Managing Chronic Prostatitis: Concerns About Finasteride and Alternatives

Medication issues

I have been diagnosed with chronic prostatitis, and my doctor prescribed Finasteride 5 mg (Proscar) to take once daily.
After about a week of taking it, I am experiencing some bothersome side effects, including a decrease in libido and a less intense ejaculation.
I previously had a urine culture for bacteria, and I will need to wait another week for my follow-up appointment.
About a month ago, I found relief from pain through warm sitz baths and taking a bladder relaxant, but as I mentioned earlier, my sexual function has been affected.
If I stop taking the medication on my own, will it impact my treatment?
An ultrasound of my prostate showed some enlargement, and my doctor mentioned two reasons: inflammation and swelling, as well as my body type.
I am now worried that stopping this medication might affect my sexual function for some time before it recovers.
Are there any other medications that can reduce prostate size without causing sexual dysfunction as a side effect? Is it common to use medications for treating prostate enlargement in young patients with chronic prostatitis? Currently, I am taking antibiotics prophylactically for two weeks.
If my follow-up urine culture shows no bacteria, does that mean it is sterile and I do not need to continue taking antibiotics?
I have a few questions, and I appreciate your assistance.

Ziyouren, 30~39 year old female. Ask Date: 2013/08/26

Dr. Xu Weikai reply Urology

Hello,
1.
I have been taking Finasteride 5mg (Proscar) daily for about a week for chronic prostatitis, and I am experiencing some bothersome side effects, including a decrease in libido and a less intense orgasm.
Since I previously had a urine culture for bacteria and need to wait another week for a follow-up, I want to know if stopping the medication will affect my treatment.
All medications have side effects, and if you cannot tolerate them, it is certainly acceptable to stop the medication temporarily.
However, stopping pain medications may impact your treatment.
It is advisable to return to the clinic immediately after stopping the medication to discuss alternative options with your physician.
2.
An ultrasound of my prostate showed some enlargement, and the doctor mentioned two reasons: inflammation and swelling, and my body type.
I am now concerned that stopping this medication may affect my sexual function for some time before it recovers.
This medication does have such side effects.
3.
Are there any other medications that can reduce prostate size without causing sexual dysfunction as a side effect? There are many types of medications, but those that reduce prostate size typically have side effects.
Note: Sympathomimetic drugs can be used to manage prostate issues without sexual side effects.
4.
Is it common to use medications for benign prostatic hyperplasia (BPH) in younger patients with chronic prostatitis? Yes, it is quite common.
5.
I am currently on a two-week course of prophylactic antibiotics.
If my follow-up urine culture shows no bacteria, does that mean it is sterile and I do not need to continue antibiotics? This depends on clinical symptoms.
Sometimes antibiotics may need to be used for 4-12 weeks.
If you have further questions, feel free to ask for more discussion and research.
Online responses can only serve as a reference; it is essential to seek medical care at a healthcare facility when necessary.
Sincerely,
Director of Urology, Hsu Wei-Kai
Taitung Hospital, Department of Health, Executive Yuan

Reply Date: 2013/08/26

More Info

Chronic prostatitis is a complex condition that can significantly impact a patient's quality of life, particularly when it comes to symptoms such as pelvic pain, urinary frequency, and sexual dysfunction. In your case, you have been prescribed Finasteride (Proscar) to manage symptoms associated with prostate enlargement, which can be a contributing factor to chronic prostatitis. However, it seems you are experiencing side effects that are concerning you, particularly regarding sexual function.

Understanding Finasteride and Its Effects
Finasteride is a medication commonly used to treat benign prostatic hyperplasia (BPH) and male pattern baldness. It works by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), a hormone that contributes to prostate growth. While effective for many patients, Finasteride can have side effects, including decreased libido, erectile dysfunction, and issues with ejaculation. These side effects can be particularly distressing, especially if they affect your sexual health and overall well-being.

Concerns About Discontinuing Finasteride
If you have been on Finasteride for about a week and are experiencing troubling side effects, it is understandable that you might consider stopping the medication. However, it is crucial to consult your healthcare provider before making any changes to your medication regimen. Abruptly discontinuing Finasteride may not necessarily lead to immediate improvement in sexual function, and it could potentially affect your treatment plan for chronic prostatitis and prostate enlargement.

Alternatives to Finasteride
There are alternative medications that may help manage symptoms of chronic prostatitis and BPH without the same risk of sexual side effects. Alpha-blockers, such as Tamsulosin (Flomax) or Alfuzosin (Uroxatral), are often used to relax the muscles in the prostate and bladder neck, improving urinary flow and reducing symptoms without significantly impacting sexual function. Discussing these options with your urologist could provide you with a suitable alternative that aligns with your treatment goals.

Managing Chronic Prostatitis
Chronic prostatitis is often categorized into different types, with chronic pelvic pain syndrome (CPPS) being the most common. Treatment typically involves a combination of approaches, including:
1. Medications: In addition to Finasteride or alpha-blockers, non-steroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and discomfort. Antibiotics may be prescribed if there is evidence of bacterial infection, but in cases of non-bacterial prostatitis, they may not be effective.

2. Physical Therapy: Pelvic floor physical therapy can be beneficial for managing pelvic pain and improving muscle function.

3. Lifestyle Modifications: Dietary changes, such as reducing caffeine and alcohol intake, can help manage urinary symptoms. Regular exercise and stress management techniques, such as mindfulness or yoga, may also be beneficial.

4. Heat Therapy: Warm baths or sitz baths can provide relief from pelvic pain.

Follow-Up and Monitoring
Given that your urine culture has returned negative for bacteria, it may indicate that your condition is non-bacterial in nature. In such cases, the focus shifts to symptom management rather than antibiotic treatment. It is essential to maintain regular follow-ups with your urologist to monitor your condition and adjust your treatment plan as necessary.

Conclusion
In summary, while Finasteride can be effective for managing prostate enlargement, its side effects can be concerning, especially regarding sexual function. It is crucial to communicate openly with your healthcare provider about your experiences and concerns. Exploring alternative medications, such as alpha-blockers, and incorporating lifestyle modifications can help manage your symptoms effectively. Always consult your healthcare provider before making any changes to your medication regimen to ensure that you are making informed decisions about your health.

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