Key Study Sept 2003

dshoskes · Post by **dshoskes** » Wed Aug 13, 2003 6:44 pm

J Urol. 2003 Sep;170(3):818-822.

Leukocytes And Bacteria In Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome Compared To Asymptomatic Controls.

Nickel JC, Alexander RB, Schaeffer AJ, Landis JR, Knauss JS, Propert KJ; CHRONIC PROSTATITIS COLLABORATIVE RESEARCH NETWORK STUDY GROUP.

PURPOSE Chronic prostatitis has been traditionally characterized by inflammation and/or infection of the prostate gland, objectively categorized by white blood cells and cultured bacteria in prostate specific specimens. We compared leukocyte counts and localization rates for bacterial cultures of segmented urine samples (VB1, VB2, VB3), expressed prostatic secretion (EPS) and semen in men diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) to men without pelvic pain (controls).

MATERIALS AND METHODS A total of 463 men enrolled in the National Institutes of Health Chronic Prostatitis Cohort study and 121 age matched men without urinary symptoms had leukocyte counts performed and 5-day bacterial cultures on specimens obtained from a standard 4-glass test (VB1, VB2, EPS, VB3) and semen. All risk factor comparisons between case and control analyses were tested using generalized Mantel-Haenszel methods, and multivariable models were developed using logistic regression methods, adjusting for clustering by clinical center within both methods.

RESULTS Men with CP/CPPS had statistically higher leukocyte counts in all segmented urine samples and EPS, but not in semen compared to asymptomatic control men. However, the control population also had a high prevalence of leukocytes. Of the men with CP/CPPS 50% and 32% had 5 or more, or 10 or more white blood cells (WBCs) per high power field, respectively, in EPS compared to 40% and 20% of the control population. Similarly, 32% and 14% of the patients with CP/CPPS had 5 or more, or 10 or more WBCs per high power field in VB3 compared to 19% and 11% in the control population. Localization of uropathogenic bacteria in EPS, VB3 and/or semen was similar in men with CP/CPPS (8.0%) and asymptomatic men (8.3%).

CONCLUSIONS Men with CP/CPPS have significantly higher leukocyte counts in all segmented urine samples and EPS but not in semen as compared to controls. There is no difference in rates of localization of bacterial cultures for men with CP/CPPS compared to control men. The high prevalence of WBCs and positive bacterial cultures in the asymptomatic control population raises questions about the clinical usefulness of the standard 4-glass test as a diagnostic tool in men with CP/CPPS.

tractor316 · Post by **tractor316** » Wed Aug 13, 2003 7:12 pm

Dr. or webslave what is a leukocytes and what does it do or indicate . Sorry I'm not very swift at this stuff .

Post by **webslave** » Wed Aug 13, 2003 7:34 pm

Well, for a start it vindicates everything I have been saying for years.

Other than that, it shows that more normal men have bacteria in their prostates and urine than men with CP/CPPS, so I guess the Tucson Prostatitis Clinic should start recruiting normal, healthy men off the streets in Arizona, with prostatitis no longer being a pre-requisite diagnosis. This presents The Prostatitis Foundation, the Felicianos in Manila, and Dr Polacheck with a wonderful business opportunity!

On a more serious note for them: I wonder about the legal ramifications of continuing to treat patients using their signature protocol, which is based on the assumption of ghostly, chimeric prostatic infection. Given that there is ample scientific proof now that their treatment paradigm is bul.., er, flawed, isn't it conceivable that their irate ex-patients may sue them with good cause?

Hopefully this study will bury Stamey's 4-glass test forever as a diagnostic tool for CPPS.

The study also implies that inflammation could be present anywhere in the GU tract (bladder, prostate, urethra etc) because of the unlocalized inflammatory findings. These findings are perfectly in keeping with a model that sees mast cell activity in epithelial and stromal tissues, near nerve endings, causing the widespread inflammation (in my opinion, that is).

tractor316 · Post by **tractor316** » Wed Aug 13, 2003 8:40 pm

Thanks , then in my humble opinion we can lay the bacteria theorey to rest.... and maybe convince more people to move in another direction . Thanks webslave .

MS · Post by MS » Wed Aug 13, 2003 8:41 pm

what is a leukocytes and what does it do or indicate

Leukocyte = white blood cells

see http://www.mult-sclerosis.org/leukocytes.html for general info.

