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Encyclopedia > Prostatitis
Prostatitis
Classification & external resources
ICD-10 N41.
ICD-9 601
DiseasesDB 10801
MedlinePlus 000524
eMedicine emerg/488 
MeSH D011472

Prostatitis is any form of inflammation of the prostate gland. Because women do not have a prostate gland, it is a condition only found in men, although women do have microscopic paraurethral Skene's glands connected to the distal third of the urethra in the prevaginal space that are homologous to the prostate, and may cause symptoms.[1] Image File history File linksMetadata Prostatelead. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // N00-N39 - Diseases of the genitourinary system: urinary system (N00-N08) Glomerular diseases Prefixes: .2 Diffuse membranous glomerulonephritis (N00) Acute nephritic syndrome (N01) Rapidly progressive nephritic syndrome (N02) Recurrent and persistent haematuria (N03) Chronic nephritic syndrome (N04) Nephrotic syndrome Lipoid nephrosis (N05) Unspecified nephritic syndrome (N06) Isolated proteinuria with specified... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... The prostate is an exocrine gland of the male mammalian reproductive system. ... A gland is an organ in an animals body that synthesizes a substance for release such as hormones, often into the bloodstream (endocrine gland) or into cavities inside the body or its outer surface (exocrine gland). ... This article concerns how a man differs from women. ... In human anatomy, the Skenes glands (also known as the lesser vestibular or paraurethral glands) are glands located on the upper wall of the vagina, around the lower end of the urethra. ...


A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits in the USA.[2]

Contents

Nomenclature

The term prostatitis refers in its strictest sense to histological (microscopic) inflammation of the tissue of the prostate gland, although historically the term has loosely been used as a rubric to describe a set of quite different conditions. To try to remedy this, the NIH devised a new classification system in 1999. NIH can refer to: National Institutes of Health Norwegian School of Sports Sciences: (Norges idrettshøgskole - NIH) Not Invented Here This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ...


Classification

According to the 1999 National Institute of Health (NIH) Classification, there are four categories of prostatitis:

Subdivisions of IIIa (inflammatory) and IIIb (non-inflammatory) exist based on levels of pus cells in expressed prostatic secretions, but these subcategories are of limited use clinically

Category I: Acute prostatitis (bacterial)

Signs and symptoms

Men with this disease often have chills, fever, pain in the lower back and genital area, urinary frequency and urgency often at night, burning or painful urination, body aches, and a demonstrable infection of the urinary tract, as evidenced by white blood cells and bacteria in the urine. There may be discharge from the penis.


Diagnosis

Acute prostatitis is relatively easy to diagnose due to its symptoms that suggest infection. Common bacteria are E. Coli, Klebsiella, Proteus, Pseudomonas, Enterobacter, Enterococcus, Serratia, and Staphylococcus aureus. This can be a medical emergency in some patients and hospitalization with intravenous antibiotics may be required. A full blood count reveals increased white blood cells. Sepsis from prostatitis is very rare, but may occur in immunocompromised patients; high fever and malaise generally prompt blood cultures, which are often positive in sepsis. A full blood count (FBC) or complete blood count (CBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. ... Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ... Immunosuppression is the medical suppression of the immune system. ... An analogue medical thermometer showing the temperature of 38. ... blood culture Blood culture is microbiological culture of blood. ...


Treatment

Antibiotics are the first line of treatment in acute prostatitis (Cat. I). Antibiotics usually resolve acute prostatitis infections in a very short period of time. Appropriate antibiotics should be used, based on the microbe causing the infection. Some antibiotics have very poor penetration of the prostatic capsule, others, such as Ciprofloxacin, Co-trimoxazole and tetracyclines penetrate well. Severely ill patients may need hospitalization, while nontoxic patients can be treated at home with bed rest, analgesics, stool softeners, and hydration. An antibiotic is a drug that kills or slows the growth of bacteria. ... An antibiotic is a drug that kills or slows the growth of bacteria. ... Ciprofloxacin is the generic international name for the synthetic antibiotic manufactured and sold by Bayer Pharmaceutical under the brand names Cipro and Ciproxin (and other brand names in other markets, e. ...


Prognosis

Full recovery without sequelae is usual. A sequela, (IPA ) (plural sequelae) is a pathological condition resulting from a disease, injury, or other trauma. ...


