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Wednesday, August 18, 2010

The Double Burden of Chronic Prostatitis

The Double Burden of Chronic Prostatitis

It doesn't seem fair: The newest hope for effective chronic
prostatitis treatment
causes infertility. Relatively young men, who are risk for chronic prostatitis, are also men who most need to retain fertility. What are the issues?

Prostatitis is an elusive illness that ranges from acute and very dangerous illness characterized by pain, fever, and sepsis to an episodic and/or chronic annoying illness characterized by pain, lack of energy, depressed mood, and social isolation. Obviously the causes and treatments of the clinical presentations that we call "prostatitis"
vary enormously. On the one side is the relatively simple antibiotic treatment of acute, febrile prostatitis. On the other is the seemingly impossible treatment of the patient few doctors like to see: The man with chronic prostatitis.

Men with chronic prostatitis uniformly begin their therapeutic journey with oral, intravenous, and/or intra-p
rostatic injection
of antibiotics. These may work, but often they do not, suggesting that by this stage the illness is not bacterial. Next are efforts to eliminate symptoms with alph
a-blockers
, massage, trigger point release, hypnosis, acupuncture, over-the-counter supplements, and an endless parade of home remedies. So what happens when these do not work?

This was the question before us when a 55-year old man with eight years of miserable symptoms asked to have his prostate excised. Understanding that there was no literature to support his request and understanding the risks, he said simply: "Fix me or shoot me." After extensive discussion, he had a laparoscopic removal of his prostate. This resulted in a complete and immediate cessation of his symptoms. Or as he summarized it while still in the hospital, the operation "pulled a golf ball out of my ass." In three years of observation, he has had absolutely no recurrence and no complications. In fact, he reports that his urination has improved and his sex life has also improved, with good erections and no more pain on orgasm.

The patient described had finished having children. However, we have now developed a prostatitis
surgery clinical trial
aiming to quantify symptom response to the kind of surgery he had. The trial is attracting patients who are younger, including men in their 30s and 40s, who have an asbolute interest in having children. For them, infertility is not an option and they hold off having surgery, which is possibly the only road to relieving them of their pain.

Laparoscopic radical prostatectomy is in common use for the treatment
of prostate cancer
. In the prostate cancer population, which is generally older, the issue of infertility is real but it rarely becomes a barrier to treatment. Not so with chronic prostatitis patients, who are typically 20 or so years younger than the prostate cancer patients.

As the clinical trial progresses and the role of laparoscopic prostatectomy is defined, it is absolutely imperative that before any man chooses it he is advised that it will cause him to be infertile. It is absolutely imperative that any man who wants children and wants prostatectomy be advised of the potential option of banking sperm.

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Arnon Krongrad, MD is Medical Director of the Krongrad Institute for Minimally Invasive Prostate Surgery. For more information, readers are directed to the Prostatitis Surgery web site and the Prostatitis Blog.