Chronic Prostatitis: Treatment Options and Expert Opinions Explained

Q: Chronic Prostatitis: Treatment Options and Expert Opinions Explained

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 am hearing for the first time. I am aware that long-term use of non-steroid

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 for your insight:
Doctor A stated that this condition can be completely cured and presented two options: 1.
Continuous medication for 3-6 months is necessary, and even if there is improvement, one should not stop the medication abruptly, as the efficacy may not reach the prostate.
Therefore, the medication must achieve a certain concentration in the bloodstream to be effective (Tamsulosin capsules once daily, and non-steroidal anti-inflammatory drug coated tablets 25 mg three times daily).
2.
Extracorporeal shock wave therapy can completely cure this condition after a certain treatment course, although the cost is relatively high.

Doctor B, on the other hand, indicated 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, making complete cure unlikely.
Instead, one should adjust their lifestyle and mindset to keep symptoms within an acceptable range.
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 of a potential cure makes me want to try, yet I have some doubts.
Therefore, I would like to ask a few questions:
1.
According to Doctor B, the medications prescribed by Doctor A are for symptom management, and the idea of needing long-term use to achieve a therapeutic concentration is new to me.
I understand 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 take these medications seriously for six months and then stop, only to have the symptoms recur, it would feel like a wasted effort.
Is there a real possibility that long-term use of these two medications could completely 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 this 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 advise reducing or avoiding it.
I did change this habit for a few months, but after no improvement, I reverted to my old habit.
Can you advise whether drinking tea is a contributing factor to this condition or if it has any impact on the symptoms?

shu, 30~39 year old female. Ask Date: 2021/07/16

Dr. Du Shixi 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 am hearing for the first time.
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 return, making the effort seem futile.
I would like to ask the physician if there is a real possibility that long-term use of these two medications could lead to a cure (i.e., no recurrence of symptoms)? --> 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 medications long-term, while others only come for medication when their symptoms are bothersome, largely depending 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 costs are quite high, I would like to ask the physician whether, in their opinion, extracorporeal shock wave therapy is merely symptomatic treatment or if it has the potential to 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 suggest limiting or avoiding it.
I have changed this habit during the process, but after several months without improvement, I returned to my old habits.
I would like to ask the physician if drinking tea is a contributing factor to this condition or if it affects the symptoms? --> For prostatitis, I do not recommend consuming beverages; you can also refer to http://www.shutien.org.tw/dr_doc_detail.aspx?bookid=801.

Wishing you good health.

Reply Date: 2021/07/16

More Info

Chronic prostatitis, particularly non-bacterial prostatitis, is a complex condition that can significantly impact a patient's quality of life. The symptoms can vary widely, including pelvic pain, urinary frequency, urgency, and discomfort during urination. Given your situation, where you have experienced a range of symptoms and have consulted multiple physicians with differing opinions, it’s essential to clarify some key points regarding treatment options and management strategies.

1. Long-term Medication Use: The suggestion from Dr. A regarding the long-term use of medications like Tamsulosin and non-steroidal anti-inflammatory drugs (NSAIDs) is grounded in the understanding that chronic prostatitis can be a persistent condition. Tamsulosin, an alpha-blocker, can help relieve urinary symptoms by relaxing the muscles in the prostate and bladder neck, thus improving urine flow. However, it does not address the underlying inflammation or pain directly. The idea of maintaining a therapeutic level of medication in the bloodstream is valid, but it’s crucial to balance this with the potential side effects of long-term NSAID use, such as renal impairment and gastrointestinal issues. Therefore, while long-term medication may help manage symptoms, it does not guarantee a cure or prevent recurrence.

2. Extracorporeal Shock Wave Therapy (ESWT): The differing opinions on the efficacy of ESWT are not uncommon in the medical community. Some studies suggest that ESWT can provide symptomatic relief for chronic prostatitis, potentially by promoting blood flow and reducing inflammation. However, the evidence for its effectiveness as a definitive cure is still limited. It may be beneficial for symptom management, but whether it can lead to a complete resolution of the condition is still debated. If the cost is a concern, it might be worth discussing with your healthcare provider whether the potential benefits justify the expense in your specific case.

3. Dietary Considerations: Regarding your habit of drinking unsweetened tea, it’s important to note that dietary factors can influence prostatitis symptoms. Caffeine and certain compounds found in tea can irritate the bladder and exacerbate urinary symptoms in some individuals. However, unsweetened tea is generally considered less irritating than caffeinated beverages. If you have not noticed any correlation between your tea consumption and symptom exacerbation, it may be acceptable to continue. Nonetheless, maintaining a balanced diet, avoiding irritants (like caffeine, alcohol, and spicy foods), and staying hydrated are essential components of managing prostatitis.

In summary, chronic prostatitis is often a challenging condition to treat, and while some patients may experience significant relief with long-term medication or therapies like ESWT, others may find their symptoms persist or recur. It’s crucial to have open discussions with your healthcare providers about your treatment options, potential side effects, and the realistic expectations of each treatment modality. Lifestyle modifications, including dietary changes and stress management, can also play a vital role in symptom management. Ultimately, a personalized approach that considers your specific symptoms, lifestyle, and preferences will be the most effective strategy in managing chronic prostatitis.

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