Category II: Chronic bacterial prostatitis

Signs and symptoms

Chronic bacterial prostatitis is a relatively rare condition (<5% of patients with prostate-related non-BPH LUTS) that usually presents with an intermittent UTI-type picture and that is defined as recurrent urinary tract infections in men originating from a chronic infection in the prostate. Dr. Weidner, Professor of Medicine, Department of Urology, University of Giessen, has stated: "In studies of 656 men, we seldom found chronic bacterial prostatitis. It is truly a rare disease. Most of those were E-coli."[3] Symptoms may be completely absent until there is also bladder infection, and the most troublesome problem is usually recurrent cystitis.


Diagnosis

In chronic bacterial prostatitis there are bacteria in the prostate but usually no symptoms. The prostate infection is diagnosed by culturing urine as well as prostate fluid (expressed prostatic secretions or EPS) which are obtained by the doctor doing a rectal exam and putting pressure on the prostate. If no fluid is recovered after this prostatic massage, a post massage urine should also contain any prostatic bacteria. Prostate specific antigen levels may be elevated, although there is no malignancy. Prostate specific antigen (PSA, also known as kallikrein III, seminin, semenogelase, γ-seminoprotein and P-30 antigen) is a protein manufactured almost exclusively by the prostate gland; PSA is produced for the ejaculate where it liquifies the semen and allows sperm to swim freely. ...


Treatment

Treatment requires prolonged courses (4-8 weeks) of antibiotics that penetrate the prostate well (β-lactams and nitrofurantoin are ineffective). These include quinolones (ciprofloxacin, levofloxacin), sulfas (Bactrim, Septra) and macrolides (erythromycin, clarithromycin). Persistent infections may be helped in 80% of patients by the use of alpha blockers (tamsulosin (Flomax), alfuzosin), or long term low dose antibiotic therapy.[4] Recurrent infections may be caused by inefficient urination (benign prostatic hypertrophy, neurogenic bladder), prostatic stones or a structural abnormality that acts as a reservoir for infection. A beta-lactam (β-lactam) or penam is a lactam with a heteroatomic ring structure, consisting of three carbon atoms and one nitrogen atom. ... Nitrofurantoin is an antibiotic. ... Quinolones and fluoroquinolones form a group of broad-spectrum antibiotics. ... Levofloxacin is relatively new fluoroquinolone antibiotic, marketed by Ortho-McNeil under the brand name Levaquin. ... There are several sulphonamide-based groups of drugs. ... Co-trimoxazole is a bacteriostatic antibiotic combination of trimethoprim and sulfamethoxazole, in the ratio of 1 to 5, used in the treatment of a variety of bacterial infections. ... The macrolides are a group of drugs (typically antibiotics) whose activity stems from the presence of a macrolide ring, a large lactone ring to which one or more deoxy sugars, usually cladinose and desosamine, are attached. ... Erythromycin is a macrolide antibiotic which has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. ... Clarithromycin is a macrolide antibiotic used to treat pharyngitis, tonsillitis, acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, pneumonia (especially atypical pneumonias associated with Chlamydia pneumoniae or TWAR), skin and skin structure infections, and, in HIV and AIDS patients to prevent, and to treat, disseminated Mycobacterium avium complex or... Alpha blockers (also called alpha-adrenergic blocking agents) constitute a variety of drugs which block alpha-adrenergic receptors in arteries and smooth muscles. ... Tamsulosin (rINN) (IPA: ) is an α1a-selective alpha blocker used in the symptomatic treatment of benign prostatic hyperplasia (BPH). ... Alfuzosin ((R,S)-N-[3-[(4-amino-6,7-dimethoxy-2-quinazolinyl) methylamino] propyl] tetrahydro-2-furancarboxamide, provided as the hydrochloride salt) is an alpha-adrenergic blocker used to treat benign prostatic hyperplasia (BPH). ...


The addition of prostate massage to courses of antibiotics was previously proposed as being beneficial.[5][6] It is though not without some risk,[7] and has not been shown in more recent trials to improve outcome compared to antibiotics alone.[8] Prostate massage and prostate milking are terms used to describe the massage or stimulation of the prostate gland in males, either for medical or sexual purposes. ...


Prognosis

Over time, the relapse rate is high, exceeding 50%.


Category III: CP/CPPS, pelvic myoneuropathy

Main article: Pelvic myoneuropathy

Pelvic myoneuropathy is a new term given to the most common form of non-bacterial pelvic pain experienced by men. ...

