Chronic Prostatitis

Overview: Chronic Prostatitis

• Prostatitis is the most common reason that men younger than age 50 years, and the third most common reason that men older than age 50 years, see a urologist. Nevertheless, most new diagnoses of prostatitis are made by primary care physicians.

• Investigators estimate that one in every two men will experience prostatitis symptoms during their life-time. Although the term prostatitis literally means prostatic inflammation, inflammation is not always present, and neither is infection.

• In fact, patients are often diagnosed with prostatitis simply because they experience pain during a rectal examination. In an effort to standardize the terminology used to describe the different types of prostatitis, the National Institutes of Health proposed the four categories.

Important Points to Consider

• Only 5% of men with prostatitis have bacterial prostatitis.

• Approved by the German Commission E for inflammatory disorders of the urinary tract, uva ursi leaves contain a potent urinary antiseptic called arbutin.

• Arbutin is hydrolyzed in alkaline urine to hydroquinone. Hydroquinone inhibits bacteria that commonly cause prostatitis.

• Owing to its high tannin content, uva ursi should not be taken for more than 1 week. Uva ursi is contraindicated in pregnant women, patients with renal disease, nursing mothers, and children younger than 12 years old.

• Approximately one third of patients with nonbacterial prostatitis respond to antibiotics, the same proportion that responds to placebo.

• The prostate naturally produces an antibacterial factor, primarily composed of zinc, which helps prevent bacterial infections. However, men with chronic bacterial prostatitis have low prostatic zinc levels despite normal blood levels.

• Current research suggests that chronic prostatitis is primarily a chronic pelvic pain syndrome, triggered by trauma, infection, irritation, or dysfunctional voiding.

• Diagnosis and treatment rely on trial-and-error methods, with symptom resolution as the primary goal. Fortunately, long-term studies indicate that symptoms rarely worsen over time.

Prevention Prescription

• Exercise at least 30 minutes three times weekly.

• Obtain at least 7 hours of sleep daily.

• Practice stress reduction and relaxation techniques daily.

• Eat two servings of soy products and at least five to nine servings of fruits and vegetables daily. Drink at least 64 oz of water daily.

• Avoid junk food, hot and spicy foods, alcohol, and caffeine.

Prostatitis Symptom Index

Monitor therapeutic response by asking patients to fill out a prostate symptom index form before initiating therapy and monthly thereafter as long as symptoms persist.

Prostatitis Symptom Index

Integrative therapeutics review

Unless symptomatic patients are allergic, start them on a quinolone antibiotic pending results of a post-prostatic massage urine culture.

If the culture result is positive. further treatment should be based on culture results. If the culture result is negative, the antibiotics can be stopped unless symptoms improve, in which case antibiotic therapy may be continued.

• Antibiotics should be taken for 1 month along with a probiotic (but not at the same time of day).

• Patients who fail to respond, and those who have recurrent prostatitis, should be referred to a urologist for further evaluation.

• Other measures that are helpful for bacterial and nonbacterial prostatitis are listed here.

Nutrition

• Pomegranate (Punica granatum) has been studied for its potential benefits in managing chronic prostatitis due to its anti-inflammatory and antioxidant properties. The bioactive compounds in pomegranate, such as ellagic acid, polyphenols, and flavonoids, have shown significant anti-inflammatory and antioxidant effects in various studies.

• Eat fresh fruits and vegetables.

• Add soy and ground flaxseed to the diet.

• Drink plenty of water.

• Avoid urinary irritants such as caffeinated beverages, junk food, tobacco products, alcohol, and spicy food.

Mind-Body Therapy

• Encourage stress reduction techniques.

• Consider meditation, counseling, and biofeedback.

Supplements

• Take a high-potency multivitamin daily.

• Also take additional zinc gluconate or picolinate 40 mg daily, plus quercetin 250 to 500 mg and an equal amount of bromelain 20 minutes before meals three times daily.

• Selenium has shown decreased bacterial infection on prostrate tissue along with a protective effect against the occurrence of Chronic Bacterial Prostatitis (CBP).

Botanicals

• Depending on symptoms, a 6-week trial of one or more of the following herbs should be tried:

  • Saw palmetto (Serenoa repens): 160mg twice daily

  • PollenAid (Secale cereale): one capsule or two tablets three times daily before meals

  • Stinging nettle (Urtica dioica): dry extract, 120 mg twice daily

• If no improvement occurs, consider trying a different herbal combination.

Pharmaceuticals

• Try a 2- to 4-week course of a cyclooxygenase-2 inhibitor to alleviate painful prostatitis symptoms.

• If muscle spasms are suspected, try a 4- to 6-week trial of an alpha-adrenergic blocker.

• If improvement occurs, continue the medication; otherwise, stop.

Biomechanical Techniques

• Recommend daily sitz baths as needed.

• Consider physical therapy and regular prostatic massage.

Prostatitis Symptom Index

• Monitor therapeutic response by asking patients to fill out a prostate symptom index form before initiating therapy and monthly thereafter as long as symptoms persist.

Prostatitis Symptom Index

Key Web Sources

• www.prostatitis.org

• https://pubmed.ncbi.nlm.nih.gov/31908068/

• https://pubmed.ncbi.nlm.nih.gov/21814801/

• http://kidney.niddk.nih.gov/kudiseases/pubs/prostatitis

• http://www.nccaom.org

Image credits: Derek Brahney