Subject: sci.med.prostate.prostatitis FAQ 3/5
Supersedes: <medicine/prostatitis-faq/part3_825706942@rtfm.mit.edu>
Date: 1 Apr 1996 18:14:48 GMT
References: <medicine/prostatitis-faq/part1_828382217@rtfm.mit.edu>
X-Last-Updated: 1996/01/29

Posting-Frequency: monthly

10.  Can prostatitis be cured?

(NOTE:  The following is not intended to recommend any specific
drug or regimen.  It is based on a review of the literature and the
reports of people in the newsgroup.  CONSULT YOUR PHYSICIAN BEFORE
UNDERTAKING ANY TREATMENT.)  These data are collected and presented
as a public service.  Some of these drugs can have very serious or
lethal side effects and thus must be discussed with your physician
before you take them.  Please be watchful for any errors or
omissions.)

The word "cure" needs to be carefully defined when dealing with
prostatitis.  Cures do occur but they need to be distinguished from
"remissions."  In the medical literature, "cures" are often
reported when there is a positive culture before treatment and a
negative one after treatment, and yet the patient may not
experience any change in symptoms whatsoever.

Because physicians do not know the cause of prostatitis, they
cannot tell when you have been cured; scientists cannot objectively
measure pain.  Many people find that certain drugs reduce their
symptoms as long as they take the drug. Other people find the
symptoms get better without treatment.  (A standard cliche of
urologists is "You will not get well, but you will get better.") 
For still other people, no drug helps.  And for some, the treatment
will work and they will never have symptoms again.    

10A.  Quinolone antibiotics.

10Ai. Noroxin (norfloxacin).
 
Noroxin is the brand name for norfloxacin, a quinolone antibiotic.
MCapstone@aol.com reports a complete resolution of all his symptoms
for over eighteen months. He was diagnosed with "non-bacterial"
prostatitis.  He was placed on two 400 mg. tabs of Noroxin a day,
and responded immediately. He took Valium simultaneously during
flare-ups.  As he got better and flare-ups became less frequent he
was tapered to one pill every other day, then one pill every three
days.  He and his physician are afraid to take MCapstone off
antibiotics because of his great response.  The newer quinolones
are sometimes thought to have better properties than Noroxin, which
was one of the first quinolone antibiotics.

10Aii.  Other quinolones.

Other quinolone antibiotics are Cipro (ciprofloxacin), Floxin
(ofloxacin), Penetrex (enoxacin) and Maxaquin (lomefloxacin). 
These are new and therefore expensive drugs. Some of their success
may be due to their newness; bacteria which have developed
resistance to other families of antibiotics may respond to
quinolones.

Anecdotally, all the quinolones have had some success treating
prostatitis, whether it is bacterial or "non-bacterial."

An infectious disease specialist says, "Seventy percent of
"non-bacterial" prostatitis responds to quinolone antibiotics." A
urologist says, "We have had great success treating prostatitis
with quinolones, especially because other drugs seldom if ever
worked in comparison."  (Remember anecdotes are not controlled
studies.  More actual studies and data on this need to be posted.)

--K.G. Naber, 1991 review article, INFECTION 19, suppl. 3. p. s170
- 177:
"A total of 23 studies with the newer quinolones in the treatment
of chronic bacterial prostatitis are available . . . The results
are promising, but further investigations, especially controlled
studies, are needed in order to determine the role of the newer
quinolones in the treatment of chronic bacterial prostatitis." 
Note that Naber is talking about "bacterial" prostatitis as opposed
to "non-bacterial."   

Naladixic acid, the precursor to the quinolones was used
extensively by the Mayo Clinic for prostatitis prior to the
availability of the current quinolones.

10B.  Bactrim.  Bactrim (trimethaprim/sulfamethoxazole or TMP/SMZ)
is an antibiotic which has been used to treat prostatitis.  It was
the favorite antibiotic against prostatitis until the quinolones
were developed.  It is still often prescribed as the first in a
series of antibiotics to be tried in treating prostatitis due to
its relative cheapness.  There have been cures reported with
Bactrim.  

10C.  Geocillin (carbenicillin) is another antibiotic that has been
used for prostatitis.  It is member of the penicillin family. 
There have been cures reported with it.

10D.  Doxycycline or minocycline.  Yet more antibiotics used for
prostatitis.  Both are in the tetracycline family of antibiotics.

