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

Top 5 reasons why urologists refuse to treat chronic prostatitis patients

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.  

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one again chris you nailed that!
Here's what may be an illuminating story, told to me by a doctor friend (a general practitioner in the UK). When he was a medical student taking courses in urology the topic of chronic prostatitis came up. The lecturer, a distinguished professor in a major university teaching hospital, advised his students that: 'When it comes to prostatitis, urology and proctology interact in the sense that you'll be coming face to face with a lot of arseholes, both literally and metaphorically.' The point, of course, is that most urologists are contemptuous of prostatitis patients, regarding them as troublesome and complaining, a 'bunch of arseholes' in other words.

When it comes to other chronic conditions like diabetes or asthma I'm pretty sure this is not the case. However, when it comes to conditions that doctors know nothing about, and can therefore do nothing about, their attitude is remarkably similar e.g. in the case of chronic fatigue syndrome.

Doctors are human beings, and we should not expect more from them than from other sectors of society. However, I would suggest that there is some deep psychological flaw in a substantial body of the medical profession that drives them to redirect their contempt to others when it would more properly be directed at themselves.
Bingo ...

"Conditions that doctors know nothing about"

This is the most important clue as we seek harmonious and effective physician-patient relations. It is the basis for most of what has been written here and what one hears elsewhere. Solve this and everything else will recede in importance.

In the meantime, some suggestions:

1) To remedy lack of knowledge, we must develop new knowledge. We need more research. This means that as a community, chronic prostatitis patients should organize as have HIV and breast cancer patients and civilly and collectively demand more support for research. Remember that HIV was a non-issue until it was organized.

2) Chronic prostatitis patients are often frustrating to doctors who see them. This is because in many cases the medical knowledge does not exist upon which to effectively treat. It is not that the doctor is stupid, but the relevant medical knowledge has not been developed. Thus, to suggest that it would be proper for the doctors to direct contempt at anyone -- including themselves -- is silly. With few exceptions, the doctor practicing at the bedside is not in the business of research: The business of developing new knowledge. So the doctor's task is not to assign blame for who did not do research but to realistically and compassionately guide his patient to what may or may not be possible using the knowledge that does exist.

3) Patients should accept reality: There is very limited knowledge about chronic prostatitis. Patients should accept realistic expectations defined in consultation with an appropriate expert without either demanding something that he cannot provide and/or directing their own frustration and/or sublimating it as misdirected anger. Their behavior, especially when they do not listen and when they are unrealistically demanding, as when they demand a cure when none is possible, can at times make them seem unbalanced, at times gets them fairly and unfairly labeled as malingering and/or crazy, and further corrodes communication. The physician-patient relationship is bidirectional. Patients would serve their interests well by keeping this in mind, suspending judgments, and staying cordial.
You disappoint me, Arnon. I expected better. Your post is littered with so many inaccuracies and false assertions, I don't know where to start.

So now it's all the patient's fault? They should stop "demanding cures when none is possible". Why do you persist in characterizing prostatitis patients as unreasonable and demanding? Is it to justify urology's do-nothing attitude in dealing with the illness? I've already told you: it's treatment we demand, not a disinterested shrug of the shoulders. But I'm curious: who told you prostatitis was incurable? Is this what you were taught at medical school? Or are you going off your own cure rates?

For the record, prostatitis is curable. Very curable. I know many men who have been cured. I will introduce you to some if you wish. On a more practical level, this is a link from the Arthur Smith Institute of Urology, which lists 21 different treatments for the illness.

They say: "Treatment of CP/CPPS is individualized for each patient and is primarily based upon the diagnosis and the specific complex of symptoms. Treatments are, therefore, quite varied. They may include:"

Before treatment begins, the patient is evaluated. The evaluation is comprehensive. Pay attention to stage 2) of the evaluation, and what they say regarding prostate massage.

So to say it's a "Condition that doctors know nothing about"--is not true. Doctors know plenty about prostatitis The problem is 95% of urologists don't want to treat it (see thread title). And to suggest that some patients have "mis-directed anger" towards their urologist, is ludicrous. If you continue to characterize the patient as unreasonable or demanding, you run the risk of looking foolish and one-dimensional. All the patient wants is treating. Nothing more.

You say, "patients should accept reality." Whose reality is this--yours? Which is a do-nothing reality; a 'blame the patient' reality; or the rather scary reality of trying to persuade prostatitis suffererers to part with their prostates? No thanks. I prefer my reality: one in which the prostatitis patient is treated by a highly-motivated urologist.

You say c.p. sufferers should organise themselves, just as HIV and breast cancer sufferers have. We have. There are forums, groups, organizations, etc, etc. I have been a member of various groups and forums. But c.p. is not comparable to the 2 disease you mention. HIV and breast cancer have a certain public sympathy, which attracts many high-profile celebrities who are able to raise significant sums of money. I know Elton John has raised over $30 million for his HIV charity. I doubt very much if any man of similar celebrity status would dare to admit he had chronic prostatitis. It would be career suicide.

You finish your sweeping overview of prostatitis patients by saying they, "can sometimes seem unbalanced....which at times gets them labelled as malingering and/or crazy...." and then warning them it's in their best interests to "stay cordial."

What happens if they don't "stay cordial?" What are you going to do? Put a contract out on them?