Signs and symptoms

In chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) there is pelvic pain of unknown cause, lasting longer than 6 months, as the key symptom. Symptoms may wax and wane. Pain can range from mild discomfort to debilitating. Pain may radiate to back and rectum, making sitting difficult. Dysuria, arthralgia, myalgia, unexplained fatigue, abdominal pain, constant burning pain in the penis, and frequency may all be present. Frequent urination and increased urgency may suggest interstitial cystitis (inflammation centred in bladder rather than prostate). Ejaculation may be painful, as the prostate contracts during emission of semen, although nerve- and muscle-mediated post-ejaculatory pain is more common, and a classic sign of CP/CPPS. Some patients report low libido, sexual dysfunction and erectile difficulties. Pain after ejaculation is a very specific complaint that distinguishes CP/CPPS from men with BPH or normal men. In medicine, specifically urology, dysuria refers to any difficulty in urination. ... Arthralgia is a term used to describe pain in the joints. ... Myalgia means muscle pain and is a symptom of many diseases and disorders. ... “Fatigue (physical)” redirects here. ... Interstitial cystitis (commonly abbreviated to IC) is a urinary bladder disease of unknown cause characterised by urinary frequency (as often as every 10 minutes), urgency, pressure and/or pain in the bladder and/or pelvis. ... Ejaculation is the ejecting of semen from the penis, and is usually accompanied by orgasm. ... Pelvic myoneuropathy is a new term given to the most common form of non-bacterial pelvic pain experienced by men. ... Sexual dysfunction or sexual malfunction (see also sexual function) is difficulty during any stage of the sexual act (which includes desire, arousal, orgasm, and resolution) that prevents the individual or couple from enjoying sexual activity. ... Impotence or, more clinically, erectile dysfunction is the inability to develop or maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. ... Ejaculation is the ejecting of semen from the penis, and is usually accompanied by orgasm. ... For other uses of the acronym BPH, see BPH (disambiguation). ...


Theories of Etiology

Theories behind the disease include autoimmunity, for which there is scant evidence, neurogenic inflammation and myofascial pain syndrome. In the latter two categories, dysregulation of the local nervous system due to past traumatic experiences or an anxious disposition and chronic albeit unconscious pelvic tensing lead to inflammation that is mediated by substances released by nerve cells (such as substance P). The prostate (and other areas of the genitourinary tract: bladder, urethra, testicles) can become inflamed by the action of the chronically activated pelvic nerves on the mast cells at the end of the nerve pathways. Similar stress-induced genitourinary inflammation has been shown experimentally in other mammals. [9] Autoimmunity is the failure of an organism to recognise its own constituent parts (down to the sub-molecular levels) as self, which results in an immune response against its own cells and tissues. ... Neurogenic inflammation is a general term used to describe the local release of inflammatory mediators from afferent neurons such as substance P and calcitonin gene-related peptide. ... CambridgeBayWeather 02:48, 23 September 2005 (UTC) Categories: Possible copyright violations ... In neuroscience, Substance P is a neuropeptide: a short-chain polypeptide that functions as a neurotransmitter and as a neuromodulator. ...


Prostatitis researcher Dr Anthony Schaeffer commented in a 2003 editorial of The Journal of Urology that: "It is well recognized that even if pathogenic bacteria are present in the prostate, as in men with established chronic bacterial prostatitis, they do not cause chronic pelvic pain unless acute urinary tract infection develops. Taken together, these data suggest that bacteria do not have a significant role in the development of the chronic pelvic pain syndrome. The clinical observation that antimicrobial therapy reduces symptomatology in men with chronic pelvic pain syndrome is being tested in a double-blinded NIH controlled study. Since antimicrobials may have anti-inflammatory activity, it is possible that these drugs may benefit the patient by reducing inflammation rather than eradicating bacteria."[10]


A year after making that statement, Dr Schaeffer and his colleagues published studies showing that antibiotics are essentially useless for CP/CPPS. [11] [12]


The bacterial infection theory that for so long had held sway in this field was again shown to be unimportant in another 2003 study from the University of Washington team led by Dr Lee and Professor Richard Berger. The study found that one third of both normal men and patients had equal counts of similar bacteria colonizing their prostates. [13]


Since the publication of these studies, the focus has shifted from infection to neuromuscular and psychological etiologies for chronic prostatitis (CP/CPPS).

