Archive-name: medicine/prostatitis-faq/part1 Posting-Frequency: monthly alt.support.prostate.prostatitis FAQ 1.  About alt.support.prostate.prostatitis and other sources of prostatitis information on the Internet 2.  About this FAQ 3.  What is prostatitis? 4.  What are the symptoms of prostatitis? 5.  How is prostatitis distinguished from prostate cancer and BPH? 6.  How common is prostatitis? 7.  Are there different kinds of prostatitis? 8.  What causes prostatitis? 9.  Can prostatitis be cured? 10. What can be done to alleviate symptoms? 11. Why is this newsgroup necessary? 12. How can we work towards a cure? Appendix. 1.  About alt.support.prostate.prostatitis and other sources of prostatitis information on the Internet The newsgroup alt.support.prostate.prostatitis was founded in the summer of 1994 as a forum for those interested in the causes and treatment of prostatitis.  Besides that, it has become a center for discussion of political and public awareness actions we can take towards finding cures for chronic prostatitis. Alt.support.prostate.prostatitis is not intended for the discussion of prostate cancer or benign prostate hypertrophy (BPH) (see section 3).  Prostate cancer is discussed in the group alt.support.cancer.prostate.  Because of difficulties in accessing alt. hierarchy newsgroups from some sites, three new newsgroups

Archive-name: medicine/prostatitis-faq/part4 Posting-Frequency: monthly 10.  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. 10A.  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.  (See the book, _Living with Cystitis_, by Dr. Lauren Gillespie.) 10B.  Frequent ejaculation.  Frequent ejaculation (2-3 times per week) is recommended in many sources, particularly when using antibiotics. 10C.  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. 10D.  Analgesics.  Over-the-counter analgesics (aspirin, Tylenol, Nuprin, Aleve, etc.) may help control pain. 10E.  Stress reduction.  Symptoms can worsen because of psychological stress, and changing your situation to avoid stress, meditation or biofeedback techniques have helped some men. 10F.  Acupuncture.   This e-mail address is being protected from spam bots, you need JavaScript enabled to view it and This e-mail address is being protected from spam bots, you need JavaScript enabled to view it have found some relief through acupuncture. 10G.  Antidepressants.  Pre_script_ion antidepressants, taken daily at a level lower than that normally prescribed for real cases of depression, have also helped in some cases. 10H.  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. 10I.  Cold compresses.  The most successful technique for the writer of this FAQ has been using a very cold Ace compress for 25 minutes each evening. 11.  Why is this newsgroup necessary? Compared with prostate cancer, prostatitis has had little attention from researchers.  It is not life-threatening, and it is difficult to treat.  Most urologists are unwilling to put much effort into determining its causes and providing treatment. We hope to use this forum to push for further research on prostatitis, with a view to finding cures by the year 2000. Many men are embarrassed by the problems caused by prostatitis, and put off seeing doctors or discussing the problems with friends and family.  This newsgroup is a place where we can exchange information and help make each other's lives a little easier. 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,      do research and provide funds for research into diagnosis and           treatment,      develop a patient registry, and      distribute literature and information about the disease. The Prostatitis Foundation 680 S. Federal St., Suite 601 Chicago, IL 60605 Illinois State President - This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Wisconsin President - This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Artist and Production Manager - This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Keeper of FAQ - This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Scientific advisor: Brad Hennenfent, MD, FACEP 680 S. Federal St., Suite 601 Chicago, IL 60605 Telephone: (312) 554-0629 Fax: (312) 786-9437 Email: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it The group has received advice and encouragement from many medical people, including: 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: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it This e-mail address is being protected from spam bots, you need JavaScript enabled to view it (Wisconsin) David Bell, MD This e-mail address is being protected from spam bots, you need JavaScript enabled to view it (Canada) Dr. Klaus Beschmann (male infertility) Breitensteinweg 44 D-64372 Ober-Ramstadt Germany Phone/fax/data: +49-6154-52782 Burton Andersen (white cell and antibiotic penetration expertise) Chief, Infectious Disease 909 CSB (M/C 787) 840 S. Wood St. Chicago, IL 60612-7323 We have also made contact the with following organizations and their officers: 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 John Koch  (Internet: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ; Bitnet: KOCH@wiscmacc) Reference Librarian/Documents Coordinator Steenbock Memorial Library, University of Wisconsin 550 Babcock Dr. Madison, WI 53706-1293 Phone: (608)263-3899    Fax: (608) 263-3221