Speaking personally, I find the tone of your post very revealing. Much more revealing than anything else you have written. I think for the first time, your real personality and thinking is slowly beginning to unravel in front of the readers' eyes. From my side of the computer screen, it's a personality and thinking which seems to eerily fit the profile of the uncaring urologist; the urologist who demands the prostatitis sufferer submit to his antiquated and out-dated thinking. A profile that prostatitis patients see all too often.
You seen to have alot of expereince with this illnes and with treatments.
You come off however as overbearing and attacking in your posts.
I don't think it is your intent - but it is what you acomplish - and all that will do is make people dismiss you - and I think that would be a shame as you have expereinces to share and lessons to offer sufferer like myself.

Like I have said before - a change in tone would go a long way to create a dialouge instead of a rant.

In terms of Dr. K. - this is his site - I came here to learn about his treatment - especially from people weho have had it - if you don't like him - why are you here? I originally thought you were heere to share your expereinces - but now it just seems like your just pissed off at any doctor that wants to try to help us.

I know most Uros are crap to CP sufferers - I've seem over 15 myself. So I know as you do that most do not care for CP or its patients and treat us as the bastard step son to be locked in the basement. But thats why we end up places like this and see doctors that at least try things to help us - like Bahn, Toth, Shoskes, and Dr K. Maybe you hate them all - so be it - but realize that most of us are here to learn and to try a variety of things to try to get better.

Your post is also full of contradictions - you claim CP can be cured - than in other posts you basicly say that you are uncurabe.

I am not trying to harass you - I am urging you to try dialogue instead of attacks.


Where do I say prostatitis is incurable? Show me.

What I do say is that it's a difficult illness to treat, if not treated correctly in its early stages. Even in its chronic form, the illness can be successfuly contained by competent and motivated urologists willing to treat it. I have posted you a link to a prestigious centre of urology in the very town where you live. Show me where they say the illnes is incurable.

You say you have been to see 15 urologists--all of them crap. Don't you have any anger towards theses urologists for wasting your valuable time? For mistreating you? For taking your money under false pretences? It seems you don't. Instead, you prefer to aim your anger at me--the one man prepared to answer your questions honestly; the one man in the crowd of sycophants and shysters prepared to warn you that not all radical prostectomies end up with a successful outcome.

Well I don't mind if you attack me. Nor do I mind if you continue to misquote me. I have great sympathy for you. You are a desperate man in pain who needs treatment--and you can't get any. But I know why you're mis-directing your anger towards me. It's the "Bearer of bad news" syndrome. In your own mind, you may have already settled on the idea of the final solution of prostate removal. You have probably thought of this for a while. Done a little bit of research, read some accounts, then suddenly, stumbled on this site by "dumb luck".

That's the phrase you use. You consider yourself "lucky" to have found this site. You see Arnon as your "saviour", the caring surgeon willing to put you out of your long-suffering misery. Maybe he is. You read the testimonials of his patients. Your confidence grows by the day. Everything is starting to look rosy. You see light at the end of the tunnel. Then suddenly, Chris sticks his ugly head above the parapet, and posts a disturbing thread about his "failed LRP". More disturbing posts about his shrunken penis. Not only that, the infidel Chris, this bitter and twisted man who has nothing positive to add to the debate, has the temerity to interrogate your "saviour", the good doctor K, the very person who is going to end your suffering.

So my "bad news" has shaken your confidence. Bad news is not something you want to hear. You want to hear good news--more positive testimonials. But maybe there is no happy ending after, you're starting to think, just an exchange for one set of symptoms for another. So you turn your anger on the "Bearer of bad news." This is evident when you ask "why am I here?"

To answer your question: it was to post a truthful account of my failed LRP. Not only did it fail, the surgeon and his accomplice made my condition worse. I have since undergone further surgery to try and correct the first. In future, James, if my posts trouble you in any way, then I suggest you don't read them
very well put chris. i have been accused of attacking people on this board and my post have been removed. its quite obvious whats going on here. ray charles could see it.
i just want us men to get help . i think that is asking too much here.
Your post was suspended because you called a specific doctor a "turd." This is as inappropriate as calling a specific patient or anyone else a "turd." Personal attacks will not be tolerated.

The rest of your comments were preserved and provided to you privately. The choice to repost or not is yours.
This whole problem needs to be taken to a higher level.

The behaviour of de-motivated and lazy urologists who refuse to treat sick men with prostatitis, who conspire against men in a "Conspiracy of Non-Action," should be exposed in the full glare of publicity.

This scandal has gone on for too long.
you are correct chris i will help you any way i can. this board has a agenda , i cant even say the experience i have had by a doctor . again deleted . cant say a doctors name that treated us very badly and rude and didnt care to help us ,that had traveled from different states . the only doctor i have met that cares and is 100% honest is dr. duke bahn period!! he has no hidden agenda he just want to help us and his staff is second to none. after reading all this im so greatful for dr. bahn . im sure if he read this he would be very sad.
This forum absolutely has an agenda as posted on the top of the home page: To share knowledge, experience, and opinion relating to prostatitis. The agenda does not have room for personal attacks, slander, and/or profanity. Any such post is deleted and repeat violations lead to suspension. Please let me know if this is not clear.
I have to admit guy's, if I were a Dr and a patient called me a turd-I would probably refuse to treat him. This kind of attitude will not help anyone. The good Dr mentioned above actually made my condition worse. Do I blame him? No I don't. It was my choice to go and seek his experimental treatment (WITH NO TRIALS). He gave me a thorough warning beforehand which I signed for that I understood the risks. I am a grown man, nobody made me go-I listened to some peoples recommendations of him and decided to take the risk. Even though his treatment made me worse, I am still thankful for his excellent scan which at least proved my prostate is just about finished and proved where my pain was coming from once and for all.

Anyone who accepts treatment before any trials are concluded does so at their own risk. If it does not work or makes you worse, then be man enough to accept the responsibility of your actions.

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