Therapy: introduction

Guidelines

The guidelines for therapy which we apply in cases of chronic prostatitis follow logically from what we have expounded in the preceding sections.

Prostatitis is ALMOST ALWAYS caused by microbes whether they are detected or not by standard laboratory procedures.
Evidence of Chlamydia, Mycoplasma, Human Papilloma Virus and herpes simplex virus is very hard to obtain in cultures or fresh samples of prostatic secretions. DNA amplification using PCR is more reliable.Anti-Chlamydia, anti-Mycoplasma, anti-HPV or anti-HSV antibodies are often found in blood samples.
In the course of prostatitis the content of prostatic secretions undergoes major modifications. It becomes alkaline and concentrations of zinc, a powerful anti-bacterial agent, are reduced.
During infection the prostate tries to circumscribe the infected area by surrounding it with a polysaccharide shield which cannot be penetrated by antibiotics that are administered systemically
Bacteria exist inside the infected, obstructed calculi and acini which cannot be reached by antibiotics and which become the source of recurrent infection.
In patients with long-term chronic prostatitis T-cells, which are reactive to normal prostatic protein, are frequently detected (Alexander, 1977). Levels of cytokines such as IL2,IL6 and TNF alpha in the sperm of these patients were much higher than normal, suggesting prostatitis may be, or may become, an utoimmune disease.
When prostatitis is caused or perpetuated by urethral-prostate reflux because of anatomical abnormalities (bladder neck sclerosis or urethral stenosis) these causes must be removed to ensure a complete cure. When the pelvic floor muscles are contracted chronically and are associated with inflammation of the pudendal nerve, besides the treatment for prostatitis,specific therapy is required.

The conclusion to these premises is as follows:

Using ultrasound to guide, therapy needs to be administered directly into the inflamed areas or inside any fibrous calcifications which may be present. Therapy is based on a cocktail of antibiotics with an acid pH, powerful anti-bacterial agents - because bacteria cause most prostatitis - and a strong anti-inflammatory agent like cortisone which reduces oedema in the canaliculi and acini, re-establishes the normal flow of prostatic secretions and inhibits any auto-immune process which may have been triggered. At the same time a long-lasting anaesthetic is injected into the pelvic floor to stop spasm of the elevator anus muscles.
The course of therapy I have just described is repeated three times at 3 to 10 day intervals.