  • Possible role of unculturable bacteria in CPPS: There have been some questions regarding the role of unculturable/ultra-fastidious organisms in prostatitis. Although a team led by Keith Jarvi reported the isolation of unusual bacteria at the American Urological Association's annual meeting in 2001,[14] it was not published in any urology journals, a sign that the paper did not withstand the peer review process. An item about the study was published in Urology Times,[15] a newsletter for urologists. However, subsequent careful PCR studies failed to replicate these findings, and medical researchers are now in general agreement that CPPS is not caused by active bacterial infection.
  • Non-bacterial prostatitis as a form of interstitial cystitis (IC): Some researchers have suggested that non-bacterial prostatitis is a form of interstitial cystitis. A large multicenter prospective randomized controlled study showed that Elmiron was slightly better than placebo in treating the symptoms of chronic prostatitis.[16] Other therapies shown more effective than Elmiron in treating interstitial cystitis, such as quercetin and Elavil (amitriptyline), can help with chronic prostatitis.

A growth medium is an object in which microorganisms or cells in experience growth. ... Peer review (known as refereeing in some academic fields) is a scholarly process used in the publication of manuscripts and in the awarding of funding for research. ... Interstitial cystitis (commonly abbreviated to IC) is a urinary bladder disease of unknown cause characterised by urinary frequency (as often as every 10 minutes), urgency, pressure and/or pain in the bladder and/or pelvis. ... Interstitial cystitis (commonly abbreviated to IC) is a urinary bladder disease of unknown cause characterised by urinary frequency (as often as every 10 minutes), urgency, pressure and/or pain in the bladder and/or pelvis. ... Quercetin is a flavonoid that forms the backbone for many other flavonoids, including the citrus flavonoids rutin, hesperidin, naringin and tangeritin. ... Amitriptyline hydrochloride is an antidepressant drug from the tricyclic antidepressant group, which is sold under the trade names Elavil®, Tryptanol® or Endep®. It is a white, odorless, crystalline compound which is freely soluble in water. ...

Diagnosis

There are no definitive diagnostic tests for CP/CPPS. This is a poorly understood disorder, even though it accounts for 90%-95% of prostatitis diagnoses.[17] It is found in men of any age, with the peak onset in the early 30s. CP/CPPS may be inflammatory (category IIIa) or non-inflammatory (category IIIb). In the inflammatory form, urine, semen, and other fluids from the prostate contain pus cells (dead white blood cells or WBCs), whereas in the non-inflammatory form no pus cells are present. Recent studies have questioned the distinction between categories IIIa and IIIb, since both categories show evidence of inflammation if pus cells are ignored and other more subtle signs of inflammation, like cytokines, are measured. In 2006, Chinese researchers found that men with categories IIIa and IIIb both had significantly and similarly raised levels of anti-inflammatory cytokine TGFß1 and pro-inflammatory cytokine IFN-γ in their expressed prostatic secretions when compared with controls; therefore measurement of these cytokines could be used to diagnose category III prostatitis.[18] Cytokines are small protein molecules that are the core of communication between immune system cells, and even between immune system cells and cells belonging to other tissue types. ... The SMAD Pathway The DAXX Pathway Transforming growth factor beta (TGF-β) is a biological protein that comes in three isoforms called TGF-β1, TGF-β2 and TGF-β3; it was also the original name for the founding member of this family that is now called TGF-β1. ... Interferon-gamma or IFN-g is a dimerized soluble cytokine which is a Type II Interferon. ...


Normal men have slightly more bacteria in their semen than men with chronic prostatitis/pelvic myoneuropathy.[19] The traditional Stamey 4-glass test is invalid for diagnosis of this disorder, and inflammation cannot be localized to any particular area of the lower GU tract.[19]


Men with CP/CPPS are more likely than the general population to suffer from Chronic Fatigue Syndrome (CFS),[20] and Irritable Bowel Syndrome (IBS). Prostate specific antigen levels may be elevated, although there is no malignancy. Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), post-viral fatigue syndrome (PVFS), and various other names, is a syndrome (or group of syndromes) of unknown and possibly multiple etiologies, affecting the central nervous system (CNS), immune, and many other systems and organs. ... IBS is an abbreviation with several meanings: International Business School - Kelajak Ilmi, (IBS) an English-language college in Tashkent, Uzbekistan [1] IBS, IBS Services Ltd. ... Prostate specific antigen (PSA, also known as kallikrein III, seminin, semenogelase, γ-seminoprotein and P-30 antigen) is a protein manufactured almost exclusively by the prostate gland; PSA is produced for the ejaculate where it liquifies the semen and allows sperm to swim freely. ...