Archive-name: medicine/prostatitis-faq/part3 Posting-Frequency: monthly 8. What causes prostatitis? A leading research has called prostatitis has been called a wastebasket of clinical ignorance.  Its causes are not clearly known. The presence of disease-causing bacteria and response to antibiotic treatment is strong evidence that many cases of prostatitis are caused by bacterial infection.  Since antibiotics do not diffuse readily into the prostate and since some bacteria appear to defend themselves with slime coatings, the lack of success with antibiotics does not necessarily mean that most cases of the disease are not caused by infection.  The basic test for infective organisms in the prostate is still the Meares and Stamey technique, in which urine samples are taken before and after prostate massage; the results of this test are often inconclusive. Some researchers believe that many cases of prostatitis are caused by autoimmune reactions, and autoimmune prostatitis has been demonstrated in laboratory animals.   Some doctors think that some cases are caused by a backflow of urine into the prostate, caused by anatomical factors or overly rushed urination.  Others believe that decreased sexual activity can lead to prostatitis, as the prostate becomes clogged up. Another theory is that some cases of prostatitis or prostatodynia are caused by too much tension in the urinary sphincter.   And it is possible that many cases diagnosed as prostatitis without a full range of tests are caused by other conditions, such as interstitial cystitis or ejaculatory duct obstruction.   9.  Can prostatitis be cured? (NOTE:  The following is not intended to recommend any specific drug or regimen.  It is _base_d on a review of the literature and the reports of people in the newsgroup.  CONSULT YOUR PHYSICIAN BEFORE UNDERTAKING ANY TREATMENT.) Since physicians do not know the cause of prostatitis, they cannot tell when you have been cured; scientists cannot _object_ively 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.  For still other people, no drug helps.  And for some, the treatment will work and they will never have symptoms again.  The following treatments have been used for prostatitis. 9A.  Noroxin (norfloxacin).  Noroxin is the brand name for norfloxacin, a quinolone antibiotic.   This e-mail address is being protected from spam bots, you need JavaScript enabled to view it 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 DadOfSix off antibiotics since he is symptom- free.   9B.  Other quinolones.  Other quinolone antibiotics are Cipro (ciprofloxacin), Floxin (ofloxacin), Penetrex (enoxacin) and Maxaquin (lomefloxacin).  All of the quinolones have had some success in treating prostatitis, whether bacterial or non- bacterial.  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. 9C.  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.) 9D.  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 surrounded 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 restruction; 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. 9E.  Bactrim.  Bactrim (trimethaprim/sulfamethoxazole or TMP/SMZ) is an antibiotic which has been used to treat prostatitis.   9F.  Geocillin (carbenicillin) is another antibiotic that has been used for prostatitis.  It a s member of the penicillin family. 9G.  Doxycycline or minocycline.  Yet more antibiotics used for prostatitis. 9H.  Keflex (cephalexin)  Still another antibiotic. 9I.  Hytrin.  This blood pressure medication is sometimes tried in cases of prostatitis or prostatodynia.  It may work by reduce urinary muscle tension. 9J.  Antifungals (Nystatin, ketoconazole, Diflucan).  Fungal prostatitis has been reported in the literature, but is rare. However, This e-mail address is being protected from spam bots, you need JavaScript enabled to view it reports palliative effects from these drugs in the absence of a diagnosis of prostatic fungal infection. 9K.  Herbal and alternative medications.  Saw palmetto capsules are available in health food stores.   This e-mail address is being protected from spam bots, you need JavaScript enabled to view it reported a temporary improvement in urinary flow from drinking saw palmetto tea, taking hot baths, and taking antibiotics.  A flower pollen compound called Cernilton has been used experimentally in Europe for prostatitis.  Experiences of newsgroup members with Cernilton have been unsuccessful. 9L.  Zinc supplements.  The role of zinc in prostate health is unclear.   This e-mail address is being protected from spam bots, you need JavaScript enabled to view it reports that he was cured after taking 50 mg of zinc for a month or so, and then switching to a general multivitamin.

Archive-name: medicine/prostatitis-faq/part5 Posting-Frequency: monthly Appendix:  Overview by Dr. Richard Berger ( This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ) GENERAL INFORMATION ON PROSTATITIS         The following represents some of my thoughts on prostatitis which I have been asked to provide to support group readers. These opinions can in no way take the place of proper evaluation of any man's particular situation and are not all-inclusive.           Up to one half of all men have prostatitis symptoms sometime in their life.  In some they become chronic and severe. In most they are a nuisance.  With proper evaluation much anxiety can be alleviated, and oftentimes symptoms can be improved if not eliminated.  Other more serious conditions of the prostate and pelvic organs may mimic prostatitis.  All symptoms need to be evaluated individually by a physician.  Self-diagnosis is foolish and can be dangerous.         Prostatitis represents a diverse group of clinical syndromes.  Often men are diagnosed by physicians with prostatitis _base_d on almost any pain between the knees and the navel.  Not all men with these symptoms have infected prostates. In fact, men with demonstrable prostatic infection are in the minority.         There are four classically recognized prostatitis syndromes. The first two syndromes are uncommon and comprise only around five percent of all men with symptoms.  These are (1) Acute Bacterial Prostatitis, with fever, painful and difficult urination, and urinary tract infection with common infection-causing bacteria. This is similar to an acute kidney infection and the man is usually quite ill; (2) Chronic Bacterial Prostatitis, with recurrent bladder infections and bacteria detectable in the urine.  The man is usually not acutely ill but has increased frequency and urgency of urination.  Pus and bacteria can be found in the urine.  