10E.  Keflex (cephalexin).  An antibiotic in the cephalosporin
family. 

10F.  Dr. Toth's Regimen.  Dr. Atilla Toth, an infertility
specialist in New York, uses IV gentamycin and IV clindamycin on
his patients for 10 days.  He mixes the antibiotics together and
gives a continuous infusion.  He has a better than 50% cure rate,
anecdotally.  He has never published this work, but hopes to in the
future when either funding or time becomes available.  Gentamycin
is a dangerous antibiotic, as they all are, but there is good
theory behind this regimen.

10G.  Transurethral resection of the prostate (TURP) or bladder
neck incision.  This surgery is often disappointing, and should
only be undertaken after seeking a second opinion.  (However, TURP
is a standard procedure in the treatment of benign prostatic
hypertrophy.)  TURP can have side effects of incontinence,
impotence and retrograde ejaculation (you ejaculate into the
bladder, so that no semen comes out).

10H.  Microwave hyperthermy or thermotherapy.  In these
experimental techniques, prostate tissue is heated by means of
microwaves. There seem to be two different machines.  With the
Prostatron, a catheter is placed in the prostate; the catheter
cools the urethra while the surrounding tissue is heated.  With the
Prostathermer, the microwave device is inserted through the rectum.

With hyperthermy, the prostate is heated to a level just below
tissue destruction.  Thermotherapy involves tissue destruction; it
is being used as a substitute for TURP surgery for BPH and
prostatitis.  These techniques are still in the experimental phase.

Side effects such as temporary impotence or incontinence are
possible.

Some summaries of studies:

-Nickel, JC.  Sorensen, R.  Randomized Double Blinded Placebo
Controlled Study to Evaluate the Effect of Transurethral Microwave
Thermotherapy in Patients with Complaints of prostatitis.  (Not yet
published)

"Of the 15 non-bacterial prostatitis patients who had at least 1
transurethral microwave therapy (TUMT) in either phase 1 or 2, 13
(87%) have either "cure" (100%) reduction in symptoms) or "marked"
improvement.

-Kumon, H., et al. (In Japanese)  Transrectal Hyperthermia for the
Treatment of Chronic Prostatitis.  Nippon Hinyokika Gakkai Zasshi
84:265-271 (1993)

36 patients with chronic non-bacterial . . . or prostadynia
underwent 5 weekly, 1-hour sessions of transrectal microwave
hyperthermia (43 degrees C) to the prostate.  11 had excellent
results, 8 good results, 8 fair results, 9 poor results.

-Montorsi, F.  Et. al.  Is There a Role for Transrectal Microwave
Hyperthermia of the Prostate in the Treatment of Abacterial
Prostatitis and Prostadynia?  The Prostate  22:139-146 (1993)

54 patients.  Some improvement in all patients.  Fifty percent
reported an improvement in life quality. Forty-seven percent
unchanged.  Three percent deteriorated.

- Choi, Nak Gyeu.  Et al. Clinical experience with Transurethral
Microwave Thermotherapy for Chronic Nonbacterial Prostatitis and
Prostadynia.  Journal of Endourology.  Volume 8, Number 1, 1994.
A one hour session using the Prostatron machine for 61
non-bacterial prostatitis patients and 17 prostadynia patients.
Complete symptom disappearance was obtained in 23% and a partial
response in 43%. (THERE ARE SIDE EFFECTS PLEASE READ THE WHOLE 10I.

Hytrin.  This blood pressure medication is sometimes tried in
cases of prostatitis or prostatodynia.  (It has also been used in
cases of benign prostatic hypertrophy).  It may work by reduce
urinary muscle tension.

10I.  Proscar.   This is a heavily-advertised treatment for benign
prostatitic hypertrophy, so it may be recommended by friends who
know you have "prostate trouble."  It blocks a metabolite of
testosterone which promotes benign cell growth within the prostate
gland.  In a certain number of BPH patients, it can actually shrink
the prostate after several months of use.  Its use in cases of
prostatitis seem to be a "stab in the dark" experiment.    

