Johns Hopkins Health Alert
Talking About Prostatitis With Dr. Alexander
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."
Posted in Enlarged Prostate on May 12, 2009
Reviewed June 2011
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"In a recent issue of The Johns Hopkins Prostate Bulletin, Dr. Richard B. Alexander..." What issue was this in? I've looked at the 4 most recent and don't find anything about prostatitis.
Posted by: boboco | May 16, 2009 1:20 PM
If infection is not currently thought be the cause of prostatitis, please explain why sulfatrim DS completely alleviates the symptoms from my occasional flare-ups. (A number of causes can generate flare-ups including alcohol, caffein, and external pressure on the prostate.)
Posted by: fredhep | May 16, 2009 5:26 PM
I just had a prostate sonogram/biopsy. During the procedure the physician said that I had a cyst and some calcification in the prostate. He said cysts are uncommon, but calcification is not unusual. When I asked him if there was something I could do to decrease the calcification, he said "not really." I read that a diet containing a balance of magnesium and zinc could help to expel the stones as sand. A physician associated with the Cleveland Clinic (an organization I respect) stated that nothing can reverse calcification. What does Johns Hopkins know for sure about prostatic cysts and calcification?
Also can calcification increase PSA levels?
Posted by: stardot | May 16, 2009 6:53 PM
I am 75yo physician who contnue to practice IM solo with a small practice, but continue to accept ER unassigned patients in a midtown hospital in atlanta,ga once or twice per month. Recently I experience an acute almost overnight a complete urinary obstruction. Went to ER treated with straight catheter and bloody urine. Catheter with leg bag inserted, antibiotics continued and alpha 1 blocher started.Catheter reoved in 4 days. Removal of catheter and cystoscope exam found bladder what urologist decribed as bladder tumor. Urinary flow is forceful now and less frequent with light amber to dark amber urine 10 days catheter removed. Could the tumor looking lesion appear from the 4 days of the 10 ml bulb moving around in the hypertrophic bladder. My question to you Dr. Alexander,should I return to the general urologist who treated me after the ER visit and removed the catheter. A cystoscopic exam will be indicated again or should I seek a urologist with experience in treating bladder cancer and tumor . This will prevent the need for a second cystoscope in a short period of time. My last Psa was 4.2 in 4/2009 on my last yearly physical examination. Thanks for a response.
Posted by: Robert Williams | July 18, 2009 11:50 PM
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My husband is 72 years old and suffers from Parkinson's Disease. Several months ago he developed TWO back-to-back urinary tract infections which led him into septic shock and nearly died. He also has an enlarged prostate and has been treated for such for several years now. The two infections followed first the removal of his catheter, and secondly following a cystoscopy. These flare ups occurred within 24-hours of the procedures. He has now stabilized, but we are concerned that if he goes ahead and has the TURP that he will develop another UTI following the surgery. We asked that the catheter be left in place up until the surgical procedure so as to avoid another flare-up.
Do you think we are being overly anxious or is this typical of what can happen to someone who has an enlarged prostate, let alone PD. The two infections left him in such a weakened state that several weeks of rehab were necessary for him to regain his strength. We do not wish to experience this again.
We also feel that the urologist who has overseen his care for two years was a bit lax in at least warning us about possible UTIs and how quickly they can kill you. We are also wondering about seeking a second opinion from another urologist.
Thank you in advance for your interest.
C.A.
Posted by: sweetcat1943gmail.com | May 14, 2009 2:09 AM