PROSTATE FOCUS 

 MARCH 2010

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Prostatitis ?

Had your teeth checked lately?

 

It appears that there is a connection between the two.  Whilst it is true the study only consisted of a few men the result is interesting nevertheless.

The prostate gland contains epithelial cells that, in turn, create PSA, (prostate specific antigen). The prostate specific antigens are inflammatory markers which are at elevated levels in the body, if and when there is either a prostate malignancy or inflammation.The study published in the United States Journal of Periodontology involved 35 male patients who had recently had a biopsy performed on their prostates due to elevated PSA levels or due to the identification of a malignancy. The same men were also checked for symptoms associated with periodontitis or gum disease.

march2010alfa























                                                                 Jones by the fire place......

"Hugo has lost it.  He has been diagnosed with a prostate problem and he says he is off to see his dentist"



The testing for periodontitis involved a full examination of the condition of the gums, a check for bleeding of the gums, and for signs of gingival inflammation. The end result of the study found that the men that had both prostatitis and periodontitis had significantly higher PSA levels than those men that either had prostatitis or periodontitis alone.

In essence, research has now revealed that when a man has periodontal disease he can worsen a condition like prostatitis and that gum disease contributes to the severity of prostatitis.

Not sure that 35 men is a viable number to draw such a conclusion but nevertheless it would be well worth ensuring that your oral health is up to spec. and/or a visit to a dentist is worth while.  PD



Hint….

Did you know that as an anti-inflammatory agent, zinc is sometimes used to treat acne, rheumatoid arthritis, and prostatitis.

 

 

 

I am sure you have heard of

CLIMATE-GATE AND GLACIER-GATE

it seems we could have our own PROSTATITIS-GATE !

 

A PHYSICIAN COMMENTS ON THE DISEASE MOST MEDICS DO NOT TALK ABOUT.

(PELVIC PAIN SYNDROME)

(This article is the first in what is hoped to be a series.)

 

There are surprises awaiting  any physician who views the literature on non-bacterial prostatitis/pelvic pain (NBP/PPS) syndrome. The most striking is the lack of advice for general practitioners on recognition and management of this common and serious condition. NBP/PPS has the same life impact as active Crohn’s disease or myocardial infarction(1)-. The  lack of information is likely to augment suffering as each new patient is met with incredulity by his family practitioner .

The research itself lacks a number of basic requirements

Most trials are of inadequate sample size (ie contain too few patients) to demonstrate an effect. Articles in journals are assessed by the editor and at least two referees. It is surprising that no one blocked publication of these tiny studies. There are now free sample size calculators available online if anyone plans future studies.

and

inappropriate control groups---------For example patients in severe pain are compared psychologically with  people with no pain at all (2) they were found to be more unhappy.

In this discussion I will frequently refer to anecdotes from patient support sites. I am aware this is an unsatisfactory source of data and in these areas there is urgent need for research by one of the professionals paid to care for prostatic disease.

NATURAL HISTORY (or usual progress of the condition)

This is undocumented.  The NIH (National Institute of Health) are attempting to correct this.

 It probably persists for some men’s lifetimes.

Anecdotes from patient support group sites suggest that in some men after the initial 3-4 years NBP/PPS may remit for a few years only to recur for  life. Men in this remission period –in the absence of any professional input -may be found advising others on how to “beat” prostatitis.

Men in remission have not uniformly been told to continue their usual prostate health regimen, including avoidance of alpha stimulants such as found in “over the counter” cold treatments such as phenylephrine (Sudafed) and persisting in regular ejaculation.

 If a condition is to last 30 years with severe late relapses studies of six month duration seem irrelevant and  I will not reference them.

 

INSTRUMENTATION --EFFECT ON SYMPTOMS

 

Instrumentation according to patient support group sites can cause a dramatic flare of symptoms. There is only one study relating to TURP on this matter (3)

Cystoscopy can apparently cause severe flare of pain lasting for days..

 According to patient groups trans urethral resection of the prostate (TURP) can cause a permanent worsening of pain. This is in contrast to a paper which recorded TURP producing a  72% cure and 19% improvement at three months-though it was suggested a number of procedures may be necessary (3). The fact that few patients are offered TURP suggests a professional  lack of confidence in this procedure for this indication.

 

INFORMATION FOR GENERAL PRACTITIONERS

There is a dearth of information for primary care physicians on how to manage this serious condition. Paradoxically they are told that lower urinary tract symptoms should be managed in primary care.

In other chronic diseases attempts are made to educate GP’s and patients  It is unconventional to hide a condition from the general medical community and public.

“The Lancet” and “British Medical Journal” have published nothing on prostatitis for well over a decade.

 

EFFECT OF LIFESTYLE  & PHYSICAL  FACTORS ON SYMPTOMATOLOGY

 

No trials have been done. Patient support groups suggest pain is increased by vibration of the perineum in vehicles and this pain and vibration can be reduced by the use of special cushions with a hole cut at the position of the prostate.

