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The majority of men will get prostate disease

Dec 25, 2004

A NUMBERS GAME

I heard that more than 50% of men will develop prostate problems in their lives. Many of them will be bothered by prostatitis, the symptoms of which include frequent visits to the bathroom, incontinence, reduced urine stream and a burning feeling upon urination.

To learn more about prostatitis, I consulted J. Curtis Nickel, MD, professor of urology and director of the Prostatitis Clinical Research Center at Queen's University in Kingston, Ontario. Dr. Nickel is author of The Prostatitis Manual: A Practical Guide to Management of Prostatitis/Chronic Pelvic Pain Syndrome (Bladon Medical).

DIFFERENT TYPES OF PROSTATITIS

According to the National Institutes of Health (NIH), the term "prostatitis" actually refers to four disorders, each of which requires a different treatment...

* Acute bacterial prostatitis. Signs of an acute prostate infection -- the least common type of prostatitis -- include fever, chills, severe burning during urination, the inability to completely empty the bladder and pain in the low back and between the legs (perineal pain). The sudden onset of severe symptoms makes this the easiest type of prostatitis to identify. See your doctor at once for proper diagnosis and treatment.
* Chronic bacterial prostatitis. The symptoms of this nagging, recurrent prostate infection also are caused by bacteria that could be the same as or different from that in acute prostatitis. When symptoms develop, they are similar to those of acute infection but less severe. These include burning upon urination, urinary frequency (especially at night), painful ejaculation and perineal, testicular, bladder and low-back pain.
* Chronic nonbacterial prostatitis. The most common form of prostatitis, this version also is known as chronic pelvic pain syndrome (CPPS). Men suffering from it have inflammation with no demonstrable bacterial infection. Symptoms include difficult and sometimes painful urination, difficult and painful ejaculation and perineal, testicular, bladder and penis pain.
* Asymptomatic inflammatory prostatitis. Although there are no obvious symptoms, white blood cells are found in prostate secretions or in prostate tissue during an evaluation for other disorders.

MOST COMMON: CHRONIC NONBACTERIAL PROSTATITIS

There is a growing consensus that the majority of chronic prostatitis has little to do with bacteria, as was previously supposed. Today, most doctors agree that chronic nonbacterial prostatitis/CPPS is the most common symptomatic type of prostatitis. According to Dr. Nickel, most of these cases are likely caused by an initiator (such as an infection, a sexually transmitted disease, an obstructive voiding pattern, such as difficult, slow or intermittent flow with no force, or a congenital malformation) in a susceptible individual. This leads to inflammation and/or nerve involvement. Dr. Nickel explains that even when the initiator is taken care of (for example, with antibiotic treatment), the process still can continue to progress through autoimmune processes and the generation of neuropathic pain, winding up in the central nervous system, where it translates, examines and modulates the pain.

THE THREE As OF PROSTATITIS TREATMENT

Treatment protocols vary depending on the type of prostatitis, a man's medical history, the duration of the problem and the history of previous treatments. It is sometimes a matter of mix and match until you find the combination that works for you. Dr. Nickel generally uses what he calls the "Three As" (alpha blockers, anti-inflammatory drugs and antibiotics) for treatment of prostatitis. Alpha blockers relax the muscle tissue in the prostate... anti-inflammatories counter inflammation... and antibiotics may help if prostatitis is caused by bacteria, or improvement may be due to their anti-inflammatory effects. Note: Dr. Nickel said that he generally recommends a four-week trial of antibiotics, except in documented chronic bacterial prostatitis, for which he prescribes eight to 12 weeks of antibiotics.

ALTERNATIVE TREATMENT OPTIONS

If you are concerned about taking antibiotics, alternative measures that many men find beneficial are hot baths, dietary supplements (for example, saw palmetto and quercetin), prostate massage, biofeedback and acupuncture. Daily Health News contributing editor Andrew L. Rubman, ND, also suggests that there are a number of naturopathic interventions that can help ease the problem...

* Saw palmetto to help ease prostate inflammation.
* Omega-3 oils to decrease inflammation.
* A balanced antioxidant supplement to decrease inflammation.
* Freeze-dried cranberry extract and non sugared-berry juice concentrates to decrease yeast and bacteria.

Talk to a naturopathic physician to develop the appropriate protocol for you. You can find a naturopathic physician through the American Association of Naturopathic Physicians (www.naturopathic.org).

To keep up with what's new in prostatitis diagnosis and treatment, visit such Web sites as the Prostatitis Foundation at www.prostatitis.org and the American Foundation for Urologic Disease at www.afud.org.