Chronic prostatitis is a public health problem

by Arnon Krongrad, MD

David was afraid. After years of peregrinations with pain, he had exhausted all the options. David knew he wasn’t crazy. The problem was the doctors: They had no more treatments for chronic prostatitis. The doctors did not want to see him.

Chronic prostatitis is a public health problem. Contrasted with fibromyalgia, autism, and breast cancer, however, nobody talks about it. President Obama declared this to be National Prostate Cancer Awareness Month, but not National Chronic Prostatitis Awareness Month. Pennsylvania declared this to be Women in Pain Awareness Month, but the men were left out. Given the ruinous impact of chronic prostatitis, the omissions seem cruel. Why is it like this?

One problem is that doctors do not know what to do with chronic prostatitis. While nearly all patients are initially treated with antibiotics, these work poorly; the same is true for alpha-blockers, prostate massage, and prostate injections, which generally work no better than placebo, therapeutic massage, and pollen extract. And so Davids haunt the clinical landscape as modern day lepers, shuttling from one unreceptive doctor to the next.

I do laparoscopic prostate cancer surgery. Prostate cancer at the early, surgical stages is asymptomatic. It came as a surprise, then, when a colleague sent David to have a laparoscopic radical prostatectomy; to the best of his knowledge – and mine – it had never before been used to treat prostatitis.

It was a delicate moment. On the one hand, there was absolutely no scientific basis for the doctor’s request. On the other, before me was a man seated on a cushion, disabled and depressed, unable to sit, urinate, or fornicate without pain. He had done everything right, but gotten nowhere. He had reached a point of desperation, pleading with his doctors to fix him or shoot him.

David is the kind of patient doctors see from time to time: The one who did not read the medical textbook, who differs from all the previous patients, who asks for something nobody’s ever done before. And whose request is scary because it involves risk for him and maybe for you. It is a moment in which Hippocrates bears down on you. At this conflicted nexus of desire and reality, there is only instinct and a most profound and bilateral trust between patient and surgeon.

When David woke up from surgery, he said: “It feels like someone pulled a golf ball out of my ass.” In the three years since, he has had no recurrence and he has regained all his functions. He says he is having better sex than ever because the pain is now gone.

And a handful of other patients with the most difficult and treatment-resistant forms of prostatitis – including one who had had pain for 45 years! – have gotten relief with the same operation. They are part of a clinical trial aimed at quantifying the association of surgery with symptom relief.

The landscape is crawling with thousands of men with severe prostate pain. They’d make a fitting backdrop of zombies for Cormack McCarthy’s apocalyptic The Road. It shouldn’t be this way. We need to talk about them. We need to find ways to relieve their pain.

Arnon Krongrad is Medical Director of the Krongrad Institute for Minimally Invasive Prostate Surgery and the not-for-profit Prostate Cancer International. He blogs at Prostatitis Blog and Scrub, Rinse, Repeat.

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