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?
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'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?
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.