Experimental tests that could be useful in the future include tests to measure semen and prostate fluid cytokine levels. Various studies have shown increases in markers for inflammation such as elevated levels of cytokines, myeloperoxidase, and chemokines.


Treatment

Physical and psychological therapy

For chronic nonbacterial prostatitis (Cat III), also known as pelvic myoneuropathy or CP/CPPS, which makes up the majority of men diagnosed with "prostatitis", a treatment called the Stanford Protocol,[21] developed by Stanford University Professor of Urology Rodney Anderson and psychologist David Wise in 1996, has recently been published. This is a combination of medication (using tricyclic antidepressants and benzodiazepines), psychological therapy (paradoxical relaxation, an advancement and adaptation, specifically for pelvic pain, of a type of progressive relaxation technique developed by Edmund Jacobson during the early 20th century), and physical therapy (trigger point release therapy on pelvic floor and abdominal muscles, and also yoga-type exercises with the aim of relaxing pelvic floor and abdominal muscles). [22] [23] While these studies are encouraging, definitive proof of efficacy would require a randomized, sham controlled, blinded study, which is not as easy to do with physical therapy as with drug therapy. Pelvic myoneuropathy is a new term given to the most common form of non-bacterial pelvic pain experienced by men. ... Pelvic myoneuropathy is a new term given to the most common form of non-bacterial pelvic pain experienced by men. ... The Leland Stanford Junior University, commonly known as Stanford University (or simply Stanford), is a private university located approximately 37 miles (60 kilometers) southeast of San Francisco and approximately 20 miles northwest of San José in an unincorporated area of Santa Clara County. ... 1996 (MCMXCVI) was a leap year starting on Monday of the Gregorian calendar, and was designated the International Year for the Eradication of Poverty. ... A recent form of antidepressant medication - Prozac Serotonin-norepinephrine reuptake inhibitor, Venlafaxine An antidepressant, in the most common usage, is a medication taken to alleviate clinical depression or dysthymia (milder depression). ... Alprazolam 2mg tablets The benzodiazepines (pronounced , or benzos for short) are a class of psychoactive drugs considered as minor tranquilizers with varying hypnotic, sedative, anxiolytic, anticonvulsant, muscle relaxant and amnesic properties, which are brought on by slowing down the central nervous system. ... Edmund Jacobson (* August 22, 1888 in Chicago; † January 1983 in Chicago) was a US-American physician in internal medicine and psychiatry and a physiologist. ... This article or section needs to be wikified. ... The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. ... Yoga (Devanagari: योग) is one of the six schools of Hindu philosophy, focusing on meditation as a path to self-knowledge and liberation. ...


Cat. III prostatitis may have no initial trigger other than anxiety, often with an element of Obsessive Compulsive Disorder or other anxiety-spectrum problem. This is theorized to leave the pelvic area in a sensitized condition resulting in a loop of muscle tension and heightened neurological feedback (neural wind-up). Current protocols largely focus on stretches to release overtensed muscles in the pelvic or anal area (commonly referred to as trigger points), physical therapy to the area, and progressive relaxation therapy to reduce causative stress. Biofeedback physical therapy to relearn how to control pelvic floor muscles may be useful.[24] For other things named OCD, see OCD (disambiguation). ... Trigger points are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. ... Biofeedback mechanism. ...


Aerobic exercise can help those sufferers who are not also suffering from Chronic Fatigue Syndrome (CFS) or whose symptoms are not exacerbated by exercise.[25] Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), post-viral fatigue syndrome (PVFS), and various other names, is a syndrome (or group of syndromes) of unknown and possibly multiple etiologies, affecting the central nervous system (CNS), immune, and many other systems and organs. ...