   Though ischaemia, (an inadequate supply of blood to an organ), has been  suggested as playing some part in aetiology, the effect of smoking has  been little studied.

Heat is suggested as being useful in the form of sitting in a tub of hot water (sitz bath).

Transcutaneous (TENS) stimulation to the lumbo-sacral region has not been studied.

Microwave treatment was intermittently reported enthusiastically in small studies(4))   The fact that 25 years later it has not been taken up generally implies that urologists are not on the whole impressed by it. Perhaps the ejaculatory duct obstruction that has occasionally been reported has influenced them.

 

LINK WITH GASTROINTESTINAL DISEASE

There is said to be a link between prostatitis and irritable bowel syndrome (IBS).

Given that microscopic colitis cannot be distinguished clinically from IBS it is possible that the link really lies between prostatitis (and interstitial cystitis) and --microscopic colitis-thus linking  poorly understood inflammatory condition (5).

 

RESPONSE TO CORTICOSTEROIDS

Knowledge of response to corticosteroids is pivotal if any non-infectious inflammatory disease is to be treated. If a condition responds to corticosteroids then other drugs will probably be effective as well (Methotrexate , azathioprine, etanercept, infliximab) Nine patients have had their response to low dose corticosteroids documented. Two months after a month’s course no effect could be discerned(7). Urologists do not treat patients with corticosteroids indicating a group lack of belief in efficacy. Many hundreds of thousands  of men in the UK alone have suffered from non-infectious prostatitis however  the trials of men studied for their response to prednisolone remains in single figures .

If corticosteroids were to worsen chronic non-infectious prostatitis (as is quite possible) there seems little point in hypothesising a T-cell lymphocyte or macrophage dependant immunological aetiology. It would not be surprising if a man who had been living with a damaged prostate for a long period had some antibodies against the damaged prostate tissue. If corticosteroids make  NIP/CPPS worse these antibodies do not cause the pain. A reasonable trial of corticosteroids will be easy and cheap to perform.

Around 2002 there was much talk of a trial of etanercept one of the new tumour necrosis factor antagonist drugs so successful in joint and gut inflammation. There is no evidence this study happened.

 

EFFECTS OF SEXUAL ABSTINENCE

 

There is some consensus that sexual abstinence worsens this condition and regular ejaculation is suggested. Patient’s self help sites describe increased pain lasting for a few days  after each ejaculation. The optimal frequency of ejaculation is unknown---there is no study. It may be this is variable from case to case but if ejaculation produces a three day flare of pain, suggesting ejaculation every three days is not likely to be of assistance

IS THERE A TRUE INFLAMMATION? ARE INFLAMMATORY CYTOKINES INCREASED IN SEMINAL FLUID OR PROSTATIC FLUID?

Probably (8) There is therefore likely to be a true component of inflammation in this condition). .

 

IS THIS CONDITION CAUSED BY PELVIC MUSCLE SPASM?

 

Muscles go into spasm over any inflamed organ so the demonstration of spasm is not evidence of causation. It may be that relaxation and myofascial trigger point massage may relieve some pain but the success needs to be demonstrated in more than one unit as the literature has many “promising” pilot studies which came to nothing.

OPPORTUNITY

At a time of austerity much suffering can be eliminated in this condition for a tiny financial investment. Simply giving the patient an A4 sheet with honest advice about ejaculation, avoiding alpha stimulants, pressure relieving cushions and  pain from procedures could reduce suffering immediately.

The opportunities for research are plentiful and cheap

 

a) Natural History---Requires talking to patients

b) Response to steroids –can be elucidated for the price of syringes and ampoules of depo–medrone  (120mg –the dose that will cause brief remission in rheumatoid arthritis) with some questionnaires.

c) TENS can be discussed with a pain specialist.

 

No comment on the individuals, agencies and specialist groups involved in prostate care is made in this article. Comment may be made at a later date.

 

REFERENCES

1)

Wenninger K et al

Sickness impact of chronic nonbacterial prostatitis and its correlates

J Urol    155(3)   915-8    1996

 

2)Clemens,J  ET AL

J UROL    180(4)   1378-82    2008

Mental health diagnoses in patients with interstitial cystitis/painful bladder syndrome and chronic prostatitis /chronic pelvic pain syndrome: a case control  study

 

3)Smart C J & Jenkins JD 1973

Br J Urol   45(6)  654-62

The role of transurethral prostatectomy in chronic prostatitis

 

4) Nickel   JC  Sorenson R  Transurethral microwave therapy of non bacterial prostatitis and prostatodynia  Initial experience   Urology   44(3)    458-60   1994

 

5)

Tavakkoli   H    et al  Journal of Research in Medical Science     July-Aug 2008    Vol 13 No 4  204-6

Is microscopic colitis a missed diagnosis in diarrhea  -predominant irritable bowel syndrome?

