Chronic prostatitis

Chronic prostatitis is a condition of unknown cause ( http://www.prostatitis.org/otherproblem.html ). Therefore there are numerous theories that exist. What I like to stress is that every patient is like a snowflake as they are all different. Everyone requires individual evaluation and treatment. Patients and physicians like the infection theory because it is easy to say that you have an infection and we will continue to need to treat you with antibiotics. Most people don’t have an infection and those that do tend to respond to antibiotics in the same manner as patients with no diagnosable infection. One can argue that we have only discovered about 10% of the worlds bacteria and therefore we simply can’t culture the organisms or we can’t culture them because they can hide in the prostate in small numbers protected by something call a biofilm. Conversely since antibiotics can be antimicrobial, antipyretic (reduce fever), analgesic (reduce pain) and anti-inflammatory one could argue that one of their other important properties is really at work. We can do our best to determine whether or not there is an infection and offer 5 day cultures.

Chronic prostatitis or Chronic pelvic pain syndrome (CPPS) as it is also referred to can have a number of etiologies. The syndrome may not even involve the prostate. There may be obstructions within the ducts of the prostate and the best therapy may be repeated prostate massage. Patients may come with the diagnosis of prostatitis but on examination may actually have tenderness and malfunction of their pelvic floor musculature. These patients are best treated with pelvic floor physiotherapy. The physical therapist that you use should have experience with this type of therapy or it may not be beneficial.

Cysts and obstructions within the prostate are sometimes seen on transrectal ultrasound and may have a role in the etiology of the patient’s symptoms. Ultrasound is a helpful tool in diagnosis and treatment.

Alternatively, there are physicians who believe that the pain and voiding dysfunction in patients with CP/CPPS may be interstitial cystitis(IC). IC is classically perceived as a disease of the bladder in women and may affect small numbers of men. Some physicians believe that they are the same disease. I am presently conducting a clinical trial at UCLA on this very issue. If you are interested you can contact Dr. Xie about this trial at 310-267-2526. 

Finally there are those that think that CP/CPPS can be caused by local nerves in the pelvis and the pudendal nerve for one has been implicated. More centrally nerves can be affected as they emanate from the spinal cord. Nerve roots if compressed can cause pelvic pain just as they cause Sciatica like pain.

As a pointed out previously, all patients are different and require individual care. While the symptoms may be the same, the cause may be completely different.