10J.  Antifungals (Nystatin, ketoconazole, Diflucan).  Fungal
prostatitis has been reported in the literature, but is rare. 
However, Garst@sunchem.chem.uga.edu reports palliative effects from
these drugs in the absence of a diagnosis of prostatic fungal
infection:

"I am aware of only one theoretical basis, that proposed by C.
Orrin Truss, M.D., of Birmingham, AL.  Truss is a clinician who
observed that antifungal medications, administered for specific
fungal infections, often cured or helped other, seemingly unrelated
ailments of his patients. Acting on these observations, he began to
prescribe oral Nystatin (principally) in more cases. He got many
positive responses and eventually developed a three-part therapy
consisting of (1) oral Nystatin, (2) low-carbohydrate diet, and (3)
immune system stimulants.  He popularized this in a book and
through TV appearances on the Sandi Freeman show (on CNN, she was
Larry King's predecessor).

Truss' theory, as I recall it:
Long-term antibiotic use or other factors may allow the overgrowth
of Candida albicans in the intestinal tract. An individual may be
come hypersensitive to the products of yeast metabolism, which
travel through the blood stream to all parts of the body.  Any
organ can be affected by these metabolites, so a wide variety of
symptoms can result.  The immune system may become slightly
compromised.  [Note: In commenting on Truss' work, many physicians
have confused the (hypothetical) condition he describes with a
disseminated yeast infection, which is *not* what he
proposes.]

I have met and talked with Truss himself.  I was his patient for a
few months, before I got tired of making four-hour trips to
Birmingham.  My impression is that he is medically conservative. 
He has never claimed that the "yeast hypersensitivity syndrome" is
a primary cause of the various diseases that he believes that it
affects.  His claims have been that it can be a contributing factor
and that clearing it up can assist recovery from other diseases. 
His first notable successes in this regard were young women who had
been diagnosed as having multiple sclerosis.  Truss' critics point
out that MS is notorious for spontaneous remissions.

After Truss, various authors jumped on the money-making bandwagon
and produced volumes of popular articles and books making all kinds
of unsupported claims, creating the appearance of a kind of
national epidemic of yeast hypersensitivity.  This gave the whole
area a very bad image with most physicians.  As far as I know (and
I haven't tried to check the literature in several years), the few
controlled studies (double blind, etc.) that have been done have
shown no correlations of recoveries with
Truss' treatment protocol.  Therefore, most physicians remain
skeptical and regard the yeast hypersensitivity syndrome as fiction
(or, in the words of one official condemnation, "unproved").

I first tried oral Nystatin after stricture surgery, perhaps 10
years ago. Terrible pain had continued for many months after I
should have been healed. I had had one genuine UTI shortly after
surgery, which antibiotics cleared up, apparently, in short order. 
I was given trial doses of virtually every antibiotic known at the
time to kill anything that might have been there. Nothing worked. 
Finally, having heard of Truss' theory, I suggested a Nystatin
trial.  I took what I later found out was a very low dose (by
Truss' standards), two pills (500,000 units each? I don't recall
for sure) twice a day.  At the end of the 3-week trial, I thought
I was just a little better, so the trial was extended. After 6
weeks, I was "normal," meaning that my pain was minimal and
tolerable.

Since then I have taken Nystatin in doses up to 16 or 32 tablets
per day (4 doses/day) for several periods of time.  In every case,
I improved.  In every case, my improved condition would persist for
some time after I stopped, but then it would slowly deteriorate,
and I would start another round of Nystatin. I once tried
ketoconazole, with similar results. Recently, I have been using
Diflucan, with similar results.

Thinking that Diflucan is a very powerful antifungal, I've been
using low does as a trial maintenance regimen.  It now appears that
one pill/week is insufficient.  I've been in a very bad period
since Jan. 1, 1995.  About 10 days ago, I decided to step up the
Diflucan to one pill/day for 3 weeks.  I am in the middle of this. 
So far, I haven't seen much improvement.

So how real is the antifungal effect in my case?  Could I simply
have been timing my uses of Nystatin and Diflucan to match the
natural rhythms of the flareups and remissions of my chronic
prostatitis?

I think that it is real.  I tried on several occasions to hold out
and wait for my bad symptoms to subside, but on those occasions,
they seemed to go on and on until I finally started taking Nystatin
or Diflucan, then they would slowly subside.  By slowly, I mean
over 4-6 weeks.

However, I don't think that whatever the antifungals treat is the
whole story. Their use has always resulted in partial, not
complete, remission.

Other than Truss' theory, I have no speculations as to what might
be going on."

