Chronic Prostatitis: Treatment Options and Expert Opinions

Q: Chronic Prostatitis: Treatment Options and Expert Opinions

Hello： 1. According to Dr. B, the medication prescribed by Dr. A is for symptomatic treatment, and the idea that long-term use is necessary to achieve therapeutic levels is something I have never heard before. I am aware that long-term use of non-steroidal ant

Treatment options for chronic prostatitis?

Hello, doctor.
I have a troubling issue I would like to consult you about.
Initially, my symptoms included 3-4 episodes of nocturia.
After treatment, my current symptoms are as follows: mild burning and itching sensation in the urethra, pain and itching in the groin area, and nocturia (1-2 times).
The level of discomfort is currently tolerable, but during times of increased discomfort, I still seek medical attention.
So far, all diagnoses have been chronic prostatitis.
The examinations I have undergone include urinalysis and digital rectal examination.
Recently, I consulted two doctors, but their opinions were completely different, so I would like to ask you:
Doctor A said that this condition can be completely cured, and there are two options: 1.
Continuous medication for 3-6 months is necessary, and even if there is improvement, one should not stop the medication arbitrarily, as the medication may not effectively reach the prostate.
Therefore, it is essential to maintain a certain concentration of the drug in the bloodstream for it to work (Tamsulosin capsules once daily, and non-steroidal anti-inflammatory drug potassium-coated tablets 25 mg three times daily).
2.
Extracorporeal shock wave therapy may completely cure this condition after a certain course of treatment, but the cost is relatively high.

Doctor B stated that this condition is recurrent and difficult to treat, and that symptom management should only be employed during severe episodes, which may include medication or extracorporeal shock wave therapy.
The cause of this condition is unclear, and a complete cure is unlikely.
One can only adjust their lifestyle and mindset to keep symptoms within an acceptable range.
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This summarizes my current situation.
Based on my own medical visits and research, most sources indicate that this condition is prone to recurrence, so I am mentally prepared for that.
However, Doctor A's assertion that it can be cured makes me want to try, although I have some doubts.
Therefore, I would like to ask a few questions:
1.
The medications prescribed by Doctor A are considered symptomatic treatment according to Doctor B, and the idea of needing long-term use to achieve a therapeutic concentration is something I have not heard before.
I know that long-term use of non-steroidal anti-inflammatory drugs may burden the kidneys; hence, I only take them when symptoms are more pronounced.
I am concerned that if I diligently take these medications for six months and still experience a recurrence after stopping, it would feel futile.
Can you tell me if long-term use of these two medications truly has the potential to cure this condition (prevent recurrence)?
2.
There is a significant difference in the opinions of the two doctors regarding extracorporeal shock wave therapy.
Since the out-of-pocket cost is quite high, I would like to know your perspective on whether extracorporeal shock wave therapy is merely symptomatic treatment or if it can actually provide a cure.
3.
I have a habit of drinking unsweetened tea.
During my medical consultations, some doctors believe it is acceptable to drink tea, while others suggest reducing or avoiding it.
I have changed this habit during the process, but after several months without improvement, I returned to my old habit.
Can you advise if drinking tea is a contributing factor to this condition or if it affects the symptoms?

shu, 30~39 year old female. Ask Date: 2021/07/15

Dr. Li Minghui reply Urology

Hello:
1.
According to Dr.
B, the medication prescribed by Dr.
A is for symptomatic treatment, and the idea that long-term use is necessary to achieve therapeutic levels is something I have never heard before.
I am aware that long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) may impose a burden on the kidneys; therefore, I usually take them only when symptoms are more pronounced.
I am concerned that if I diligently take the medication for six months and then stop, the symptoms may recur, making the effort seem futile.
I would like to ask the physician if long-term use of these two medications truly has the potential to cure this condition (i.e., prevent recurrence)? --> Clinically, it is possible to see improvement in symptoms or significant relief, but it is difficult to predict who will definitely improve and who will not.
Some patients take medication long-term, while others only come for medication when their symptoms are more bothersome; it largely depends on the individual patient.
2.
There is a significant difference in opinions between the two physicians regarding extracorporeal shock wave therapy.
Since the out-of-pocket cost is quite high, I would like to ask the physician whether, in their opinion, extracorporeal shock wave therapy is merely symptomatic treatment or if it can be a curative therapy? --> Without experience, I cannot make a judgment.
3.
I have a habit of drinking unsweetened tea.
During my medical visits, some physicians believe it is acceptable to drink tea, while others advise reducing or avoiding it.
I have changed this habit during the process, but after several months without improvement, I returned to my old habit.
I would like to ask the physician if drinking tea is a contributing factor to this condition or if it has any impact on the symptoms? --> For prostatitis, I do not recommend consuming beverages; you may refer to http://www.shutien.org.tw/dr_doc_detail.aspx?bookid=801.

Wishing you good health.

Reply Date: 2021/07/15

More Info

Chronic prostatitis, particularly chronic pelvic pain syndrome (CPPS), is a complex condition that can significantly impact a patient's quality of life. Your symptoms, including urinary urgency, discomfort in the groin, and urethral burning, are common among those diagnosed with chronic prostatitis. The variability in opinions from different physicians regarding treatment options can be confusing, so let's delve into your questions and provide some clarity.

1. Long-term Medication Use and Potential for Cure: The medications prescribed by Dr. A, such as Tamsulosin and non-steroidal anti-inflammatory drugs (NSAIDs), are indeed aimed at managing symptoms rather than curing the underlying condition. While some patients report improvement with long-term use, it is essential to understand that chronic prostatitis often has a multifactorial etiology, including psychological, neurological, and inflammatory components. Therefore, while these medications can help manage symptoms, they may not necessarily lead to a complete resolution of the condition. The concern about potential kidney damage from long-term NSAID use is valid, and it is crucial to have regular follow-ups with your healthcare provider to monitor kidney function and overall health.

2. Extracorporeal Shock Wave Therapy (ESWT): The effectiveness of ESWT in treating chronic prostatitis is still a topic of ongoing research. Some studies suggest that it can provide symptom relief, but the evidence for it being a definitive cure is limited. Dr. A's assertion that it can lead to a complete cure may be optimistic, as many patients experience only temporary relief. The cost of this treatment is a significant consideration, and if you are contemplating this option, it would be wise to weigh the potential benefits against the financial burden and the lack of guaranteed results.

3. Impact of Tea Consumption: Regarding your habit of drinking unsweetened tea, there is no direct evidence linking tea consumption to the exacerbation of prostatitis symptoms. However, caffeine and certain compounds in tea can irritate the bladder in some individuals, potentially worsening urinary symptoms. If you notice that your symptoms worsen after consuming tea, it may be worth reducing your intake. On the other hand, staying hydrated is essential, so consider balancing your fluid intake with water and other non-irritating beverages.

In summary, chronic prostatitis is a challenging condition that often requires a multifaceted approach to management. While medications can help alleviate symptoms, they may not provide a permanent solution. Shock wave therapy may offer some relief, but its effectiveness as a cure is not well established. Lifestyle modifications, including dietary changes and stress management, can also play a crucial role in managing symptoms. It is essential to maintain open communication with your healthcare providers, discuss your concerns, and explore all available options to find a management plan that works best for you. Regular follow-ups and possibly consulting a specialist in chronic pain or urology may provide additional insights and treatment options tailored to your specific situation.

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