So, switching it up a little bit. We've been talking about radiation,
but now going into surgery. So, if a man has symptomatic prostatitis
and he goes and gets surgery, would that just relieve all the issues?
It is a consideration. So, I am no fan of surgery for prostate cancer. The best surgeons
still leave 5-10% of men incontinent; men get something called climacturia where they ejaculate
urine 20% of the time; and other problems: greater risk of erectile dysfunction and whatnot. But,
it is true that some men who have very troublesome inflamed chronically
prostates, if they have their prostate removed surgically, that those symptoms can improve,
and if they get through the operation and they're not incontinent and they're not ejaculating urine,
they could be better off in terms of their quality of life and their symptoms.
So, there's this thing called chronic pelvic pain. Can you explain what that is,
and then also, how many men are getting this after surgery?
Well, some men have it before surgery. So, chronic pelvic pain is really very much in line with this
whole idea of an inflamed prostate, prostatitis, and it is not a very well understood entity,
just like prostatitis isn't very well understood. You mentioned it occurring after surgery. Well,
anytime someone has a knife put to their body and has a body part removed, inevitably, the surgeon
is going to have to cut some nerves. Most of the time, those nerves heal fine, but unfortunately,
sometimes the nerves don't heal fine and maybe 5% of the time, people will be left with chronic
ongoing, unremitting pain from the operation which no one really knows how to fix. So, I'd say it's
maybe 1 in 20 patients or 1 in 30 patients has unfortunate chronic pain issues after undergoing
prostate surgery and actually, it's true for many surgeries, not just prostate surgery.
We've talked about surgery; we've talked about radiation, now going into hormone therapy.
So, how is—basically—how effective is hormone therapy for a man who has symptomatic prostatitis?
Well, it's a big price to pay, of course. When we talk about hormone therapy we're usually thinking
about Lupron. There's a much milder form of hormone therapy called finasteride or dutasteride,
those are the generic names for Proscar and Avodart, and they only block dihydrotestosterone
which is the testosterone that's in the prostate, so they have less tragic side effects than, say,
Lupron does. Lupron which takes away your libido and slows your metabolism and causes muscle
wasting. All kinds of really big issues. To answer your question, we don't think of the stronger
Lupron treatments as a way to treat prostatitis. It's just overkill, but we do think of
finasteride, dutasteride, Avodart, Proscar, those medicines, as a potential therapy for inflamed
prostates because sometimes the inflammation may be. related to the nature of what the prostate
does which it makes sort of a sugary fluid for the sperm to swim in, and finasteride and Avodart shut
down the production of that fluid, and some men will have notable improvement in their prostatitis
type symptoms. Not everybody, but some do. The problem is that a minority of men that take
finasteride and Avodart can also lose their libido. Maybe 20-25% of men. It's reversible when
the pill is stopped if it is stopped in a timely fashion, but people need to be warned about that,
and again, may come at too high a price to fix urinary symptoms but flatline the libido.
I know one question I got on Helpline is I had a patient call and they were concerned
that they had a urologist where they were going for prostatitis and they got prostate cancer,
and they saw a medical oncologist. They were wondering, did they need
to see both doctors or is the medical oncologist trained also
to deal with the prostatitis and take all those issues into consideration.
Most are not. We, since we specialize in prostate cancer, are sort of unique. We see a large volume
of men with these prostate-related issues, and certainly, we're qualified to deal with it,
but your average medical oncologist is seeing people with very advanced prostate cancer
and they would naturally think about referring these kinds of issues to a urologist.
So, next we're going into supplements in food. Is there anything that a man
should be eating or not eating to help with symptomatic prostatitis?
Yeah, people oftentimes discover for themselves that certain dietary patterns are better or worse
and it seems like there are some stress-related
components. People. talk about asthma or their eczema getting worse when they are under stress,
and men will also talk about their prostatitis symptoms getting worse when they are under stress.
Eating refined sugars and, you know, high-fat diets, these sorts of things in some men
will definitely make their prostatitis symptoms worse. So, it's not like there is any black and
white prescription you can lay out, but we do know for sure that there is some connection between
excess stress and, you know, a refined sugar diet that exacerbates prostatitis symptoms.
Are there any other lifestyle changes, like will exercise or anything affect it?
Well, I can't point to any specific study, but it seems like exercise is beneficial for almost
everything, and it certainly does reduce stress. People that exercise regularly feel more robust
and healthy and happy, and the stresses of life relatively speaking are diminished
compared to the person who is unwilling to exercise.
My last question is in regard to imaging and will basically any form of prostatitis affect
the image quality or affect basically the reading of how that will play out?
Yes. You can see prostatitis as non-specific changes on multiparametric MRI and on color
doppler. The trained physicians that are reading these scans
all the time don't really have much difficulty making a distinction, but
there are a lot of people who are still in their learning curve with these imaging modalities and
could potentially confuse prostatitis changes seen on imaging as something that might be cancerous,
but the properly trained physicians aren't likely to make that mistake.