10L.  Prednisone.  Account of experience by John Garst,
garst@sunchem.chem.uga.edu:  "My experience with this [Prednisone]
is ambiguous. Before my 9-month remission, I had been taking
Nystatin for a long time. Then I came down with a winter-time
chest-and-sinus congestion. For this, I was given successive rounds
of two antibiotics, the names of which I could dig up from medical
records, but which I don't remember off-hand. After a few days
of the first antibiotic, everything cleared up wonderfully,
including my nasal passages.  I breathed more easily than I could
remember previously. Then, after a week, even though I was still on
this same antibiotic, I stopped up badly again.  When this
condition persisted for a few more weeks, I was given a round of a
second, different antibiotic.  If it had any noticeable effect, it
was minor.  At this point, my physician prescribed a prednisone
taper.  It did not have the anticipated effect after a few days of
use, but by a couple of weeks later my chest and sinus problems had
resolved and I noticed that my prostate pain was also much better.
In fact, it became virtually nonexistent.  This remission lasted
until I was given additional antibiotics about a year later for a
similar chest congestion.  Then the prostate pain returned.

What caused the remission?  Was it the Nystatin, one or both of the
antibiotics, or the prednisone?  I don't know.  It might have been
the prednisone, but then again, it might not have been.

A couple of years later, I tried another prednisone taper, this
time with no effect on my pain.  However, I believe that this was
the time when it was eventually found that one of my strictures had
returned.  A dilation relieved it, and I got better.  This may not
have been a fair trial for the prednisone.

I haven't tried it since.  I really have no idea whether or not it
is an effective therapy.  Others had posted about the use of
anti-inflammatory agents, so when I became aware of a recently
developed micro-dose prednisone therapy for rheumatoid arthritis,
I posted information about that.  The microdoses (5 mg/day) are
said to prevent pain without side effects.  Whether or not this
might work for some cases of chronic prostatitis/prostatodynia, I
don't know."
  
10M.  Carrot juice/beta carotene.  Several newsgroup members report
marked improvement after drinking several glasses of fresh carrot
juice a day.  (Canned carrot juice can be pretty vile-tasting;
fresh or frozen carrot juice is much more drinkable.)  Other
newsgroup subscribers have noticed improvement after taking beta-
carotene capsules.

10N.  Saw palmetto.  Saw palmetto berries or saw palmetto tea are
herbal remedies for prostate problems.  Domonkos@access.digex.net
reported a temporary improvement in urinary flow from drinking saw
palmetto tea, taking hot baths, and taking antibiotics.  Saw
palmetto is available at moth health food stores.  

10O.  Cernilton.  Cernilton is a flower pollen compound which has
been used experimentally to treat prostatitis in Europe. 
Ophth1@aol.com has the most info on this.

10P.  Zinc supplements.  The role of zinc in prostate health is
unclear.  Digmedia@nlnet.nf.ca reports that he was cured after
taking 50 mg of zinc for a month or so, and then switching to a
general multivitamin.

10Q.  Other herbal and alternative medications.  There are a
variety of alternative medications that have been used in cases of 
prostatitis.  Given the current state of medical ignorance about
the causes and cures of prostatitis, it is difficult to evaluate
claims made for specific alternative medications.  Undoubtedly,
some are no better than the proverbial "snake oil."  Others may
help certain individuals.  Since prostatitis is so unpredictable,
it is hard to determine whether an improvement was caused by a
specific medication, rather than some other change in your
lifestyle.  If you experiment with alternative medications, 1) be
prudent, 2) consult a physician in case of any ill effects, 3) keep
the sci.med.prostate.prostatitis newsgroup informed of your
experiences, and 4) don't necessarily expect what worked for you to
work for everyone else. 
         

11.  What can be done to alleviate symptoms?

When prostatitis is not cured, several things can be done to help
alleviate symptoms.  Not all of them work for everyone, and the
best techniques for you must be found through trial and error.
     
11A.  Dietary changes.  Caffeine, alcohol, spicy foods and/or
acidic foods may irritate the prostate, and most doctors recommend 
either eliminating them or using them very lightly.  Some doctors
recommend the Gillespie diet used in cases of interstitial
cystitis, which avoids acidic foods such as citrus fruits and
tomatoes.  To lower the acidity of the urine, one urologist has
recommended drinking a teaspoon of baking soda in a glass of water
on a regular basis. (See the book, _Living with Cystitis_, by Dr.
Lauren.Gillespie.)    
     