Food allergies

Anecdotal evidence suggests that food allergies and intolerances may have a role in exacerbating CP/CPPS, perhaps through mast cell mediated mechanisms. Specifically patients with gluten intolerance or celiac disease report severe symptom flares after sustained gluten ingestion. Patients may therefore find an exclusion diet helpful in lessening symptoms by identifying problem foods. Studies are lacking in this area. Pelvic myoneuropathy is a new term given to the most common form of non-bacterial pelvic pain experienced by men. ... Wheat - a prime source of gluten Gluten is an amorphous ergastic protein found combined with starch in the endosperm of some cereals, notably wheat, rye, and barley. ... Coeliac disease (also termed non-tropical sprue, celiac disease and gluten intolerance) is an autoimmune disease characterised by chronic inflammation of the proximal portion of the small intestine caused by exposure to certain dietary gluten proteins. ...


Pharmacological treatment

There is a substantial list of medications used to treat this disorder.[26]


Alpha blockers (tamsulosin, alfuzosin) are moderately helpful for many men with CPPS;[27] duration of therapy needs to be at least 3 months.[28] Tamsulosin (rINN) (IPA: ) is an α1a-selective alpha blocker used in the symptomatic treatment of benign prostatic hyperplasia (BPH). ... Alfuzosin ((R,S)-N-[3-[(4-amino-6,7-dimethoxy-2-quinazolinyl) methylamino] propyl] tetrahydro-2-furancarboxamide, provided as the hydrochloride salt) is an alpha-adrenergic blocker used to treat benign prostatic hyperplasia (BPH). ...


Quercetin has shown effective in a randomized, placebo-controlled trial in chronic prostatitis using 500 mg twice a day for 4 weeks.[29] Subsequent studies showed that quercetin, a mast cell inhibitor, reduces inflammation and oxidative stress in the prostate. Quercetin is a flavonoid that forms the backbone for many other flavonoids, including the citrus flavonoids rutin, hesperidin, naringin and tangeritin. ...


Pollen extract (Cernilton)] has also been shown effective in randomized placebo controlled trials.[30][31][32]


Commonly used therapies that have not been properly evaluated in clinical trials are dietary modification, gabapentin, and amitriptyline. Therapies shown to be ineffective by randomized placebo/sham controlled trials: levaquin (antibiotics), alpha blockers for 6 weeks or less, transurethral needle ablation of the prostate (TUNA). Levofloxacin is relatively new fluoroquinolone antibiotic, marketed by Ortho-McNeil under the brand name Levaquin. ... An antibiotic is a drug that kills or slows the growth of bacteria. ... A shoal of skipjack tuna Tuna are several species of ocean-dwelling fish in the family Scombridae, mostly in the genus Thunnus. ...


At least one study suggests that multi-modal therapy (aimed at different pathways such as inflammation and neuromuscular dysfunction simultaneously) is better long term than monotherapy.[33]


Prognosis

In recent years the prognosis for CP/CPPS has improved greatly with the advent of multimodal treatment, phytotherapy and protocols aimed at quieting the pelvic nerves through myofascial trigger point release and anxiety control.


Category IV: Asymptomatic inflammatory prostatitis

Signs and symptoms

These patients have no history of genitourinary pain complaints, but leukocytosis or bacteria have been noted during evaluation for other conditions. White Blood Cells is also the name of a White Stripes album. ...


Diagnosis

Diagnosis is through tests of semen, EPS or urine that reveal inflammation in the absence of symptoms.


Treatment

No treatment required. It is standard practice for men with infertility and category IV prostatitis to be given a trial of antibiotics and/or anti-inflammatories however evidence for efficacy are weak.[34] Since signs of asymptomatic prostatic inflammation may sometimes be associated with prostate cancer, this can be addressed by tests that assess the ratio of free-to-total PSA. The results of these tests were significantly different in prostate cancer and category IV prostatitis in one study.[35] Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. ...


References

  • Nickel J.C., Moon T., "Chronic bacterial prostatitis: an evolving clinical enigma", Urology 66:1:2-8 (July 2005).
  • Shoskes D.A., "Use of antibiotics in chronic prostatitis syndromes", Can. J. Urol. 8 Suppl 1:24-8 (June 2001).
  • Dimitrakov JD, Kaplan SA, Kroenke K, Jackson JL, Freeman MR., Management of chronic prostatitis/chronic pelvic pain syndrome: an evidence-based approachUrology. 2006;67(5):881-8
  • Stevermer, James J., Easley, Susan K., "Treatment of Prostatitis", American Family Physician 61:10 (May 15, 2000) [1]

