other study convinces me otherwise..!!) is that most of this, for most men, is prostate based pain, but the pelvic floor becomes involved and its response to pain is for the muscles to contract, in turn adding more pain to the cycle. This would also explain why some men get some relief from PT & muscle relaxants such as Valium etc (Myself included with occasional valium).
I have read "headache in the pelvis" but it just does not fully add up to me. The book totally dismisses any prostate involvement bacterial or not. It does not explain why the majority of Dr Krongrads trial patients (and other surgeons patients) are experiencing large to total pain reductions after prostate removal. If it did not, he would have given up the trial after the first few patients surely..!!
I forgot to add above, that "headache in the pelvis" also does not explain the 70% of patients found to have early organ confined cancer. I would like to hear how the authors of that book would explain that one LOL....!!!!! They would probably try to turn it around and say something like "the early stage cancer was causing the pain", even though we know that for the most part, early prostate cancer causes no symptoms. Perhaps they would even go further still and call it pure coincidence..!!
I have similar stories as yours, but I had two bouts of e.coli bladder infection before I was aware of the prostate problem. I wish I had stayed on the antibiotic for 2 months instead of 5 days.
What measures did you take to deal with your bladder infection?
Have you ever done a culture of your EPS?

Nik said:
I believe the equivalent program here in the UK is called "Who wants to be a millionaire?" LOL...!!!!
Can I choose "phone a friend?" ....!!!

I have considered PT but where I live is a long way from any therapists with any experience in this condition.
Also I have had an ecoli urine infection just before all this got really bad and every urologist who has examined me (At least 6) has confirmed that my pain is always located to my heavily calcified prostate and left seminal vesicle-just where a large calcification/stone sits at the neck (hi res scan) where it joins the prostate. Along with my regular nightsweats, often burning urethra & very occasional fever's, I am 99% convinced mine is bacterial or at least prostatic in origin.
When a Dr applies pressure during the DRE directly to the prostate, my urethra burns and I experience urinary urgency. When he pushes my left SV, I scream out in pain...!!!

I would not hesitate in suggesting PT for anyone with less obvious symptoms to mine, to at least see if it helps and as a diagnostic measure, as its non invasive and might give some men temporary symptom relief.
Cipro took care of the bladder infection. 5 Uro's I have seen all refused to do massage and culture because they said its no longer a valid method & antibiotics I had tried already, should have covered any infection, and if they found bacteria what was the point in knowing if it could not be cured.
I have another Dr appointment tomorrow to ask for a referral to a urologist who is willing to perform this procedure. I am hoping for more luck this time.
Do you all ever get the urinary issues? Things like the urgency, burning, and/or incomplete emptying feeling? Also, any pain in the bladder? Just curious to see how our symptoms compare. These things have flared up for me in the last week, big time.
In the beginning I had serious urinary issues, up 5-6 times a night for a pee. The lack of sleep really played on my mind. That did settle down after I did this treatment involving EDTA suppositories and tetracycline for 3 months. Its one Dr Shoskes did a trial on. No bladder pain as such but definitely burning urethra, and dribbling after urination or emptying my bowels. Its as if the prostate inflammation is holding my urinary sphincter open for about 5 minutes after a pee.

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