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

A patient from Guatemala reported this week that his father also had severe, treatment resistant, chronic prostatitis. His report is very similar to that of another patient, a Russian, who reported that his grandfather, like him, had severe, treatment resistant, chronic prostatitis. The Russian, who recently had surgery with me and who seems at 6 months to be doing well, says that in the 1970s, in Moscow, his grandfather had a radical prostatectomy, which cured his pain for good.

 

How commonly does chronic prostatitis run in families?
Is there an environmental, infectious explanation?
Is there a genetic explanation?

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Replies to This Discussion

Rick:

 

My father and grandfather both had chronic prostatitis. So far my son has shown no symptoms but he is only 23. However, at 19 both my father and I had already had problems.

 

 

I had a grandfather who, I believe, had chronic prostatitis. Unfortunately, I can't confirm as there is no one around these days who can remember. In fact, he had an operation to remove his prostate at a relatively early age (this was during WW2) and I suspect that it may have been to deal with chronic prostatitis. I'm interested to know if surgery (open surgery, of course)  was done at that time for this problem and if it had any positive effect. Or did they stop doing it then because it wasn't effective enough? I know I've inherited other things from him which seem to have skipped a generation e.g. asthma, and the fact that I have two cousins who share him as a grandfather and who also have chronic prostatitis, one severe, one relatively mild, make me believe that that was what he was in fact suffering from. For some guys, I think there may be an inherited tendency which, given the right circumstances, develops into the condition.
Prostate surgery is ancient, tracing back at least a few thousand years. By the 1930s, modern forms had been devised, including open perineal prostatectomy, which had been around since the turn of the century. So it's certainly technically possible that your grandfather had prostate surgery during WW2.

Your story resembles that of my Russian patient, who also reports a grandfather with prostatitis and prostate surgery, a prostatectomy that relieved his symptoms. Interesting that in both cases this skipped a generation.

How old are your cousins? At what age did their symptoms and your symptoms begin?

I'll never know if my grandfather was helped by the operation because, unfortunately, he died a couple of days after from a heart attack. He had a prior history of heart problems and probably his body wasn't up to having major surgery.

As for my own symptoms, they started when I was in my 40's, although it's only in my 50's that they've had a real impact on my life. My cousins, as far as I know started to have symptoms in their 50's. 

One reason I'm so interested in the historical aspect of this is because I have contacted several surgeons internationally who carry out robotic or LRP and asked them if they do the procedure for chronic prostatitis. Without exception, (when they have deigned to reply), they have all simply said 'no'. No one has given me any explanation why not. That's why I'd like to know if in the past the open surgery was tried and then rejected because it didn't work, and if this belief has just carried over into more modern procedures. There must have been a point at which the medical profession decided, 'OK, we won't do this any more because it's not working.' Or is it simply because surgeons have an overwhelming number of cancer patients and don't have the time to do it for chronic prostatitis sufferers? I can understand that a life-saving operation has to have priority. I just find it very frustrating that no one will explain why they won't do it.

I am now aware of any point at which the profession said "we've tried and found it doesn't work, so we're stopping."

 

Does it make any sense to relate the suffering of prostate cancer and prostatitis? Is this not very subjective and individual? And is it not the case that prostatitis ruins lives in ways that prostate cancer does not? Think about it. Dave Radford, whose successful outcome is detailed in this video, was barely living when he had prostatitis. Now that it's gone, he's fully functional. Does not every patient, including patients without cancer, deserve to be relieved of misery?

As a sufferer myself, I of course fully agree that we deserve to be relieved of misery. However, the general response from surgeons is that they only do this procedure for prostate cancer patients. It's the surgeons themselves who introduce this idea. I'm still wondering why. Is it that they are unaware of the extent of the chronic prostatitis patients' misery? I find this hard to believe, given that every urologist sees so many men with prostatitis.

If you don't know how to treat someone's misery, then you may sometimes dismissively condemn him as a malingerer or psycho. This has certainly been reported by many of the patients who subsequently had effective treatment with LRP. For an example, see the comments by Dr. Muff, who had prostatitis for years, about how he was treated by his doctors (start at 12:34).

 

Most urologists do understand that prostatitis patients can be miserable. However, in the absence of a history with a given treatment, in this case LRP, they'll remain skeptical. It takes time for practice patterns to change. Remember it took 1-2 decades after the discovery of Helicobacter pylori before we stopped doing surgery for stomach ulcer.

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