Footnotes

  1. ^ R F Gittes and R M Nakamura (1996). "Female urethral syndrome. A female prostatitis?". West J Med. 164 (5). 
  2. ^ Collins MM et al (1998). "How common is prostatitis? A national survey of physician visits.". J Urol. 159 (4). 
  3. ^ Schneider, H., Ludwig, M., Hossain, H. M., Diemer, T. & Weidner, W. (2003). "The 2001 Giessen Cohort Study on patients with prostatitis syndrome – an evaluation of inflammatory status and search for microorganisms 10 years after a first analysis". Andrologia 35 (5). 
  4. ^ Shoskes D, Hakim L, Ghoniem G, Jackson C (2003). "Long-term results of multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome". J Urol 169 (4): 1406-10. PMID 12629373. 
  5. ^ Nickel J, Downey J, Feliciano A, Hennenfent B (1999). "Repetitive prostatic massage therapy for chronic refractory prostatitis: the Philippine experience". Tech Urol 5 (3): 146-51. PMID 10527258. 
  6. ^ (1999) "Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis". Prostate Cancer Prostatic Dis 2 (3): 159-162. PMID 12496826. 
  7. ^ Sengoku A, Yamashita M, Umezu K (1990). "[A case of Fournier's gangrene: was it triggered by prostatic massage?]". Hinyokika Kiyo 36 (9): 1097-100. PMID 2239620. 
  8. ^ Ateya A, Fayez A, Hani R, Zohdy W, Gabbar M, Shamloul R (2006). "Evaluation of prostatic massage in treatment of chronic prostatitis". Urology 67 (4): 674-8. PMID 16566972. 
  9. ^ Neurotensin mediates rat bladder mast cell degranulation triggered by acute psychological stress. Urology. 1999 May;53(5):1035-40 (Sant GR, Theoharides TC et al)
  10. ^ Schaeffer AJ (2003). "Editorial: Emerging concepts in the management of prostatitis/chronic pelvic pain syndrome.". J Urol. 169 (2). 
  11. ^ Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial Ann Intern Med. 2004 Oct 19;141(8):581-9 (Alexander RB, Schaeffer AJ, Nickel JC, Pontari MA, McNaughton-Collins M, Shoskes DA et al)
  12. ^ Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in men: a randomized placebo-controlled multicenter trial Urology. 2003 Oct;62(4):614-7 (Nickel JC, Downey J, Clark J, Casey RW)
  13. ^ Prostate Biopsy Culture Findings of Men With Chronic Pelvic Pain Syndrome do Not Differ From Those of Healthy Controls J Urol. 2003; 169(2):584-588 (Lee JC, Berger RE et al)
  14. ^ AUA Meeting 2001 (html) (2001). Retrieved on 2006 December 9.
  15. ^ New bacteria strains found in prostatitis patients (html) (2001). Retrieved on 2006 December 9.
  16. ^ Nickel, JC et al (2005). "Pentosan polysulfate sodium therapy for men with chronic pelvic pain syndrome: a multicenter, randomized, placebo controlled study.". J Urol. 173 (4). 
  17. ^ Habermacher GM, Chason JT, Schaeffer AJ. (2006). "Prostatitis/chronic pelvic pain syndrome.". Annu Rev Med. 57. 
  18. ^ Ding XG, Li SW, Zheng XM, Hu LQ. (2006). "[IFN-gamma and TGF-beta1, levels in the expressed prostatic secretions of patients with chronic abacterial prostatitis]". Zhonghua Nan Ke Xue. 12 (11). 
  19. ^ a b Leukocytes and bacteria in men with chronic prostatitis/chronic pelvic pain syndrome compared to asymptomatic controls J Urol. 2003 Sep;170(3):818-22 (Nickel JC, Alexander RB, Schaeffer AJ)
  20. ^ Leslie A Aaron et al (2001). "Comorbid Clinical Conditions in Chronic Fatigue, A Co-Twin Control Study". J Gen Intern Med. 16 (1). 
  21. ^ The Stanford Protocol (html) (2005). Retrieved on 2006 December 9.
  22. ^ Trigger Points and Relaxation in the Treatment of Prostatitis J Urol. 2005 Jul;174(1):155-60 (Anderson RU, Wise D, Sawyer T, Chan C.)
  23. ^ Sexual Dysfunction in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Improvement After Trigger Point Release and Paradoxical Relaxation Training J Urol. 2006 Oct;176(4 Pt 1):1534-8; discussion 1538-9 (Anderson RU, Wise D, Sawyer T, Chan C.)
  24. ^ Cornel EB et al (2005). "The effect of biofeedback physical therapy in men with Chronic Pelvic Pain Syndrome Type III.". Eur Urol. 47 (5). 
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  28. ^ "...treatment duration should be long enough (more than 3 months)"Yang G et al (2006). "The effect of alpha-adrenergic antagonists in chronic prostatitis/chronic pelvic pain syndrome: a meta-analysis of randomized controlled trials.". J Androl. 27 (6). 
  29. ^ Shoskes, DA et al (1999). "Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial.". Urology. 54 (6). 
  30. ^ Suzuki T, et al (1992). "[Clinical effect of Cernilton in chronic prostatitis]". Hinyokika Kiyo. 38 (4). 
  31. ^ Yan, H et al (2004). "[Efficacy of Prostat in the treatment of NIH category IIIA prostatitis]". Zhonghua Nan Ke Xue. 10 (12). 
  32. ^ Elist J (2006). "Effects of pollen extract preparation Prostat/Poltit on lower urinary tract symptoms in patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome: a randomized, double-blind, placebo-controlled study.". Urology 67 (1). 
  33. ^ Potts JM (2005). "Therapeutic options for chronic prostatitis/chronic pelvic pain syndrome.". Curr Urol Rep. 6 (4). 
  34. ^ "Several inflammatory and reactive alterations of sperm quality seem to be proven; nevertheless, the impact of these findings on male fertility remains in many cases unclear."Weidner W, et al (1999). "Relevance of male accessory gland infection for subsequent fertility with special focus on prostatitis.". Hum Reprod Update. 5 (5). 
  35. ^ "The ratio of free-to-total PSA is significantly different in PCa and NIH category IV prostatitis." Effect of NIH-IV prostatitis on free and free-to-total PSA Eur Urol. 2004 Dec;46(6):760-4. (Stancik I et al)

