Dr. Emmanuel L. Sta. Cruz

I. WHAT IS PROSTATITIS?

   

    Prostatitis is an infection of the Prostate Gland and may be without symptoms. Prostatitis can affect all adult men from all walks of life, young and old, those in monogamous or polygamous relationships alike and even virgins. It may be acquired early in their teens from organisms found in soiled underwear, previous sexual contact or an inadequately treated Urinary Tract Infections (UTI). 

    Almost all men are harboring various organisms inside their Prostate. Definitely an infection of the Prostate is not healthy. Ironically the test and means to diagnose Prostatitis is not routinely done.

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II. WHAT ARE THE POSSIBLE SYMPTOMS OF PROSTATITIS?

 

    Prostatitis may initially be silent or without symptoms. Although it may manifest as any one or more of the following:

 

1. URINARY PROBLEMS

• Frequent scanty urination

• Weak urinary stream/force (having to push)

• Urinary splitting (splitting of urine flow)

• Intermittent urination (interrupted flow) 

• Nocturia (waking up at night to urinate more than once)

• Difficulty in starting to urinate

• Urgency (difficulty in holding urination)

• Blood in the urine

• Recurring UTI

 

 2. SEXUAL PROBLEMS/ ERECTILE DYSFUNCTION (E.D.)

• Difficulty in getting or maintaining an erection

• Premature ejaculation

• Lack of gratifying sensation or discomfort during ejaculation

• Lack of interest in sexual activity

• Blood in the semen

 

 3. PAIN SYNDROME (CPPS)

• Low back pains

• Testicular discomfort

• Perineal discomfort (between anus and testicles)

• Hypogastric discomfort (lower abdomen)

• Dysuria (pain during urination)

 

 4. INFERTILITY

• Low sperm count

• Poor motility

 

 5. ELEVATED PSA

• Virtually 100% of biopsied men with elevated PSA has Prostatitis (Neal et al., 1992).

 

 6. ENLARGED PROSTATE

• Most Enlarged Prostates have Prostatitis, so it is best to do the prescribed test for Prostatitis to arrive at the proper diagnosis.

 

III. HOW TO DIAGNOSE PROSTATITIS

   

     A key to a successful treatment of Prostatitis is having sufficient diagnostic test for Prostatitis. These entail doing a Wet mount, Grams Stain and Cultures of the Expressed Prostatic Secretion (EPS) or Prostate fluid collected by means of Prostatic Massage. Cultures should not be limited to Streptococcus, Staphylococcus and the coliform organisms but should include cultures for Ureaplasma and Mycoplasma bacteria as well as a Direct Fluorescence Antibody (DFA) test for Chlamydia by Immunofluorescence microscopy. But sadly, there are very few institutions (hospitals, laboratories or clinics) that have bothered to equip their facilities with a complete diagnostic test for Prostatitis, hence these prescribed test are not routinely being done. Urinalysis, Prostate ultrasound, DRE, PSA, IVP or Cystoscopy cannot directly diagnose Prostatitis.

    For as long as the prescribed tests for Prostatitis are not routinely done, Prostatitis will remain the most undiagnosed and untreated medical disease. Early detection prevents the Prostate Problem from going beyond the early and easily treatable stage. So it is best to promote Prostate Health before it's too late.

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IV. TREATMENT OF PROSTATITIS

    

    Prostatitis is treatable medically with Culture-based antibiotics combined with thrice weekly Prostate Massage. This disease is basically Non-Surgical. Prostatic Massage has been the principal therapy for Prostatitis since the turn of the 20th century (Campbell's Urology 8th ed.). This is to drain out organisms or open clogged pockets and allow new WBC (soldiers of the body) and antibiotics to enter the Prostate glands as new fluid refills the glands after the massage. Otherwise, "there is an inherent failure of the antibiotics to penetrate the prostate" (Stamey & Meares, 1978) without a Prostate Massage.

    Repetitive Prostate Massage is the best thing that has ever happened to Prostate Disease Treatment and Prevention. Prostate Massage in itself can be curative as the drainage flushes the harmful organisms out of the glands. Effectively, one does not have to waste money on antibiotics as the said organisms have already been expelled.

Prostate Massage is a technique that has to be learned and a skill that has to be developed. Prostate Massage is not about brute force, it is about feel and touch. Prostate Massage should be done by an experienced physician. A variation in technique and skill could spell a difference at times in terms of the volume of Prostate Fluid that is expressed from the glands and the completeness or effectiveness of the Prostate Massage, which is the most essential component of an adequate diagnosis and treatment of Prostatitis.

