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Information and Online Resources

Arnon_Krongrad_MD — Mon, 24 Oct 2011 23:51:41 GMT

We are developing a directory on a site run by Dr. Krongrad of web sites, social networks, articles, and videos related to chronic prostatitis and prostate cancer. You are invited to have a look.

Copyright, The Krongrad Institute

Laparoscopic Prostatectomy for Severely Symptomatic, Treatment-Refractory Chronic Prostatitis

Arnon_Krongrad_MD — Tue, 03 May 2011 13:52:00 GMT

Many cases of chronic prostatitis can be impossible to remedy. New findings suggest that laparoscopic prostatectomy may cure even some of the most severe and treatment-refractory cases.

A study newly published in UroToday International Journal shares preliminary observations from an ongoing clinical trial. Looking at what may be the most severely symptomatic and treatment-refractory cohort described in the scientific literature, the trial seeks to quantify symptomatic changes after minimally invasive, laparoscopic prostate removal.

In brief, in this initial cohort, there was a uniform reduction of symptoms as measured by the Chronic Prostatitis Symptom Index (range 0-43). On average, the CPSI score dropped from 35 before surgery to 7.5 by one year after surgery. The findings may be seen in the context of other commonly suggested treatments for chronic prostatitis, which are reviewed in the paper.

Click here to download a copy of the manuscript.

An Update About Trigger Point (Myofascial) Release and Paradoxical Relaxation for Chronic Prostatitis

Arnon_Krongrad_MD — Mon, 21 Feb 2011 19:23:00 GMT

A new report relating to trigger point (myofascial) release is coming out in the Journal of Urology that provides an update on an ongoing study. The study appears to be the only one of its kind.

Trigger Point Release for Chronic Prostatitis to read some of the details.

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Finasteride Prevents Prostate Bacterial Infection

Arnon_Krongrad_MD — Tue, 08 Feb 2011 17:22:00 GMT

The 5-alpha reductase inhibitor finasteride is commonly prescribed as a treatment for benign prostate hyperplasia. Does it have a role in the treatment of prostatitis?

Using a rat experimental model, researchers in Korea have tested if pretreatment with finasteride, ciprofloxacin, or finasteride plus ciprofloxacin could have an effect on the prostates of rats infected with Escherichia coli:

Relative to control, the finasteride group showed less infection and inflammatory infiltration.
The addition of ciprofloxacin antibiotic further enhanced the preventive effect of the finasteride.

As the authors note, the mechanism of action of finasteride is not known. We do know that finasteride can cause atrophy of the prostatic epithelium (lining), so presumably any preventive effect is somehow mediated by epithelial cell death. In any event, the effect begs the question of whether or not men would take finasteride -- which carries some risk and inconvenience -- for the prevention of bacterial prostatitis; this seems generally unlikely.

The data suggest that finasteride does not have much of a role in the treatment of chronic pelvic pain syndrome. The new observations do ask if finasterideis a useful treatment and/or adjunct to antibiotic treatment of bacterial prostatitis.

Copyright, The Krongrad Institute

Acute Prostatitis Sidelines Cyclist

Arnon_Krongrad_MD — Mon, 17 Jan 2011 18:15:00 GMT

It's no news for patients with acute prostatitis: You cannot ride a bicycle when you have perineal pain. But apparently it's news to the cycling world.

French cycling star Cyril Dessel has been temporarily sidlined by what the media are alternatively describing as acute prostatitis and acute urinary tract infection. Based upon reports in the lay press, this appears to be a first-of-kind, acute episode, which means that Mr. Dessel has a very good chance of making a quick and complete recovery. We wish him just that.

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How Durable is the Effect of Surgery for Prostatitis?

Arnon_Krongrad_MD — Mon, 03 Jan 2011 19:30:00 GMT

Many treatments for prostatitis are associated with short-duration symptomatic effect. How long does the effect of surgery last?

Treatment choice is driven by the degree to which a treatment reduces symptom severity. Given that many treatment, e.g. massage, can confer transient relief, patients considering treatments of any kind need to also consider the durability of treatment.

As described by individual patients, laparoscopic prostatectomy has completely eliminated prostatitis symptoms. How long can the effect endure?

The durability of the therapeutic effect of laparoscopic prostatectomy on prostatitis symptoms is not well characterized. However, individual reports show that this effect can last beyond 2 years. One should note that few prostatitis treatments have been in any way measured 2 years after initiation. As such, these reports of a therapeutic effect with surgery are among the longest measures of any treatment for prostatitis.

Here are relatively long-term individual reports of the effect of surgery on prostatitis symptoms:

1) 18 months after surgery

2) 24 months after surgery

3) 30 months after surgery (video by David Radford; upper right video)

Copyright, The Krongrad Institute

Does Winter Cause Prostatitis?

