Archive | Chronic Prostatitis

Pelvic pain

Pelvic pain: Symptom — Overview covers definition and causes of pelvic pain.

Article courtesy of All MayoClinic.com Topics

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Prostatitis: Can sexual activity make it worse?

Some men with prostatitis have pain with ejaculation or sexual intercourse.

Article courtesy of All MayoClinic.com Topics

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Alpha Blocker Improves Symptoms of Chronic Prostatitis

Recent findings show that treatment with a specific alpha blocker helps reduce symptoms and improve quality of life for men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).  This alpha-blocker, called silodosin, works by selectively relaxing the muscles in the neck of the urinary bladder and prostate.  It has been approved in Canada, the United States, the EU and Japan to treat symptoms of another prostate gland condition, benign prostatic hyperplasia, which is commonly referred to as an enlarged prostate.

Although CP/CPPS is the most common form of prostatitis, it is the most misunderstood and difficult to treat because the symptoms are very similar to other conditions and requires a significant amount of testing and screening to identify.

Curtis Nickel, a professor in the Department of Urology, practicing urologist at Kingston General Hospital and Canada Research Chair in Urologic Pain and Inflammation, emphasized that antibiotics are commonly used as a treatment, but they are not typically effective.  This could be because CP/CPPS does not seem to be caused by a bacterial infection.

CP/CPPS is a debilitating condition; patients with this condition suffer from discomfort in the lower pelvic area including the bladder area, testicles, and penis.  Symptoms may be severe and can include painful and frequent urination and difficult or painful ejaculation.  The cause of CP/CPPS is not known.

In Dr. Nickel’s study, about 60 percent of men reported feeling better after treatment with silodosin as opposed to 30 percent of participants who were given a placebo.  These results for patients feeling better is higher than a similar study he conducted several years ago that tested the effects of a different alpha blocker.

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Research Study for Treatment of Lower Urinary Tract Symptoms (LUTS) Due To Benign Prostatic Hyperplasia (BPH)

Are you a man age 50 or older?

Do you have to urinate frequently during the day and at night?

Do you have trouble urinating?

Are these and other urinary problems interfering with your life and your relationships?

If you answered “yes” to the above questions, you may be a candidate for the L.I.F.T. Study.

The L.I.F.T. Study is an FDA approved research study to evaluate the UroLift system to support a premarketing application to FDA. Its purpose is to determine the safety and effectiveness of the UroLift system for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). The study is being conducted at urology practices throughout the U.S., in Canada and in Australia.

BPH is a non cancerous condition that causes the prostate to enlarge as men age. When the enlarged prostate presses on the urethra, it can cause bothersome urinary symptoms. The UroLift System is a minimally invasive approach to treating BPH that lifts/holds the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue. The goal of UroLift system treatment is to relieve symptoms so you can get back to your life and resume your daily activities.

The UroLift system is an investigational device as such is limited by Federal Law to investigational use only.

To find out more about L.I.F.T. Study and UroLift system treatment and study locations, go to www.neotract.com.

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Prostatitis Diet – Foods that Irritate the Prostate

Prostatitis is condition where the prostate gland is inflamed or infected. Symptoms include frequent urination, burning or pain when urinating, feeling of not emptying the bladder completely, fever/chills and low back pain.

There are certain foods that can trigger or worsen the symptoms of prostatitis. It is important to notice whether certain foods trigger your symptoms and stay away from these foods to help reduce or alleviate prostatitis symptoms.

Below is a list of foods that irritate the prostate and it may be wise to avoid these foods –

Spicy Foods – The oils in the peppers concentrate in the prostate and this can lead to irritation.

Alcohol – When you have prostatitis, your doctor will advise that you increase your fluid intake. Alcohol is dehydrating which is contrary to your doctor’s recommendation.

Citrus Juice – The acid in the citrus juice irritates the urethra. You may find that citrus juices worsen your symptoms while citrus fruits do not. Tomato and tomato juices can make your condition worse as these too are very acidic.

Caffeine – Caffeine is a diuretic. The frequent urination that is caused by the consumption of caffeine can irritate the prostate. Caffeine can also cause dehydration.

Fried Foods – The prostate is easily affected with the amount of calories and fat that is absorbed in the fried food.

Also avoid foods that can cause food allergies or food sensitivity as according to some research, allergy is considered one of the major causes of chronic non-bacterial prostatitis.

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Best Treatments for Chronic Pelvic Pain

Nearly 25 percent of men diagnosed with chronic pelvic pain fail to find relief. Chronic pelvic pain is a poorly understood, yet debilitating syndrome. Generally, three treatments for the condition exist: antibiotics, anti-inflammatories, and alpha-blockers or nerve inhibitors. So far, these treatments are the only mainstream treatments found to be effective in curing or reducing symptoms of chronic pelvic pain.