After each often successful antibiotic treatment of symptoms, the bladder infection reoccurs, with the same bacteria being cultured out of the urine time after time, because the bacteria are not being eradicated from the prostate.  A four-glass urine test (or prostatic localization test ) is needed to make the diagnosis. This is performed by comparing the number of bacteria in the first little bit of urine that is voided to the number of bacteria in the urine specimen obtained after a prostatic massage performed during a rectal exam.  If ten times more bacteria are found in the post-massage urine than the first voided urine, then the diagnosis of Chronic Bacterial Prostatis is made.  Inflammation (pus cells) can usually be found in any secretions that are pressed out of the prostate at the time of the exam.  Chronic Bacterial Prostatitis is best treated with 6-12 weeks of an antibiotic to which the organism is sensitive and which gets into the prostate well.  The cure rate is around 60 percent.  Those men that aren't cured may need long term low dose antibiotics to keep symptoms away.          Men who do not have the above two syndromes may have the third recognized prostatitis syndrome, (3) Chronic Idiopathic Prostatitis. Men may complain of a variety of symptoms, including genital, back, lower abdominal, perineal (the area between the scrotum and anus), penile, or scrotal pain.  They may also experience some urinary symptoms.  This syndrome is characterized by the above mentioned pain, pus cells in prostatic secretions, and the absence of common urinary bacterial infection detected by the four-glass urine test.  The cause of this syndrome is unknown.  It may respond to antibiotics temporarily but it often recurs.  It may be that the symptoms normally get better or worse even without treatment. Since men usually get treatment when the symptoms are at their worst, it may seem like the antibiotics are helping because the symptoms are getting better on their own.  Uncommonly this syndrome may be related to a sexually transmitted disease.  This can be ruled out by urethral cultures or other tests for gonorrhea and chlamydia.  Rarely these symptoms may be caused by a structural problem in the urinary tract such as scarring or a cyst.  These can be diagnosed by tests such as a urinary flow rate and prostatic ultrasound which your physician may perform.         The last syndrome is (4) Prostatodynia.  This syndrome is characterized by the same pains and urinary symptoms as Chronic Idiopathic Prostatitis.  There are, however, no or few pus cells in prostatic secretions.  The four-glass localization test is negative for infection causing bacteria.  The cause of this syndrome is unknown.         In my opinion the evaluation of a man with chronic pains possibly coming from the prostate should include the following: 1)Urethral cultures for gonorrhea and chlamydia to rule out sexually transmitted diseases; 2) First-void and post-massage urinalyses, standard culture and bacterial count to rule out Chronic Bacterial Prostatitis; 3) A urinary flow rate and post voiding bladder residual urine test to screen for problems in the urethra, bladder or prostate. The results of this test may suggest the need for further diagnostic tests such as cystoscopy (looking inside the urethra and bladder).  If symptoms are mild, these tests may be all that is needed and the man can be reassured that he does not have anything that will turn into cancer, nor may he infect sexual partners.  If symptoms are severe and debilitating other tests may be indicated.  These may include 4) cystoscopy under general anesthesia to rule out other diseases such as stones, tumors or conditions mimicking prostatitis such as interstitial cystitis; and 5) transrectal prostate ultrasound to look for abnormal anatomy in the prostate.         It is my opinion that treatment should be _base_d on clinical and laboratory findings.  Too often men are treated with repeated courses of antibiotics without cultures being obtained, or in the face of normal culture results.  Many men therefore come to believe that they have a chronic, untreatable infection.  This is probably not true.  Although we do not understand the cause for Idiopathic Prostatitis or Prostatodynia, we have little or no evidence that it is caused by a chronic infection, is sexually or otherwise transmittable, or is related to the development of cancer or any other disease.  If an initial course of antibiotics is ineffective in the face of normal cultures, it probably should not be repeated. However, only by obtaining cultures can your physician be sure that you do not have an infection.         Few treatment studies have been done on the 95 percent of prostatitis that is not caused by urinary pathogenic bacteria. Treatments that may be tried include antihistamines such as Vistaril, drugs such as Hytrin which block the sympathetic nervous system, drugs such as Proscar which shrink the prostate, and drugs which may treat deep pain, such as Elavil.  If cystoscopy reveals findings consistent with a bladder condition called interstitial cystitis then treatments for this condition may be instituted. Pains in the pelvis can be caused by pelvic muscle spasms, which may feel very different from muscle spasms in the arms or legs. Physical therapy can be used to help relax these muscles and may therefore be very beneficial either alone or in conjunction with other treatments.  Prostatitis symptoms are often associated with depression, decrease in social and sexual activity, and sometimes with sexual dysfunction.  These problems often need to be addressed beyond treatment of the prostatitis. Help is available. As more studies into the cause and treatment of Prostatitis are performed, other rational treatments should be developed and the indications for each treatment clarified. John Koch  (Internet: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ; Bitnet: KOCH@wiscmacc) Reference Librarian/Documents Coordinator Steenbock Memorial Library, University of Wisconsin 550 Babcock Dr. Madison, WI 53706-1293 Phone: (608)263-3899    Fax: (608) 263-3221