11B.  Frequent ejaculation.  Frequent ejaculation (2-3 times
per week) is recommended in many sources.  This is supposed to keep
the prostate free of obstruction, and to speed the movement of
antibiotics.    

11C.  Prostatic massage.  Some men report an improvement in
symptoms after a digital rectal exam.  In the past, some urologists
would perform periodic massages of the prostate.  It is now harder
to find urologists willing to do this, though some men are able to
massage their own prostates using a lubricant such as K-Y jelly and
and rubber gloves.
     
11D.  Hot sitz baths.  Hot sitz baths, in which the perineum
is bathed in a pan of very hot water for at least 20 minutes, seem
to reduce pain in many cases. 
     
11E.  Analgesics.  Over-the-counter analgesics (aspirin,
Tylenol, Nuprin, Aleve, etc.) may help control pain.
     
11F.  Stress reduction.  Symptoms can worsen because of
psychological stress, and changing your situation to avoid stress
may help.  Meditation or biofeedback training have helped some men.

11G.  Acupuncture.  Lotone@aol.com and J.Bernardes@wlv.ac.uk have
found some relief through acupuncture.
     
11H.  Antidepressants.  Prescription antidepressants, taken daily
at a level lower than that normally prescribed for real cases of
depression, have also helped in some cases.
     
11I.  Anti-anxiety medications.  Some doctors will prescribe
anti-anxiety medications, such as Valium, Xanax or Klonopin.  These
sometimes help to reduce symptoms, perhaps by treating the urinary
sphincter hyperreflexia and pelvic floor spasm that accompanies
prostatitis.  Relieving the spasm of the prostate gland and pelvic
floor may relieve much of the pain of prostatitis and prostadynia.

11J.  Ditropan (oxybutynin).  This medication relaxes the smooth
muscles of the bladder and can decrease urgency and frequency.  

11K.  Cold compresses.  The most successful technique for the
writer of this FAQ has been using a very cold Ace compress for 25
minutes directly under the prostate each evening.

  
12.  How can we work towards a cure?

In May, 1995, members of this newsgroup founded The Prostatitis
Foundation.  The Prostatitis Foundation hopes to:
     provide statistics on prostatitis to agencies and doctors,
     provide funds for research into diagnosis and treatment,
     develop a patient registry, and
     distribute literature and information about the disease.

Donations to the Prostatitis Foundation are tax-deductible.

The Prostatitis Foundation 
Information Distribution Center
Parkway Business Center
2029 Ireland Grove Road
Bloomington, IL 61704
Telephone: (309) 664-6222

An informational brochure and bibliography of articles is available
for $1 postage and handling.  A stamped, self-addressed envelope is
encouraged.

Illinois State President - DadOfSix@aol.com
Wisconsin President - Maverick@msn.fullfeed.com
Artist and Production Manager - ken@ideasmith.com
Keeper of FAQ - JohnnK@aol.com

Scientific advisor:

Brad Hennenfent, MD, FACEP 
680 S. Federal St., Suite 601
Chicago, IL 60605
Telephone: (312) 554-0629
Fax: (312) 786-9437 
Email: BCapstone@aol.com

We have  made contact the with following organizations and
their officers:

Leroy M. Nyberg, Jr. PhD, MD
Director, Urology Programs NIH/NIDDK/KUH
Natcher Bldg., Room 6AS.13G
45 CENTER DR MSC 6600
Bethesda, MS 20892-6600
Telephone: (301) 594-7717
Fax: (301) 480-3510
Email: leroy_nyberg@nih.gov

Claude Gerard
Founder and President
American Prostate Society
1340 Charwood Rd., Ste. F
Hanover, MD 21076
Telephone:  (410) 859-3735
Fax:  (410) 850-0818

Thomas Bruckman
Executive Director
American Foundation for Urologic Disease
300 W. Pratt St., Ste. 401
Baltimore, MD 21201
Telephone: (410) 727-2908
Fax: (410) 528-0550

Susan Reid
National Kidney & Urologic Diseases Information Clearing House
3 Information Way
Bethesda, MD 20892-3580
Telephone: (301) 654-4415
Newsgroups:

John Koch  (KOCH@macc.wisc.edu)
Reference Librarian/Documents Coordinator
Steenbock Memorial Library, University of Wisconsin-Madison
550 Babcock Dr.
Madison, WI 53706-1293
Phone: (608)263-4581    Fax: (608) 263-3221


