Meeting a pain in the prostate

Adam Cresswell, Health editor

July 09, 2005

POLITICIANS have to sit through a lot of bum-numbing meetings, but sometimes this pain in the rear stops being a laughing matter - as John Anderson knows only too well. When the former Nationals leader announced his return to the backbench last month, he revealed he had endured 12 months of almost constant discomfort, including a persistent urge to urinate, difficulty sleeping and pain when sitting still for long periods.

Given that seats in committee rooms, on commercial flights, at ceremonial dinners and in parliamentary debates are usually pressing the posterior ministerial flesh, it's no surprise that Anderson decided his job wasn't exactly helping him get better. Anderson's complaint, which he has termed congested prostate, is quite different to prostate cancer, and while painful, is much less malignant.

The prostate is about the size of a large nut and helps keep sperm active. It produces most of the fluids in semen, but does not produce hormones.

Prostate cancer can be a life-threatening condition, but other things can go wrong with the gland. At the opposite end of the severity spectrum to cancer is benign enlargement of the gland. Somewhere in between is prostatitis. The term prostatitis in fact covers four main conditions: acute bacterial prostatitis, chronic baterial prostatitis, non-bacterial prostatitis, and prostatodynia. The last two are these days now grouped together as Chronic Pelvic Pain Syndrome, which is sub-divided into an inflammatory type (which equates to non-bacterial prostatitis) and non-inflammatory (prostatodynia). All these conditions can be painful, and often the pain is "referred" - that is, felt in other parts of the body, such as perineum, lower back, urethra and testes.

The men affected by these conditions are usually aged between 25 and 50. The two sub-types of prostatitis covered by the term Chronic Pelvic Pain Syndrome (CPPS) are by far the most common, and also the least understood.

Non-bacterial prostatitis is found in men of all ages, and its symptoms can disappear and return with little warning, with the repeat attacks sometimes lasting several months.

According to the US-based National Kidney and Urologic Diseases Information Clearinghouse, in the inflammatory type of the condition fluids such as urine and semen contain cells produced by the body to fight off infection, but have no trace of any known infection-causing agents.

The non-inflammatory kinds appear to feature no known infectious agents and tissue samples reveal no infection-fighting cells either. It is thought the symptoms in these cases may be caused by urea crystals forming in prostate tissue as urine from urine. Treatment for this form of prostatitis is difficult. Antibiotics do not work as there is no bacterial cause; patients are advised not to strain when emptying the bladder, are encouraged to engage in normal sexual activity and to use stress management techniques. A change of diet and taking warm baths may help. However, while it had been thought that a type of drug called an alpha blocker, which helps to relax the muscle tissue in the prostate, might also help, a study last year found the opposite.

The GP newspaper Medical Observer reported the US study of almost 200 men with severe chronic prostatitis or chronic pelvic pain syndrome found none of the study participants had significant relief of their symptoms after six weeks of treatment with an antibiotic, an alpha blocker, both drugs combined or a dummy pill. The study was originally reported in the journal Annals of Internal Medicine (2004;141:581-89). Paul Cozzi, senior lecturer in surgery at the University of NSW and consultant neurologist at St George Hospital in southern Sydney, says differentiating between any of these four main types of prostatitis is "difficult and not particularly scientific".

In acute bacterial prostatitis, patients typically feel very ill and have a high temperature; treatment often involves a few days in hospital on antibiotics. However, chronic prostatitis is generally much more difficult to treat, as patients often do not respond to antibiotics. Newer treatments are emerging, such as microwave therapy that helps to bring down the inflammation and also kills any bugs. Pelvic floor stimulation is another treatment gaining some favour. The most important message, Cozzi says, is that men need to have more regular check-ups to detect problems early.

"Men's health is going to get more on the mainstream political agenda - it's important that men are aware of what the prostate is and what it does, and what can go wrong with it," he says.

More info about John Anderson at http://www.aph.gov.au/house/members/member.asp?id=4K4