 

7) Bates  SM   et al

BJU International 2007   99(2)   355-9

A prospective randomized, double-blind trial to evaluate the role of a short reducing course of oral corticosteroid therapy in the treatment of chronic prostatitis /chronic pelvic pain syndrome.  

8)

Penna,G et al

Eur Urol 2007    Feb  51(2)    524-33

Seminal plasma cytokines and chemokines in prostatic inflammation: interleukin 8 as a predictive biomarker in chronic prostatitis/chronic pelvic pain syndrome and benign prostatic hyperplasia.  (Written by our undercover medic ! ) 

 

‘The PHA has been in existence since 1993 and in spite of the occasional flurry of interest, prostate massage almost twenty years ago and recently the thought that much of the pain can be labelled as pelvic pain rather than prostate, virtually nothing has changed and men still labour on, (if they are capable) with the constant pain.

We are indebted to the U.S. medic who found that quercetin combined with bromelain provided a treatment, if not a cure.  The PHA found a company who would combine these into a capsule for us.  Over the years since then we have found many men have controlled their pain to such a great extent that many have been able to lead a near normal life.’  (PD)


Climate change

and medical research.

 

Climate change seems to be the flavour of the year so far, with errors on the IPCC reports becoming more outrageous by the day.  Even the king pin Dr Pachauri is now found to have constructed a golf course,l at his TERI complex, that uses thousands of gallons of water whilst all around the land is parched and yellow. 

But lies and omissions are not only the stuff of climate warmists but also of the companies you rely on to provide your medical capsules and other medical treatments.

Dr. Scott Reuben has pleaded guilty to faking dozens of research studies that were published in medical journals. Pfizer’s grant of $75,000 to study Celebrex meant that his study was quoted by hundreds of doctors and researchers as proof that Celebrex helped reduce pain during post surgical recovery.  Yet he enrolled no patients into his study.

The faked studies netted the good doctor over $400,000 dollars over a 13 year period.

 

Check here to read more of this story.

http://www.nbcconnecticut.com/news/...

 

 

A letter from a reader and my reply.

 

 

In May 2009 I had a turp   Nine months after the operation I asked my doctor if I should continue with my medication Flomaxtra.  Can you tell me why 9 months after the operation it was necessary to continue with the medication or have I been too hasty and should I still be on it ?

 

Please advise, I have a check up soon regarding my PSA.

 

 

 

 

REPLY…

 

Flomaxtra does only one thing.  It relaxes the muscles of the prostate, chiefly the upper sphincter, (muscle) which allows the bladder to expel urine which it often cannot do because of the increased pressure that an enlarging prostate brings.

 

The action of the prostate operation, I assume you mean a TURP, a trans urethral resection of the prostate, is to remove that top sphincter as well as some of the excess prostate growth.

 

So it follows that after the operation the use of Floxmax would seem not necessary nor suitable, I think most medics would agree,  although I am not a medic I hasten to add. 

 

If it comes to a discussion on the necessity it would be interesting to discover what was the reason for the prescription !  It amazes me that a medic would not explain to you the reason for the medication so that you can make an informed choice.

 

Psa's are only a good idea if you know the consequences of them and once again are fully informed of the steps which would be necessary should the medic find the reading is above a set limit.  The problem is that the follow up tests and possible treatments are not always necessary. 

 

If you can access a computer please check out our site and read our advice and Newsletters to obtain a greater knowledge of the prostate gland. 

 

COMMENT..

 

This illustrates the complete lack of communication between the medic and the patient.  How many months has the patient been worrying about the medication.  Even when he queried the Flomax he apparently received no advice.

 

It seems he truly had no reason why he was taking the drug, otherwise he would have known that he had no need to take it after the operation as he had no top sphincter to control.  He is now worried about his PSA test.  It would seem from his past experience with his medic that he will have no idea of why he is scheduled for a test nor of any of the consequences of what a medic would decide is a high reading. 

 

As readers will know an increasing reading is not necessarily the sign of an aggressive cancer.. 

 

 

 

Tuesday, November 10, 2009

Blood vessels might predict prostate cancer

"The study of 572 men with localized prostate cancer indicates that aggressive or lethal prostate cancers tend to have blood vessels that are small, irregular and primitive in cross-section, while slow-growing or indolent tumours have blood vessels that look more normal.

The findings were published Oct. 26 in the Journal of Clinical Oncology. OSU news release. . .

"It's as if aggressive prostate cancers are growing faster and their blood vessels never fully mature," says study leader Dr. Steven Clinton, professor of medicine and a medical oncologist and prostate cancer specialist at Ohio State's Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute.

Medics have been looking for ways to separate tiger cancers from pussy cat ones for a few years since it was evident that many men being having surgical treatment and hormones just didn’t need them.  Is this the way ?  PD.


 

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