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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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Also Blake,


If you have not yet had an ultrasound on your prostate, you will need one. Better sooner rather than later, so that your physician (s) can build a fuller picture of your condition. Make sure the ultrasound has the colour doppler software , so the radiologist can observe blood flow surrounding the prostate. The ultrasound will also show if you have any calcification.


It's critical that you are correctly diagnosed. Only then can you be properly treated.




What you're saying is not true.  There is no money in chronic prosatititis compared to something like prostate cancer. Those $400 tests you mention are peanuts compared to treatment options involved in prostate cancer. For example, a radical LRP will cost you upwards of $25,000--then there's further post-operative costs. How does that compare with your $2,400 for six cystoscopies? And a cystoscopy doesn't cure c.p--it's just an investigative tool.


I think if there was money in c.p., the research funds would want to get involved. But they don't; and that's one of the main problems with this disease. It's ignored by the medical community. Whereas cancer, there's a million and one trials taking place throughout the world on any given day. Every country on earth can boast of numerous speciality cancer clinics. But can they boast of any speciality chronic prostatitis clinics? No. In many ways, c.p. is much more difficult to treat than prostate cancer and more time consuming--yet the financial rewards for the urologist are far less.  


I understand your frustration, my friend. But you're barking up the wrong tree. Now what's happening with you? Has the urologist suggested an ultrasound yet? If he hasn't, he should have.



I think Ego plays the biggest part. Here is the way the medical community as a whole acts toward a patient
" sir there is nothing wrong with you its all in your head, the reason that antibiotic or this antibiotic worked for you is a placebo affect,I could have gave you a sugar pill and it would have worked just as good. "

Now Imagine a man just shot, standing there with a bullet wound in his shoulder, standing before a doctor in pain saying help me doc , now imagine a doctor telling him "sir there is nothing wrong with you its all in your head" this is how the chronic prostatitis patient feels.

Is it to much to ask for ? For a doctor to show emotion and listen to the patient and show some signs of pitty or remorse
instead of being rude,arrogant,shallow, egotistical. All the urologists I seen I felt like I was talking to a brick wall they made me
feel like I was alone in this. I just don't understand why doctors treat people like this


The knowledge base for eliminating the symptoms of chronic prostatitis is incomplete. In this setting, the best of efforts of the even most skilled, experienced, and motivated specialist may in many individual cases come up short of the clinical objective. When this is the clear reality, to condemn an entire profession is to obscure the only real path forward: research. That is the path taken in the setting of other illnesses, ranging from breast cancer to HIV infection. Perhaps energy can be more constructively directed to forming a public advocacy group for chronic prostatitis, so as to seek to direct more resources to the development of more knowledge that can make a real difference at the bedside.

Your reply - while logical and valid - does little to acknowledge that there are many in your profesion with neither the skill to identify proper treatment protocols that work for many men or for offering referels to the few doctors that actually treat this illness with any measure of success - I went through half a dozen urologists until I found one that would work with me - and "experiment" - to find a treatment that actually provided some relief (in my case - injections provide some durable relief for long periods).


It is good to know a "final" option like surgery from Dr K is available when all else fails - but a better answer is a first line multi-modal approach using various drugs, injections, massage, etc - until you find something that may provide relief for you - then when/if nothing works anymore - we have Dr K to assist us.


I find it unfortunate that you defend the many practioners in your profesion that do not even pretend to try to help patients with this ailment - they should just put a sign on their door that says "no prostatitis patient accepted" and save us the humiliation and demeaning treatment....


That was not meant as a refutation and/or acknowledgement and/or defense of anything. Surely it was not a defense of not trying to help a patient who has walked in the door (nor of pretending to try to help). And agreed, if a doctor's intention is to not try to help, then this should be communicated to a would-be patient in advance of an appointment.


That said, the only apparent path forward is a focus shifted to constructive pathways to bedside enlightenment. We need a much better understanding of why patients have the symptoms they do and we need much better remedies than currently available. It is an opinion based upon observations about the breast cancer and HIV communities that the chronic prostatitis patient community would do itself good by first understanding that in many cases, the available remedies simply do not work -- which in itself leads to patient and professional frustration at the bedside -- and second organizing and advocating for change, which means research, which means dedicated resources.


