How do you treat prostatitis and will it recur? In a recent issue of The Johns Hopkins Prostate Bulletin, Dr. Richard B. Alexander, an internationally recognized expert on chronic prostatitis, answered these common questions about prostatitis.
Q. Is an approach that combines more than one form of treatment for the various aspects of prostatitis, such as infection, inflammation, and neuromuscular spasm, now usually recommended for chronic prostatitis?
Dr. Alexander: Yes. However, I typically start with one therapy at a time. If the patient appears to get absolutely no benefit from one therapy, such as an alpha blocker, then I might drop it and try something else, such as Prosta-Q. I tend to add medications over time to see if a combination of therapies can help the patient get better.
Frankly, as hard as it is to believe, what really helps is to tell people the truth about their condition. A big part of my time with prostatitis patients is spent dispelling myths that men have taken to be truths. The most common myths include:
- Prostatitis is caused by a sexually transmitted disease.
- A man with chronic prostatitis is harboring bacterial organisms in his prostate that cannot be eradicated, even with several courses of antibiotics.
- A patient can transmit this infection to his wife or sexual partner.
- Normal men do not have bacteria in their prostate.
I explain to my patients that infection is not currently thought be the cause of their prostatitis. I also explain that sexually transmitted diseases are not likely to be involved either, and that they should not be concerned about transmitting any infection to their partner.
Most men, including those without prostatitis, have bacteria in their prostate, but these organisms are not causing any disease. When patients finally hear the facts based on objective data, many of them are able to take solace from this information and move on with their lives. They can get on with trying to understand the factors in their own lives that can influence the prostatitis and that they can do something about. Such factors include physical activity, diet, stress reduction, and other lifestyle factors
Q. How likely is it that chronic prostatitis will recur in men who have a very good response to one of the current treatments?
Dr. Alexander: By its very nature, prostatitis is a chronic disease, and it's likely to recur. Even so, we don't have good data on how many of the two million men diagnosed with chronic prostatitis each year actually get cured and never need medical treatment again. I tell patients that we have therapies that are not likely to cure them but that rather will help get them better. That's what we're shooting for at this point. There are patients who do get better, but they still tell me, "Doc, I feel better but it's still there. I know it."