For the Manfred Mann album, see 2006 (album). ... December 9 is the 343rd day (344th in leap years) of the year in the Gregorian calendar. ... For the Manfred Mann album, see 2006 (album). ... December 9 is the 343rd day (344th in leap years) of the year in the Gregorian calendar. ... For the Manfred Mann album, see 2006 (album). ... December 9 is the 343rd day (344th in leap years) of the year in the Gregorian calendar. ... For the Manfred Mann album, see 2006 (album). ... December 11 is the 345th day (346th in leap years) of the year in the Gregorian calendar. ...

See also

Pelvic myoneuropathy is a new term given to the most common form of non-bacterial pelvic pain experienced by men. ... Quercetin is a flavonoid that forms the backbone for many other flavonoids, including the citrus flavonoids rutin, hesperidin, naringin and tangeritin. ... It has been suggested that this article or section be merged into Alternative medicine. ... Molecular structure of flavone The term flavonoid refers to a class of plant secondary metabolites based around a phenylbenzopyrone structure. ... Anti-inflammatory refers to the property of a substance or treatment that reduces inflammation. ... This article or section needs to be wikified. ... Binomial name Serenoa repens Hooker Saw Palmetto, Serenoa repens, is the sole species currently classified in the genus Serenoa. ... Genera Many; see list of Arecaceae genera Arecaceae (sometimes known by the names Palmae or Palmaceae, although the latter name is taxonomically invalid. ... A Hupa man. ... The urinary system is the organ system that produces, stores, and eliminates urine. ... The reproductive system is the ensembles and interactions of organs and/or substances within an organism that strictly pertain to reproduction. ... Interstitial cystitis (commonly abbreviated to IC) is a urinary bladder disease of unknown cause characterised by urinary frequency (as often as every 10 minutes), urgency, pressure and/or pain in the bladder and/or pelvis. ...

External links


  Results from FactBites:
 
Prostate Cancer Causes, Diagnosis, Information, Symptoms, Treatment, Signs, on MedicineNet.com (900 words)
Prostate cancer is a malignant tumor made up of cells from the prostate gland.
Prostate cancer is a malignant (cancerous) tumor (growth) that consists of cells from the prostate gland.
Thus, prostate cancer is the most common malignancy in American men and the second leading cause of deaths from cancer, after lung cancer.
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