Something I'd like to address is, a lot of the YouTube comments we get, people see blood
in the urine, they have, you know, urinary issues, and a lot of times because they don't
know that prostate cancer doesn't have any symptoms, they immediately jump to prostate
cancer because they see blood and obviously that's alarming. So, can we talk about, for
a second, the common symptoms that we'd have with prostatitis and how that's not prostate
cancer?
Yeah, so, what was distinct in the story that I shared was that this individual had what
we call chronic prostatitis and he didn't have any symptoms. So, just a high PSA. But,
men that feel something—we call that acute prostatitis and they can have blood in their
urine, they can feel feverish, they can have pain in their pelvic region, discomfort with
sexual activity, all these things, and oftentimes that's a bacterial infection and it will respond
to anti-biotics and improve and then the PSA levels will drop once the acute prostatitis
is passed. So, the confusing thing is that a lot men that have acute prostatitis can
also have chronic prostatitis and they can also have, of course, low-grade prostate cancers
all mixed and we're trying to use PSA to sort all of this out and PSA just doesn't have
the horsepower to make that distinction. It just goes up with any problem—it's not specific
for cancer or prostatitis. And the acute prostatitis you're talking about is a known entity that
urologists are familiar PSAs run high for a while, but then they come down afterwards
when you give a course of anti-biotics.
So, we've covered the symptoms. Now, in those treatments, how long do they take and are
they really effective? What's the fear of maybe the, you know, the prostatitis coming
back? Is this a chronic thing that they're going to have to be doing?
You may have to take anti-biotics for three, four, six weeks sometimes to get rid of acute
prostatitis. It's a difficult thing to erradicate and then it does tend to come back again and
it often will turn into a chronic prostatitis situation. We don't have easy good solutions.
I use antibiotics now in my practice a lot less frequently because you may solve a short
term problem, get the PSA down, but then it's right back again after a year or two. So,
more symptomatic things, saw-palmetto, anti-inflammatories like Aleve or Advil and just patience waiting
for it to kind of run its course and calm down on its own. Otherwise, these men can
be on and off antibiotics all the time.
So, I know you're mainly prostate cancer, but since you're checking PSAs, I would imagine
that you're seeing a lot of men with acute prostatitis. So, how do you handle those men?
These are people that have symptoms—feel sick—and usually they go on antibiotics
and those antibiotics are effective in most cases. There are some men that have antibiotic
resitant prostatitis and it can be a very debilitating condition. Dr. Duke Bahn who
perhaps many of our listeners have heard of, a specialist, an interventional radiologist
that does color doppler ultrasound for prostate cancer and prostate prostatitis has actually
developed an injection of antibiotics and cortisone that he puts in the prostate in
these men with these really difficult prostatitis illnesses. So, that is a backup plan. It's
not widely available. I'm not aware of anyone else in the United States that's doing that,
but some men have really challenging acute prostatitis situations and it's nice to know
that there's someone out there who has a backup plan if the standard antibiotics aren't working.
So, the antibiotics you're talking about are like Cipro or Levaquin, anything in that category?
uh-huh, yeah. The Septra, there's a whole list of antibiotics, but when you hear of
antibiotics for prostatitis Cipro and Levaquin are the most popular.
What type of side effects would those antibiotics have? Do they have any and anything that patients
with maybe prostate cancer need to be aware of?
Well, Cipro and Levaquin are of a concern because they can cause weakening of the Achilles
tendon. I've used a substantial amount of these antibiotics and haven't really seen
that problem, but when you look in the warnings, that is possible for people even to develop
a rupture of their Achilles tendon which is a very serious injury, so we're always hesitatant
to use these antibiotics unnecessarily, and then when they're used for longer and longer
periods, it's probably that the risks of tendon problems would go up. So, apart from that,
all antibiotics can mess up the flora of your intestines and cause diarrhea, but otherwise,
they're pretty well tolerated.
Is there anything a patient can do to mitigate the side effect with the Achilles tendon?
No, it's just a matter of luck of the draw and physicians need to be careful not to overuse
these medicines unless they're really really necessary.
And with the injection from Dr. Bahn, what success have you seen with those patients
getting that injection?
Excellent. He's developed a national reputation for the treatment of prostatitis and thankfully
that type of resitant prostatitis is farly rare, but some men completely incapaciated
by constant pain from the infection in their prostate and I'd say he has been very successful
in helping 3 out of 4 patients who go to see him who get these injections and they get
notable relief.
And do they have any side effects?
No, no, it's a very safe injection.
Thanks for watching. If you would like more information about anything we spoke about
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