Arnon_Krongrad_MD — Thu, 28 Oct 2010 15:17:00 GMT

There are reasonably good data to show that environmental forces can cause prostatitis. What about the weather?

The Baltic Times, which focuses its coverage on Latvia, Lithuania, and Estonia, has run an article on its web site listing an array of seasonal illnesses ranging from psychosis to osteochondrosis. Along with this listing, it provides tips of diet and its role in disease prevention.

Among the various ailments, the article lists bladder inflammation, urethral inflammation, and prostatitis as consequences of cold wind, wet snow, wet feet, and lack of physical movement such as resulting from working in a sedentary environment. So the inquiring scientist, who does not reject clues potentially relevant to the epidemiology of prostatitis, asks: Are there any data to support this contention?

Copyright, The Krongrad Institute

Looking at Photographs of Romantic Partners Can Reduce Pain. So can Listing Sports That Do Not Use a Ball.

Arnon_Krongrad_MD — Sat, 16 Oct 2010 22:48:00 GMT

Nonspecific mind-body interventions are frequently invoked as a remedy for pain. Can your romantic partner be that nonspecific mind-body intervention?

Researchers at Stanford University have published a study that has the lay press all abuzz with the proclamation that love conquers all, even pain. But this is not exactly what the study found.

The study relied upon 15 college students -- 7 men and 8 women -- who self-reported themselves to be in head-over-heels romantic partnerships. Each student was asked to bring in photographs of his/her romantic partner. Each was also asked to supply a photo of an equally attractive acquaintance.

Investigators then caused pain to each of the study subjects while:

Exposing them to photographs of their romantic partners
Exposing them to photographs of the other attractive person
Asking them to list sports that do not use a ball

Exposure to photographs of romantic partner and the sports-list distraction attenuated the intensity of pain; exposure to photographs of other attractive acquaintances had no effect on pain sensation. Functional MRI, which looks at activity in the brain, showed that the brain centers active in exposure to photographs of romantic partners and in doing a distracting sports list are not the same.

The study suggests mechanisms by which attenuate the pain inflicted by scientists. It does not prove, however, that these mechanisms are universally effective. For example, what if your romantic partner is the source of your pain? Would looking at a photograph of your romantic partner be useful? Somehow, one gets the sense that it would only accentuate the pain.

Likewise, the study provides no evidence that such mechanisms would be effective in real-world and especially chronic pain conditions. Would looking at photographs of your romantic partner help to diminish the chronic pain of prostatitis?

The study is useful in the context of ongoing research and in illustrating that pain is a complex phenomenon, with its attenuation apparently mediated by different neural circuits. As for clinical application, given the relative safety of looking at photographs of romantic partners and listing sports that do not use a ball, there seems to be little risk in trying them.

As for the media, we await the day when the headlines faithfully represent science.

Pseudomonas Prostatitis Causing Fever of Unknown Origin

Arnon_Krongrad_MD — Fri, 15 Oct 2010 05:30:00 GMT

We generally think of bacterial prostatitis as an immediately recognizable illness of troubling symptoms. It turns out that this is not always the case.

A case report just published in next month's Clinical Nuclear Medicine details the story of a 45-year old man in Taiwan who presented to his doctors with fever of unknown origin (FUO). Upon testing with a PET CAT scan, he was found to have activity in the rear of his prostate, on both sides.

A blood test showed that he had a high prostate-specific antigen (PSA) and his urine grew Pseudomonas bacteria after a vigorous massaging of his prostate. A trans-rectal prostate biopsy showed inflammation. The patient was treated with Ciprofloxacin antibiotics and his fever resolved. His urinalysis and PSA then normalized.

Lesson learned: Prostatitis, as defined here by inflammatory cells, high PSA, and infected urine, does not always require diagnostic symptoms. Actually, it's rather remarkable that it took a PET scan to diagnose prostatitis, which ordinarily is a very symptomatic illness.

What is even more remarkable is that the doctors put a needle into a prostate of a man with fever and urine infection. There was a very real risk of causing sepsis and putting his life at risk. So this case ended well. But a word to the wise: If you have febrile prostatitis, be very cautious about accepting a needle put into it and definitely before you've been started on antibiotics.

Copyright, The Krongrad Institute

The Antifungal Vinclozolin Causes Prostatitis in Aging Rat Offspring

Arnon_Krongrad_MD — Mon, 11 Oct 2010 23:47:00 GMT

One ordinarily thinks of antibiotics as a remedy for prostatitis. Is it possible that some classes of antibiotics are actually one of the causes of prostatitis?