Given the numbers afflicted, it remains a mystery as to why men with chronic prostatitis have no effective representative advocacy organization. Is this how it should be? Twenty years from now, do we want more threads like this or do we want better treatments? If the latter, which steps are necessary? Do patients have a role in pushing for those steps?

I believe the answer to your question is simply  this:

Men do not die of prostatitis (99% of them at least).


If people do not die of the disease - and if the disease is hidden (people do not see it - like they see MS or parkinsons) - there is no urgnecy to do anything about it.


I can say that when my symptoms are at their height - the last thing in the world I would want to do is start an advocacy group.


Most of those things have been started or pushed by the surviving family/friends of those that dies of breast cancer or aids or similar maladies.


Since we don't die - we just hide in our homes and rot........and I beleive that the medical community for the most part would like to keep it that way as we are a low profit diseasethat most doctors can not profit enough off of non-surgical treaments to make it worth their while at thier practice.


 I in no way mean to be disrespectul to you - but too many of your peers have treated too many of us too badly for us to be overtly nice about the topic......


I do appreciate that you offer a sollution - thank you for that - and I will likely come to you for it once my pain can not be controlled through other means....

Several separate issues.


I do not take responsibility for another doctor just as you do not responsible for another patient. Sure, some doctors have been disrespectful, just as some patients have been disrespectful. None of this substantiates a conspiratorial argument that all doctors want to keep patients in pain or that all patients are obnoxious.


This is not about being overtly nice, but about moving beyond the repeated statement of the problem that not all physician-patient interactions are happy. Obviously that is true. This is about illness and the limitations of current knowledge. So as to the culture of advocacies, there are numerous examples. Either way, since advocacies are often led by or symbolized by people who are not afflicted, e.g. Elizabeth Taylor for HIV, one might think that a chronic prostatitis patient's wife or other might jump in. And if one thinks there is a stigma associated with prostatitis, just think how stigmatized was HIV. There is a way forward, but the first step is to see it.


For what it's worth, one missing ingredient has been a forum in which patients could constructively and openly engage with each other, which means putting aside sarcasm and sweeping condemnations long enough to look at what will drive progress: data, funding sources, funding priorities ...

In response to chris and dr kongrad over this whole post about urologists I agree with chris that so far most of my doctors have not treated my condition with any good care or proper effort and the only urologiust I saw worsened my condition severely but there are good doctors that don't just do it for the money and dr k is right you have to work with those doctors and be polite its wrong to say doctor kongrad wants to cut out prostates he is helping people in suffering I don't like that statement. But I think like doctor Kongrad said we need to work together to get noticed and again chris you are right this disorder could be cured a lot more but not while its ignored therefore we need to get together and make a much better protocal based on scientific facts and treatments that do work with better tests and dignosis procedures .I feel a lot of work that needs to be done is more common sense based than anything people should not get given drugs before they know what there physical problem is and we as people who understand whats happening should organise what we think would of worked best with doctors so the next man dosent suffer the same! I will be writing my own case study based on what I believe happened in my case and how treatment effected me and how I think things should be changed but other people will need to agree on this! Doctors and patients for change to happen no one person can treat everyone we have to help the people that don't know to understand better! Allthough many are ignorrant including my own father who I now will not speak to as he has allways been that way and this time he really got to me, We need to stay calm to perswade enough to listen for change to happen I think that what the doctor is saying this is the most important step I would say for now for improving what we can where we know we can get it! .

Blake, you put the videos relating to biofilms in the Risk Factors and Causes group: click here.

I have suffered with prostititis for over 4 years. Does anyone know of a good protititis treating MD in the NE Tenn area?

and I want to add more: it would require thinking, something they all seem to be incapable of. culture from semen is the best, yet all seem to flatout refuse this, with a few exceptions. Another issue, which you all should push for, is anaerobic cultures. anerobes are difficult to culture, but they are the major cause of bacterial vaginosis in females. if you have any foul smell of urine or semen, or even the glans of the penis, that is an anaerobic infection.

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