THE OTHER PROSTATE PROBLEM
Nomen Nescio
THE OTHER PROSTATE PROBLEM
By Timothy Gower
Jan 14, 2002
It has been called "the forgotten prostate disease." Yet prostatitis
leads to more than 2 million visits to doctors' offices in the United
States each year and is the most common urological problem among men
younger than 50, though older guys can develop it too.
The medical establishment has paid far more attention to prostate
cancer and enlarged prostate in recent years, but that situation is
beginning to change. That is, in part, because of a new federal study
of men with prostatitis that may yield valuable information about how
best to treat this mysterious and often frustrating disease.
Prostatitis is a blanket term for several related conditions with
similar symptoms. Some sufferers develop a frequent and urgent need to
urinate, which is also the key characteristic of an enlarged prostate,
also known as benign prostatic hyperplasia, or BPH. Other symptoms,
such as a burning sensation while urinating and erectile dysfunction,
can occur too. The hallmark symptoms of prostatitis, however, are pain
and discomfort in the pelvic area, groin or lower back. In some cases,
the discomfort is merely annoying, like sitting on a golf ball. For
other patients, though, prostatitis means sheer anguish. "Some men
describe it as feeling like they've been impaled on a spear," says
Clark Hickman, an associate dean at the University of Missouri-St.
Louis. Hickman, a prostatitis sufferer who runs a telephone support
group for the illness, says prostatitis pain can be so debilitating
that some men end up on work disability.
In a small minority of cases, men complaining of prostatitis symptoms
turn up in doctors' offices with severe fever too. That's a sure sign
of acute prostatitis, which is caused by an infection and is easily
treated with antibiotics.
However, the majority of men complaining of pain down under don't have
a fever, and they test negative for bacterial infections. Yet many
doctors in this country nonetheless treat these cases of chronic
prostatitis with antibiotics, which are designed to fight infections.
Not surprisingly, antibiotics often prove to be worthless in relieving
prostatitis, though many men with the condition end up taking them for
years anyway, risking side effects that can include gastrointestinal
problems and headaches. "[Prostatitis] is often treated as an
infectious disease because we really don't know what else to do," says
University of Maryland urologist Richard Alexander. He adds, however,
that doctors keep prescribing antibiotics to men with chronic
prostatitis because a portion of them feel better if they take the
drugs, even though they don't have an infection.
That may be because the antibiotics act like anti-inflammatory drugs,
says urologist Scott Zeitlin of the UCLA School of Medicine. Indeed,
many prostatitis patients have clear signs of inflammation in their
prostate fluid, which isn't surprising (the suffix "itis" refers to
inflammation). Yet other men experiencing pelvic pain and other
symptoms reveal no signs of inflammation.
Don't worry if you're confused. "The cause of this condition is
unknown," Zeitlin says. While many theories have been proposed, no one
is sure why men get chronic prostatitis in the first place, he says.
"This all makes chronic prostatitis a very difficult disease to
explain to a patient, and to treat."
Zeitlin and his colleagues at UCLA are conducting a nationwide,
multi-center study, sponsored by the National Institutes of Health, to
measure the value of two drugs commonly used to treat chronic
prostatitis. One is Flomax, a medication that's better known as a
treatment for urinary problems linked to BPH. The other drug--the
antibiotic Cipro--became a household word since it's considered the
therapy of choice for anthrax infection. Men with prostatitis who
participate in the study will be given Flomax, Cipro, a combination of
the two drugs or an empty placebo pill for six weeks, then followed
for six weeks to determine whether their symptoms improve.
In addition to other drugs (such as pain relievers), doctors recommend
a wide range of remedies and preventive measures for chronic
prostatitis, though none is guaranteed to work. Sitz baths (sitting in
a tub of warm water) help some men, while some doctors suggest that
men perch on a cushion if they plan to sit for a long period. Avoiding
spicy foods or alcohol and caffeine--all of which can cause flare-ups
in some men--is sometimes recommended.
Ejaculation brings relief for some men, while worsening prostatitis
anguish in others. A technique known as prostatic massage, first
popularized in the early 1900s, appears to be making a comeback. A
doctor inserts a gloved finger into the patient's rectum and rubs the
prostate. The goal is to empty ducts within the gland, which, if
clogged, can cause pain.
This method might be a tough sell to men who freak out when it's time
for the annual digital rectal exam, especially because several
massages per week are necessary (some men even learn to self-massage).
But Zeitlin and urologist Daniel Shoskes of the Cleveland Clinic in
Weston, Fla., found in one study that about 40% of difficult-to-treat
prostatitis cases improved with a combination of massage and
antibiotics.
Zeitlin and Shoskes also found in a 1999 study, published in the
journal Urology, that 82% of men with prostatitis who took a dietary
supplement called Prosta-Q (whose main active ingredient is the plant
nutrient quercetin) experienced at least a small improvement in
symptoms.
However, other clinicians are skeptical. "No one really knows what's
in this stuff but the people who make it," says University of Maryland
urologist Richard Alexander, noting that the U.S. Food and Drug
Administration doesn't regulate the content and purity of dietary
supplements.
Alexander is a leading proponent of the theory that chronic
prostatitis may be an autoimmune disorder, which occurs when the
body's immune system attacks its own organs or tissues. He is studying
whether men with chronic prostatitis benefit from the drug Enbrel,
which is used to treat rheumatoid arthritis, another autoimmune
disease. However, Alexander adds, there's often no accounting for how
prostatitis patients will respond to various therapies for this
baffling condition.
chronicprostatitis.com
> Zeitlin and Shoskes also found in a 1999 study, published in the
> journal Urology, that 82% of men with prostatitis who took a dietary
> supplement called Prosta-Q (whose main active ingredient is the plant
> nutrient quercetin) experienced at least a small improvement in
> symptoms.
>
> However, other clinicians are skeptical. "No one really knows what's
> in this stuff but the people who make it," says University of Maryland
> urologist Richard Alexander, noting that the U.S. Food and Drug
> Administration doesn't regulate the content and purity of dietary
> supplements.
There's a little bit of professional jealousy here. It's not a fair
comment from Dr Alexander. He knows that ProstaQ contains very pure
quercetin.