9/25/2012 11:52:00 AM Dr. K for Sept. 25, 2012 Prostatitis is a common condition with no clear cause
DEAR DOCTOR K: I have chronic prostatitis. Antibiotics haven't helped. What other treatment options are there?
DEAR READER: Prostatitis is an inflammation of the prostate. This walnut-sized gland secretes fluid into semen. Prostatitis is widespread and affects men of all ages. According to a study published in the World Journal of Urology, about two out of every 100 men worldwide suffer from chronic prostatitis.
The type of prostatitis you have -- chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) -- is the most common type. Yet we don't know what causes it. Doctors have suspected that a bacterial infection causes the condition, but so far, no clear evidence of a bacterial cause has been found. Other types of infections, such as with viruses, have not been studied very often.
White blood cells, a sign of infection, are usually found in urine and prostate secretions. However, no bacteria are evident. Still, doctors often prescribe antibiotics in case there's an undetected bacterial infection. But as in your case, such treatment is generally ineffective.
CP/CPPS may result from a cascade of events. The initial event may be an undetected infection (from some sort of microbe that we haven't discovered yet), or a physical trauma that causes inflammation. Over time, the inflammation leads to heightened pain sensitivity. The condition may extend beyond the prostate. The chronic inflammation may affect the nerves near the prostate gland. This, in turn, could affect bowel, bladder and sexual function. These are all reasonable theories, but they are unproven.
Symptoms of CP/CPPS include:
-- Pain in the lower back and genital area;
-- Having to urinate frequently and urgently (feeling like you can't hold it in);
-- Burning or painful urination and ejaculation.
Treatment aims to reduce discomfort. Pain medications that reduce inflammation -- such as aspirin, ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs) -- may help. So may hot baths.
Your doctor may prescribe one or more drugs. Anticholinergic drugs reduce urinary symptoms by decreasing bladder contractions. Alpha blockers relax the muscles at the neck of the bladder, easing the flow of urine. Pregabalin (Lyrica), a drug used to treat fibromyalgia, may reduce pain. (I've placed a list of such treatments on my website.)
Myofascial trigger release, a form of massage, and biofeedback have been found in small studies to reduce pain and other symptoms. They might be worth a try.
Finally, three plant-derived substances may help: cernilton, quercetin and saw palmetto berry extract. Studies have been small, but findings have been generally positive.
We have more information on prostatitis in our 2012 Annual Report on Prostate Diseases. (Learn more about this report at AskDoctorK.com, or call 877-649-9457 toll-free to order it.)
Permit me to get on my soapbox for a minute. Why is it that we don't know the cause or cure for such a common condition? The fraction of total government expenditures spent on research is going down, yet the tools to solve these riddles are in hand. We just need to find the money, as a society, to use those tools.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)