Los Angeles Times


Healthy Man, The Other Prostate Problem

January 14, 2002  

Timothy Gower

It has been called "the forgotten prostate disease." Yet prostatitis leads to more than 2 million visits to doctors' offices in the United States each year and is the most common urological problem among men younger than 50, though older guys can develop it too.

The medical establishment has paid far more attention to prostate cancer and enlarged prostate in recent years, but that situation is beginning to change. That is, in part, because of a new federal study of men with prostatitis that may yield valuable information about how best to treat this mysterious and often frustrating disease.

Prostatitis is a blanket term for several related conditions with similar symptoms. Some sufferers develop a frequent and urgent need to urinate, which is also the key characteristic of an enlarged prostate, also known as benign prostatic hyperplasia, or BPH. Other symptoms, such as a burning sensation while urinating and erectile dysfunction, can occur too. The hallmark symptoms of prostatitis, however, are pain and discomfort in the pelvic area, groin or lower back. In some cases, the discomfort is merely annoying, like sitting on a golf ball. For other patients, though, prostatitis means sheer anguish. "Some men describe it as feeling like they've been impaled on a spear," says Clark Hickman, an associate dean at the University of Missouri-St. Louis. Hickman, a prostatitis sufferer who runs a telephone support group for the illness, says prostatitis pain can be so debilitating that some men end up on work disability.

In a small minority of cases, men complaining of prostatitis symptoms turn up in doctors' offices with severe fever too. That's a sure sign of acute prostatitis, which is caused by an infection and is easily treated with antibiotics.

However, the majority of men complaining of pain down under don't have a fever, and they test negative for bacterial infections. Yet many doctors in this country nonetheless treat these cases of chronic prostatitis with antibiotics, which are designed to fight infections.

Not surprisingly, antibiotics often prove to be worthless in relieving prostatitis, though many men with the condition end up taking them for years anyway, risking side effects that can include gastrointestinal problems and headaches. "[Prostatitis] is often treated as an infectious disease because we really don't know what else to do," says University of Maryland urologist Richard Alexander. He adds, however, that doctors keep prescribing antibiotics to men with chronic prostatitis because a portion of them feel better if they take the drugs, even though they don't have an infection.

That may be because the antibiotics act like anti-inflammatory drugs, says urologist Scott Zeitlin of the UCLA School of Medicine. Indeed, many prostatitis patients have clear signs of inflammation in their prostate fluid, which isn't surprising (the suffix "itis" refers to inflammation). Yet other men experiencing pelvic pain and other symptoms reveal no signs of inflammation.

Don't worry if you're confused. "The cause of this condition is unknown," Zeitlin says. While many theories have been proposed, no one is sure why men get chronic prostatitis in the first place, he says. "This all makes chronic prostatitis a very difficult disease to explain to a patient, and to treat."

Zeitlin and his colleagues at UCLA are conducting a nationwide, multi-center study, sponsored by the National Institutes of Health, to measure the value of two drugs commonly used to treat chronic prostatitis. One is Flomax, a medication that's better known as a treatment for urinary problems linked to BPH. The other drug--the antibiotic Cipro--became a household word since it's considered the therapy of choice for anthrax infection. Men with prostatitis who participate in the study will be given Flomax, Cipro, a combination of the two drugs or an empty placebo pill for six weeks, then followed for six weeks to determine whether their symptoms improve.

In addition to other drugs (such as pain relievers), doctors recommend a wide range of remedies and preventive measures for chronic prostatitis, though none is guaranteed to work. Sitz baths (sitting in a tub of warm water) help some men, while some doctors suggest that men perch on a cushion if they plan to sit for a long period. Avoiding spicy foods or alcohol and caffeine--all of which can cause flare-ups in some men--is sometimes recommended.

Ejaculation brings relief for some men, while worsening prostatitis anguish in others. A technique known as prostatic massage, first popularized in the early 1900s, appears to be making a comeback. A doctor inserts a gloved finger into the patient's rectum and rubs the prostate. The goal is to empty ducts within the gland, which, if clogged, can cause pain.

This method might be a tough sell to men who freak out when it's time for the annual digital rectal exam, especially because several massages per week are necessary (some men even learn to self-massage). But Zeitlin and urologist Daniel Shoskes of the Cleveland Clinic in Weston, Fla., found in one study that about 40% of difficult-to-treat prostatitis cases improved with a combination of massage and antibiotics.

Zeitlin and Shoskes also found in a 1999 study, published in the journal Urology, that 82% of men with prostatitis who took a dietary supplement called Prosta-Q (whose main active ingredient is the plant nutrient quercetin) experienced at least a small improvement in symptoms.

However, other clinicians are skeptical. "No one really knows what's in this stuff but the people who make it," says University of Maryland urologist Richard Alexander, noting that the U.S. Food and Drug Administration doesn't regulate the content and purity of dietary supplements.

Alexander is a leading proponent of the theory that chronic prostatitis may be an autoimmune disorder, which occurs when the body's immune system attacks its own organs or tissues. He is studying whether men with chronic prostatitis benefit from the drug Enbrel, which is used to treat rheumatoid arthritis, another autoimmune disease. However, Alexander adds, there's often no accounting for how prostatitis patients will respond to various therapies for this baffling condition.

You can write the Prostatitis Foundation for more information at 1063 30th St., Smithshire, IL 61478, or visit the group's Web site at www.prostatitis.org. Men in the L.A. area who are interested in enrolling in the study should contact Yining Xie at Harbor UCLA Medical Center ([310] 222-3819) or Maryellen Raimo at Charles R. Drew University of Medicine and Science ([310] 668-4545).

Massachusetts freelance writer Timothy Gower is at tgower@mediaone.net. The Healthy Man runs the second Monday of the month.

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