    It is likewise important to monitor the WBC count of the Prostate Fluid collected after every massage as this count is generally reflective of the degree of infection, wherein a higher WBC count may represent a more severe infection while a lower count may suggest a resolution of the infection. The collective results of the WBC count serve as one of the objective parameters that a physician can use as a guide for monitoring the patient's response to the treatment.     

    Interpreting these results is a complex matter and would need sufficient experience as Prostatitis cases are varied and have many variables such as the size and consistency of the Prostate, Atrophy of the glands, multitude of organisms involved, as well as the severity and the stage of the Prostate Disease Process a patient is in at the time of treatment.

Naturally, various Prostatitis patients' response to treatment would also be varied. Thus, lowering the WBC count back to normal (5 WBC/hpf) in a single course of antibiotic therapy may not be achievable in many cases due to these   variables. 

    My experiences have taught me that most, if not all, Prostatitis cases involved multiple organisms, and usually, there is no single medicine that can eradicate all of them. Oftentimes, it may take two to three courses of different culture-based antibiotics for Prostatitis to fully resolve. And in a few cases, maybe even more.

    How to interpret these test results that would indicate that the susceptible organisms have been fully eradicated is one of the greater challenges a doctor has to face as his experiences in interpreting the results of the WBC count of the the EPS will play a role in making a decision on when to stop the use of antibiotics. This decision could spell the difference between the success or failure of the course of a treatment.

    So Prostatitis treatment is greatly dependent on the vastness of the doctor's experience and the Principles of Management that he has acquired through years of practice as well as his skill in doing Prostate Massage, which could vary from one doctor to another.

The initial response of a patient's treatment is greatly dependent on the extent or gravity of the Prostatitis condition he is in. One cannot expect a simple solution to a more complex problem. But with a sound Principle of Management for Prostatitis and the perseverance of the patients, most of these infections could resolve with the proper antibiotics when these are given at the right length of time.

    Prostatitis treatment could be easy, moderately complicated or frustratingly difficult. So it is best to diagnose and adequately treat Prostatitis early on while it is easier and less complicated. Any inadequately treated stage of Prostatitis treatment could make the problem more difficult to solve.

    It is of utmost importance to diagnose and treat as well the sexual partner/s of Prostatitis patients with the same antibiotic/s as the counterpart of Prostatitis in men is Cervicitis in women. Otherwise, all efforts in treating Prostatitis in men can go to waste, as whatever infection with the man is with the woman and vice versa. We should prevent re-infection at all times and we cannot leave it to chance. One of the lapses in the treatment of Prostatitis today is the lack of effort to treat the partners of Prostatitis alongside them. Prostatitis is a Genitourinary problem.

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V. PROSTATITIS IS NOT AMENABLE TO SURGERY

    

    Surgical treatment by Transurethral Resection of the Prostate (TURP), which scrapes the inner section, is fundamentally ineffective for Prostatitis and may even make it worse, since the peripheral zone of the Prostate is not effectively removed by this procedure and may even seal off the infected glands which could lead to Prostate Cancer.

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VI. OTHER REMEDIES TRIED IN THE PAST

 

    Direct injection of the Prostate gland with antiseptic and various chemicals have been tried in 1917 and 1936 but all these were doomed to fail because the Prostate gland is not a single gland wherein antiseptics can diffuse; rather, it is made up of thousands of very tiny individual glands that are separate from one another. Therefore, whatever substance (Chemicals or antibiotics and others) injected into the Prostate will not diffuse or spread into other glands and whatever ducts or glands that has been hit by the needle would be cut and damaged which may cause fibrosis (scarring) or, if the ducts were cut, the organisms in the glands that drain in those ducts may be trapped and become inaccessible even by massage. These trapped organisms could be a precursor to the development of Prostate Cancer.

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VII. COMPLICATIONS OF UNTREATED PROSTATITIS

 

1. Enlargement or hardening of the Prostate Gland such as BPH

2. Prostate Cancer

3. Erectile Dysfunction

4. Infertility

5. Recurring UTI

6. Chronic Pelvic Pain Syndrome

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VIII. PROSTATITIS CAN LEAD TO PROSTATE CANCER

   

    Chronic inflammation has been suggested to be linked to the development and progression of Prostate Cancer. In addition, Prostate Cancer occurs more frequently in the presence of histological evidence of Prostatitis (Wang et al., 2004). The infection-induced Prostate Cancer was shown in various studies by Bostwick (2004), Nelson (2003) and others.

    Despite the potential of an infection leading to Cancer, little interest is given to diagnose and treat Prostatitis in the hope of preventing Prostate Cancer.

    For as long as Prostatitis is continually ignored and not treated adequately, Prostate Cancer will likely continue to affect more younger men who were not usually prone to have Prostate Cancer a decade ago.

    Why not diagnose and treat Prostatitis before Prostate Cancer develops?