The Journal of the American Medical Association published a new review in the January 5 issue that notes about 9 percent of men in the United States suffer from different types of inflammation of the prostate gland. Symptoms include pain in the pelvis, urethra or penis, back pain, trouble urinating and frequent urination.

Up to 95 percent of these cases are caused by chronic pelvic pain syndrome triggered by chronic prostatitis, which is an inflammation of the prostate gland that surrounds the male urethra. Usually, this condition is caused by a chronic bacterial infection and is most likely to affect men between the ages of 35 and 45.
“This is a very ambitious study, and it appears to shed some light on a very challenging condition,” said Dr. Paul C. Cook on the most recent study. Cook is a urologist at the Hermann Memorial Medical Center in Houston and is not connected to the study. “The fact that they distilled it down to only 23 studies in all the literature that met their criteria exemplifies that there [are so few] really good controlled studies out there.”
Researchers found that the most effective treatment for chronic pelvic pain syndrome was a combination of antibiotics and alpha-blockers. This combination helped the most to alleviate the main symptom of pain during urination; however, anti-inflammatory medications are also helpful for those patients who seek help for pain.

The role of antibiotics remains unclear to the researchers, as infection has to be ruled out before a man is diagnosed with chronic pelvic pain syndrome. The speculation is that the antibiotics might work against unrecognized germs, and the researchers noted that antibiotics such as quinolones also have anti-inflammatory properties.

Alpha-blockers are used to block the nerves going into the muscles of the prostate and are often prescribed along with antibiotics for the condition. If that combination doesn’t work, then a new antibiotic is tried. But constantly switching from one antibiotic to another is discouraged.

“If the patient comes back and the treatment isn’t working, it’s time to rethink the diagnosis,” Cook said. “It’s time to start thinking outside the box.”

“It’s very important that the patient be a partner with their physician,” explains Cook. “I always encourage patients to do independent research on their condition.” This helps the patients work together with their physician to pinpoint the problem.

Several factors predispose men to pelvic pain syndrome and include infection, hormone imbalance, allergic and immune system triggers, and psychological and hereditary traits, said the researchers. Dr. Samadi, chief of robotics and minimally invasive surgery at Mount Sinai, even notes that men who are not sexually active for a long time may be a bit more prone to the syndrome.

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Experts Disagree on Prostate Cancer Prevention Drugs

Prostate cancer is the second-leading cause of cancer death in men. However, there is good news.  Drugmaker GlaxoSmithKline (GSK) produces a medicine called Avodart, generically known as dutasteride, which can reduce your risk of developing the disease. An international, four-year, placebo-controlled and randomized study conducted by GSK revealed that dutasteride cut the risk of prostate cancer by 23% — a fantastic result. However, despite these findings, many medical professionals advise against prescribing this drug. In an editorial by published in The New England Journal of Medicine, Dr. Patrick Walsh raises several issues regarding the study and its conclusions.

Walsh questions whether the dutasteride-prevented cancers were clinically significant. While the drug did lead to a significant reduction in low-grade prostate cancer incidence, the more lethal, higher-grade cancers were mostly not affected. Also disconcerting was an increase in heart failure discovered among patients taking dutasteride.

Finally, Walsh questions the study’s conclusions. He believes the drug doesn’t prevent cancer, but only temporarily shrinks tumors that have a low potential for being lethal. While the drugs do successfully treat prostate conditions by reducing prostate-specific antigen levels and shrinking the gland, he worries that the drug lead to worse problems later on by lulling men into a false sense of security.

However, the study’s lead author Dr. Gerald Andriole, chief of urological surgery at Washington University School of Medicine, disagrees. “The major problems with screening for prostate cancer using PSA . . . is what has been referred to “overdiagnosis” and “overtreatment,” he notes. As well as preventing BPH-related problems, “both finasteride and dutasteride actually improve the ability of PSA [tests] to detect the most aggressive cancers,” a desirable outcome of the study that will be reported in a later paper, and one that could reduce the chance of overdiagnosis. Instead, he recommends that PSA tests be used differently for men on the drugs, adjusting for the expected lower levels shown in patients taking dutasteride and finasteride.

Men worried about prostate cancer will likely rejoice to hear that they might be able to reduce their risk. However, the experts still disagree on the drug’s effectiveness, or even safety. As always, the best plan of action is to discuss treatment options with your doctor or medical health professional.

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New Study Shows Pregabalin is Not Effective in Chronic Prostatitis

A study led by Michel A. Pontari, MD, from the Temple University School of Medicine in Philadelphia, Pennsylvania, and colleagues from the Chronic Prostatitis Collaborative Research Network 2 has revealed that pregabalin therapy for 6 weeks is not more effective than placebos.

Pregabalin is an anticonvulsant drug often used for neuropathic pain, particularly chronic pain.  The drug has been approved to treat disorders such as fibromyalgia and spinal cord injury.  Because current evidence suggests that chronic prostatitis and chronic pelvic pain syndrome may be neurogenic pain syndromes, with urogenital pain as a defining symptom, it has previously been suggested that pregabalin could be used to treat the disorders.  Pontari’s new findings suggest the drug may be ineffective.