Does this mean there should no longer be a distinction between inflammatory and noninflammatory (e.g. IIIA and IIIB) CPPS?

dshoskes · Post by **dshoskes** » Wed Aug 13, 2003 10:05 pm

There probably is relevance between inflammatory and non-inflammatory CPPS, it's just that counting white cells in EPS is probably not the correct way to make the distinction.

james-d · Post by **james-d** » Thu Aug 14, 2003 12:22 pm

While I fully agree that the use of antibiotics to treat CP may not be acomplishing the intended goal of eradicating bacteria - it does for many men (myself included) provide a measure of relief far greater then anti-inflamatories, bioflavinoids, and other treatment adjuncts.

I guess - I see no problem in usng an antibiotic for symptomatic relief if that relief is hard to get (or impossible to get) any other way.

Once all other therapies have been attempted - if antibiotics improve the quality of your life - for whatever the physiological reason - isn't that better then suffering in constant unending pain?

I fully understand the limitations and side effects of long term antibiotic therapy - but given the current treatment options - for some of us it is all that works at the moment.

I keep trying other therapies in hopes they will be as successful - but until then - I remain on my combo of antibiotics, quercitan, and assorted supplements that allow me to at least go to work and live a semi-normal life.

I guess I feel that there is a lot of bashing of antibiotics here - yet they obviously help some people - even if it is only transitory and symptomatic relief.

I make no claims to understand this condition - just that I beleive that for many of us - these antibiotics that are so hated here - do function in the role of a viable therapy.

Look at it this way - if I inveneted a new drug that provided symptomatic relief for people (the way levaquin does for many) that was not an antibiotic - but worked for some people - we would view it as a viable option - so why not view the use of selected antibiotics the same way - maybe thee is no infection - maybe it is some unknown mechanisim that is working inside the body that provides the relief - but untill there is a better treatment, medicine, or surgical option out there - lets at least admit that it has its place as a theraputic altrnitive for some.

As an aside - I am currently attempting a version of Dr. Bahn's injection therapy - if anyone is interested - I will post my progress under the "injection" heading. Next round is next week.

Post by **webslave** » Thu Aug 14, 2003 2:48 pm

Have you tried any neuromuscular therapy? Read the book "Headache in the Pelvis"?

Yet you are prepared to countenance >>this sort of problem<< before investigating alternatives?

james-d · Post by **james-d** » Thu Aug 14, 2003 3:27 pm

You misunderstand me.
I am discounting NO therapy.
I have looked into muscular causes/sollutions as well.
I have NOT yet gone to someone to try the Stanford/Wise-Anderson Protocol or whatever it may offically be called - but I am open to it.

I guess that is my point - be open to lots of things - whatever works for people - and for some of us - that means long term anti-biotics at the moment.

Yes - I have suffered tendon problems - I have found that large amounts of magnesium and calcium taken 8 hours after quinolones greatly reduces the problem with tendons.

There are several studies that show the quinolone induced tendon myopothy (sp?) mimicks magnesium deficiancy - so I experimented with magnesium supplements at 8 hour intervals after quinolone use and have found that it mitigates "most" of the tendon problems - but not all.

I am not advocating long term use of antibiotics - just acknowledging that they have a valid place in the protocol.

I will buy and read that book - did you find it helpful?

Post by **webslave** » Thu Aug 14, 2003 3:43 pm

I am virtually cured, James, just mild and occasional pain (usually from dietary indiscretion or too much sitting), so I have not gone heavily into the new neuromuscular therapies. I can only encourage you to investigate other therapies before continuing on long term antibiotics. We do not hate antibiotics here, by the way. They are very, very useful drugs. But we hate them being used as anti-inflammatories, with the twin downsides of potential bodily harm and bacterial resistance.

james-d · Post by **james-d** » Thu Aug 14, 2003 3:56 pm

I appreciate your input - and I believe I have investigated 95% of everything that the cp.com and this forum put forth.

I have not tried the anti-histimines yet - that is my next stop if the injections fail miserably.

I have found this site very useful - its where I learned about quercitan/Quercetin (helps a bunch!) and dougnut pillows (essential) and injections (trying them now) as well as other therapries. Its just that when I totally stop anti-biotics life becomes impossible to live (pain, fever, sweats, inflamation, etc).

Can I ask what elements of the protocols have you had the most success with?

Post by **webslave** » Thu Aug 14, 2003 4:07 pm

Removing stress from my life. Removing wheat from my diet. Stopping a career that involved 8-10 hours of tense sitting every day. Using Quercetin. Self massaging my deep pelvic muscles in the early days (thought I was massaging the prostate). A warm, dry climate. Antihistamines (Allegra + Zantac). Ester C and Calcium. More here:
https://www.ucpps.men/prostatitis-tips-things-that-help-and-hurt

Different things work for different people. You may need a totally different set of measures. Or maybe the Wise protocol will cure you with time! At least try it.