One of the more unusual forms of prostatitis is acute, fungal prostatitis. For example, blastomyces, a fungus commonly associated with dermatitis, can infect the prostate. As with bacterial infections, fungal infections are treated with antibiotics, albeit a different class from the one used to treat bacterial prostatitis. In other words, antibiotics are considered a treatment of prostatitis.

While it may seem totally ironic, it turns out that vinclozolin, an antifungal used principally in agricultural work, e.g. growing grapes, can cause profound changes in male sexual organs. Among these changes seen in the aging offspring of exposed laboratory rats are reduced anogenital distance and:

purulent prostatitis
hypospadias
seminal vesicle inflammation with atrophy
Leydig cell hyperplasia
accelerated vaginal opening (in female offspring)

The mechanism by which vinclozolin causes these changes appears to be hormone sensitive, in that testosterone supplementation blocks it. In any event, these experimental data illustrate that the triggering event in some forms of prostatitis may be chemical, not infectious.

They also demonstrate that the triggering event may not actually be a direct toxin applied to the prostate. Rather, it may be a toxic exposure applied to a parent.

We are not aware of any data to show that exposure to antifungals in humans leads to development of prostatitis in their aging offspring. Still, at the very least, the vinclozolin example illustrates that the search for the causes of prostatitis may benefit from a broadening to include chemical agents and an examination of parental exposures.

The Effect of Exercise on the Symptoms of Chronic Prostatitis

Arnon_Krongrad_MD — Sun, 10 Oct 2010 18:43:00 GMT

Interventions for chronic pain often include several modalities applied at the same time. What is the contribution to the aggregated therapeutic response of prostatitis symptoms of an exercise component?

Mind-body interventions such as tai chi include emotional and physical elements. More direct physical treatments for chronic pain can also include many components: Physical therapy with trigger point release, flexibility exercise, isometric strengthening, and the like. Some components of such multi-modality interventions are tolerated better than others. Thus, it becomes potentially useful to dissect out the relative contribution of each component to any perceived therapeutic effect.

The effect of exercise on the symptoms of chronic prostatitis is reviewed here.

Copyright, The Krongrad Institute

Patient Story: Prostatitis Surgery After Colon Resection

Arnon_Krongrad_MD — Wed, 06 Oct 2010 21:10:00 GMT

Many patients have other procedures before having laparoscopic prostatectomy for severe, treatment-resistant chronic prostatitis. One patient first had a colon resection.

Previous surgery changes anatomy, obscures lines of dissection, and causes scarring and artificial adherence. All this makes surgery more complicated for the surgeon and increases the risks for the patient.

Click here to read what happened when Peter went for prostatitis surgery after first having had a colon resection. See what happened after 30 years of symptoms and pain.

Copyright, The Krongrad Institute

Nerve Growth Factor in Prostatitis Secretions

Arnon_Krongrad_MD — Wed, 06 Oct 2010 16:48:00 GMT

Administration of antibodies to nerve growth factor has been associated with reduced pain in osteoarthritis. Is there possible relevance to chronic prostatitis?

Pain is mediated by nerve, which are affected by many variables. Among the best characterized is a protein known as nerve growth factor (NGF). A study just published in the British Journal of Urology shows that in patients with chronic prostatitis/chronic pelvic pain syndrome:

The concentrations of NGF are almost twice highter in patients and controls
The concentration of NGF was correlated with pain
The concentration of NGF did not vary with treatment
Treatment success did decrease the concentrations of NGF

The observation that high NGF concentrations is higher in prostatitis patients does not mean that NGF is involved in the mediation of pain. It could just as easily mean that high NGF is a marker of the prostatitis condition, perhaps a consequence of whatever caused the prostatitis in the first place. At the same time, this study does lay a theoretical groundwork to parallel what has been shown in osteoarthritis, in which antibodies to NGF brought symptom relief.

Copyright, The Krongrad Institute

Patient Story: Trigger Point Release, Epidural Injections, Spinal Cord Stimulator and More

Arnon_Krongrad_MD — Wed, 06 Oct 2010 15:01:00 GMT

To help communicate the experiences of patients who have had prostatitis surgery, this web site hosts patient self reports. A new prostatitis surgery story has been posted in which a patient describes his experiences with trigger point relerase, epidural injections, physical therapy, and even the use of a spinal cord stimulator.

Have a look at just how many doctors he saw. And the varying kinds of doctors that he saw. This is not uncommon for patients with treatment refractory chronic prostatitis.

Copyright, The Krongrad Institute

Osteoarthritis Pain Reduction With Tanezumab

Arnon_Krongrad_MD — Tue, 05 Oct 2010 20:32:00 GMT

Nerve growth factor, a protein that affects how nerve fibers function, is present in high concentrations in such chronic pain conditions as osteoarthritis and prostatitis. So what happens when patients receive drugs that target growth factor?