In Dr. Pontari and his colleagues’ randomized trial, the effects of pregabalin were compared with placebos in 324 men who have had pelvic pain for at least three of the last six months.  The men were taken from 10 tertiary care centers and were randomly assigned in a 2:1 ratio to receive pregabalin or placebo for six weeks.  By the end of the fourth week, the dosage of pregabalin was increased from 150 to 600 mg/day.  After six weeks, the study showed a higher percentage of the patients who received pregabalin were classified as responders because they reported at least a 6-point decrease in the primary endpoint when compared with the subjects who were taking a placebo (47.2% vs. 35.8%); however, the difference is not statistically significant.

On the other hand, the researchers did find greater reductions in the mean NIH-CPSI total score and sub-scores for those patients who received pregabalin when compared to the patients who received the placebo.  And these men also had a much higher Global Response Assessment response rate (31.2% vs. 18.9%).  The Global Response Assessment is a 7-question patient self-reported assessment measuring perception of change in symptoms.

Yet the Medical Outcomes Study 12-Item Short Form Health Survey, Sexual Health Inventory for Men, and Hospital Anxiety and Depression Scale scores were all similar between the two groups.

“A 6-week course of pregabalin compared with placebo did not result in a statistically significant reduction in the NIH-CPSI total score by at least 6 points, the primary outcome, an amount of change previously shown to be clinically perceptible to participants,” concluded the authors.

Although the results were published in Archives of Internal Medicine, Dr. Pontari and the researchers explain that one limitation of the trial is that participants had symptoms for a long time.  Patients who have experienced the symptoms of CP/CPPS for shorter periods of time may have responded differently to pregabalin.  In addition, the pregabalin therapy was only administered for 6 weeks in the study.  “It may take a longer period of treatment before a beneficial effect is seen,” suggest Pontari and his team.

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Acute Prostatitis

Acute prostatitis is a rapidly-developing inflammation or infection of the prostate gland.

Causes

Acute prostatitis is generally a result of bacterial infection. Some sexually transmitted diseases such as chlamydia and gonorrhea can cause acute prostatitis, especially in men younger than 35. If caused by an STD, the symptoms will usually appear soon after exposure to the infected partner. For men over 35, prostatitis is often caused by E. coli infections occurring spontaneously or after epididymitis, urethritis, and urinary tract infections. Additionally, acute prostatitis may occur from trauma to the prostate or urethra.

Who is at risk?

Men ages 20-35 who have multiple sexual partners or unprotected anal intercourse are at high risk for developing acute prostatitis. Men ages 50 or over who have benign prostatic hyperplasia (an enlarged prostate) are also at an increased risk due to their susceptibility to urinary tract infections.

Symptoms

An infection in or around the testicles may be present, especially if the prostatitis was caused by an STD. Generally, symptoms begin quickly and cause great discomfort. They include:

-Burning with urination

-Abdominal pain

-Inability to completely empty the bladder

-Pain with urination, bowel movement, or ejaculation

-Fever, chills, flush

- Blood in semen or urine.

Treatment

The majority of acute prostatitis cases are resolved completely with medication, diet, and behavioral changes. Your doctor may prescribe you antibiotics and stool softeners to reduce pain that occurs during bowel movements. Doctors recommend that prostatitis patients urinate often and completely to decrease symptoms. Warm baths may also relieve lower back and abdominal pain. Substances that can irritate the bladder should also be avoided, such as alcohol, caffeine, tobacco, hot or spicy foods, and citrus fruit and juices. Water intake should be increased to 64-128 ounces per day to help cleanse bacteria from the bladder.

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What is Chronic Bacterial Prostatitis?

Chronic bacterial prostatitis is a persistent inflammation of the prostate gland caused by a bacterial infection. To be diagnosed as chronic, symptoms must have been present for three months or more.

Who is at risk?

Chronic prostatitis is a common disorder, and around 10% of men will develop it at some point during their life. Men of all ages can be affected, but chronic prostatitis is most common in men ages 30-50.

Symptoms

Symptoms of chronic bacterial prostatitis tend to come and go, and include:

-          Pain and discomfort around base of the penis, around the anus, and above the pubic bone/lower back.

-          Pain when passing stools and urine

-          Abnormally frequent or urgent urge to urinate

If you are experiencing fever or symptoms that occur suddenly and intensely, you may actually have acute prostatitis.

Treatment

If you are diagnosed with chronic bacterial prostatitis, your doctor will prescribe you antibiotics. However, it is important to completely follow through with these antibiotics, because you are at risk from the infection coming back (flaring up) if the infection is not completely cleared from the prostate gland.  Between flare-ups, you may experience residual mild pain and a more frequent urge to urinate.

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