450 patients with osteoarthritis were treated with tanezumab, an antibody to nerve growth factor, or placebo. In short, the antibody significantly reduced pain and improved function. To read the results, which are available free of charge on the internet, click here.

We are not aware of any such study for the treatment of prostatitis pain. However, given the success of tanezumab with osteoarthritis, the principle has been proved and perhaps this study has opened the door to a new approach to the treatment of pain from chronic prostatitis, also.

Copyright, The Krongrad Institute

Public Awareness About Prostatitis

Arnon_Krongrad_MD — Tue, 05 Oct 2010 19:15:00 GMT

Diabetes has Mary Tyler Moore and prostate cancer has Pat Robertson. Who does prostatitis have?

The sad fact is that prostatitis, the bastard child of diseases, has no public awareness campaigns and no public face. For this reason, we are delighted to learn this morning that Improbable, a British theatre group, has decided to bring prostatitis into the limelight. With its debut next week of Panic (inspired by the Greek god Pan), the play brings up the sensitive subject of its artistic director's prostatitis.

Those of you who love avante garde theatre and/or prostatitis awareness are invited to buy tickets and attend. The play opens first at the Sydney Opera House in Australia.

Copyright, The Krongrad Institute

Chronic Pain Survey

Arnon_Krongrad_MD — Mon, 04 Oct 2010 21:36:00 GMT

Have you ever felt the need to communicate your experience with chronic pain and/or medical care? An online, anonymous survey now lets you do just that.

The physician-patient interface can leave patients frustrated. This at times seems especially true for patients with chronic illness for which no cure seems possible. Hoping to manage complex, subtle, and shifting symptoms that can leave them depressed and socially isolated, patients with chronic illness sometimes also have to carry the burden of unsympathetic friends, family members, and/or medical professionals.

Among the illnesses for which such complaints are common are the chronic pain conditions fibromyalgia, irritable bowel syndrome, and interstitial cystitis. For examples of failed communication, have a look at the videos posted on the Prostatitis Surgery home page.

Patients with chronic pain are being invited to share their experiences via a survey that does not ask them to identify themselves. The purpose of the survey, says its author Susan Bilheimer, is to help guide her research and to help express the level of need for understanding and help. According to her press release, the survey is being supported by the National Vulvodynia Association and the Interstitial Cystitis Association.

Anybody with an interest in participating may do so by clicking here.

Koalas Threatened by Chlamydia Epidemic

Arnon_Krongrad_MD — Thu, 30 Sep 2010 01:07:00 GMT

Chlamydia is a disease of humans and animals, too. Now comes word that chlamydia are spreading across Australia's koala prostates, causing infertility in the females, and threatening the species with extinction.

The existence of koala prostate chlamydia infection is not news. However, the phenomenon has now apparently reached epidemic proportions to a degree that threatens the furry marsupial with extinction within 30 years. Because there is no vaccine for chlamdia, veteranarians are working feverishly to develop a solution that will keep Australia's national symbol soundly sleeping in the trees.

We will bring you updates as they come in. Stay tuned.

Copyright, The Krongrad Institute

Pregabalin (Lyrica) Not Effective for Chronic Prostatitis

Arnon_Krongrad_MD — Wed, 29 Sep 2010 02:40:00 GMT

A new study published in the Archives of Internal Medicine showing that pregabalin (Lyrica) is no better than placebo in reducing the pain of chronic prostatitis. Click here to read a summary.

Copyright, The Krongrad Institute

Anonymous Video Posted on You Tube

Arnon_Krongrad_MD — Tue, 28 Sep 2010 18:25:00 GMT

Chronic pelvic pain syndrome is sometimes treated with pelvic trigger point release. An anonymous party has posted a video on You Tube reviewing his impressions of the approach.

Trigger point release has been studied scientifically, as reviewed on this page. The video, which does not advocate for a specific treatment, does imply that progress requires transparency and research. This video implicitly asks questions that it does not answer. Among them:

Does pelvic trigger point release help some patients? Which ones? By how much? What proportion of patients?
Are there treatments that are equal or better than pelvic trigger point release?

Patient experience and feedback are the basis of all treatments: There is no science or medicine without it. The producers of this video have given personal opinions and impressions. However, without knowing their identity and/or the perspectives of the people they are talking about, one is left unsure about their credentials, interests, and motivations. At the very least, there is an inescapable irony in what they are doing: Promoting transparency while concealing their numbers, histories, and identities.

At the end of the day, the only legitimate goal is to develop new knowledge that will help a patient achieve his health goal. The process of developing new knowledge is called research, which requires thought, effort, and tenacity. For research to work, there is no way around constructive bilateral communication, which cannot happen when the communicating parties hide behind veils of anonymity.

Copyright, The Krongrad Institute