The Prostate Gland And Prostatits! What Men Should Know

Prostatitis is a condition in which the prostate gland becomes inflamed. It can be caused by a bacterial infection, decreased immune function, or a reduction in muscle-related function.Prostatitis is a term that describes a group of disorders that have related symptoms.

Prevalence
According to the Professional Guide to Diseases, 9th ed., as many as 35% of men older than 50 have chronic prostatitis and about 50% of males will be diagnosed with prostatitis at some point during their lives. This high number of men with the condition results in an estimated 2 million outpatient visits per year made by men seeking treatment for prostatitis, according to the National Institutes of Health (NIH). Overall, prostatitis accounts for 25% of all office visits involving the genitourinary system by young and middle-aged men.

Types of Prostatitis
There are four types of prostatitis. Even though these different types share some similarities, they also have some differences.

• Acute bacterial prostatitis (category 1): Acute bacterial prostatitis is the least common and most serious type of prostatitis. The usual course of treatment is antibiotics.

• Chronic bacterial prostatitis (category 2): Chronic bacterial prostatitis can lasts for months and is associated with long-term complications also caused by bacterial infection. Long-term antibiotics is the typical course of treatment.

• Chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS) (category 3): This form of prostatitis is most common and the main focus of this article. For diagnosis, symptoms must be present for at least three months, and they tend to come and go. Like chronic bacterial prostatitis, experts do not know why men get this form of the disease. Some men have symptom relief without treatment while others require a variety of treatment options. In some cases, symptoms become unbearable and require surgery.

• Asymptomatic inflammatory prostatitis (category 4): Men who have this form of prostatitis typically have an elevated PSA (prostate-specific antigen) level and an inflamed prostate, but they don't have the classic symptoms of prostatitis. The standard treatment is a course of antibiotics, after which the PSA levels usually return to normal within four to six weeks.

Symptoms of CP/CPPS
Symptoms of chronic nonbacterial prostatitis are similar to those of acute and chronic bacterial prostatitis. The symptoms tend to come and go and include:

• Blood in the urine or semen
• A strong urge to urinate
• Difficulty starting the urinary stream
• A weak urinary stream once it starts
• Dribbling
• Frequent nighttime urination
• Pain and/or burning when you urinate
• Pain in the genital and pelvic area
• Pain when ejaculating
Although CP/CPPS is a non-definitive diagnosis, a combination of urinary dysfunction and pelvic pain has to be present for CP/CPPS to be ruled in.

For some men, symptoms of CP/CPPS improve over time without treatment. Others have chronic symptoms for a lifetime.

Diagnosis
Health care providers can use the following tools for diagnosing prostatitis:

• Chronic Prostatitis Symptom Index developed by the NIH (NIH-CPSI) – This questionnaire take 5 minutes to fill-out and explores the 3 most important domains of patients' experience: pain (location, frequency, and severity), voiding symptoms (obstructive and irritative), and, very important, impact on quality of life

• Digital rectal examination (DRE) – prostate may be tender or very painful

• Urinalysis and urine culture to rule out infections

• Physical Exam of the pelvic muscles
Note: PSA test is not of value and should not be taken, as it will likely be falsely elevated.

Why Conventional Medicines Fails in treating CP/CPPS

Chronic prostatitis (CP/ CPPS) is the most difficult type of prostatitis to treat and these are the patients who have failed conventional treatments. For CP /CPPS most doctors prescribe a list of medications from long-term antibiotics (which do not work because CPPS is not caused by bacteria) to BPH medications to other drugs to treat the symptoms of chronic prostatitis. Unwanted side effects from conventional treatments include Gastro-intestinal and sexual dysfunction.

The reason these treatments don't work is that CP/CPPS requires a whole-patient approach where the treatment begins outside the prostate. The naturopathic medical model is specifically applicable with this patient population.

Naturopathic Interventions
The naturopathic approach to treating CP/CPPS is to look at the patient's lifestyle factors of Food intolerances, Gastro-intestinal health, Trigger points in the pelvic area, hydration, supplements, intake of healthy fats, exercise, and stress factors.

Food Allergies and Comorbidities
A whole-person centered approach as suggested through diet, supplements, and lifestyle choices can help support the patient in overall health. Many men who have prostatitis also have other medical problems such as irritable bowel syndrome (IBS) and fibromyalgia. Many patients who have IBS have intestinal permeability or “leaky gut” which is caused by intolerance to certain foods or ingredients.

Standard food allergy test like the Antigen leukocyte antibody test (ALCAT) may be helpful in determining the culprit food. It is more accurate than standard allergy tests, such as radioallergosorbent (RAST) skin testing. Men who can identify which substances they are hypersensitive or allergic to may be able to significantly reduce their prostatitis symptoms.

An elimination diet is a less-expensive alternative to the ALCAT. An elimination diet involves removing certain foods or ingredients from the diet that one suspects are causing allergic reactions while keeping a food diary.

Omega-3 Fatty Acids
Omega-3 fatty acids can be useful due to it's anti-inflammatory benefits. Omega-3 fatty acids calm the inflammatory response and prevent tissue damage and swelling that lead to pain and illness, as in prostatitis.

Green Tea
Catechins in green tea can destroy certain bacteria and viruses and help manage prostatitis, as well as enhance the immune system and combat several forms of cancer, including prostate cancer. Although there are several different kinds of catechins, the most powerful is epigallocatechin gallate, EGCG.

In a rat model of chronic bacterial prostatitis, the animals were given placebo, catechins, the antibiotic ciprofloxacin, or catechins plus ciprofloxacin. The catechins group alone showed modest improvements in inflammation and bacterial growth compared with the placebo group, but the combination of catechins and ciprofloxacin demonstrated significant improvements when compared with placebo. (Lee 2005)

In a more recent study, researchers used rat models of chronic prostatitis and found that nanocatechins (catechins altered using nanotechnology) had more effective anti-inflammatory and antimicrobial effects on rat chronic prostatitis than “normal” catechins because the body was able to absorb them better. (Yoon 2010)

One caution MEN must know when choosing green tea is to watch the caffeine content. Caffeine is a diuretic and can stimulate the bladder, causing an urgent need to urinate. On average, one cup of green tea has 25 milligrams of caffeine, while black tea has nearly twice as much. When shopping for green tea, choose decaffeinated.

Natural remedies Men Can Consider
• Beta-sitosterol is a cholesterol-like substance derived from plants (phytosterol) that can be used to manage symptoms associated with prostatitis, such as urinary frequency, urinary urgency, and flow problems.

• Cranberry contains phytonutrients called proanthocyanidins (PACs), and more specifically A-type PACs, which are not found in other berries. A-type PACs help prevent bacteria from attaching themselves to the walls of the urinary tract, which in turn helps prevent the development of urinary tract infections. This quality makes cranberry helpful in managing the health of men with pelvic discomfort, which can include urinary urgency, urinary flow problems, and urinary frequency.

• Diindolylmethane (DIM) is a phytonutrient that is released in the body when gastric acid from the digestive process acts on indole-3-carbinol, the precursor to DIM. Research shows that DIM has the ability to promote and support metabolism of estrogen and related hormones by enhancing the

liver's ability to metabolize estrogen to a weaker factor called 2-hydroxyestrone, which helps protect prostate tissue from inflammation and cancer. DIM may also improve prostate function.

• Green tea contains potent antioxidants known as catechins, which have an ability to support prostatitis health, as was demonstrated in several animal studies. (Lee 2005; Yoon 2010)

• Pollen extracts (also known as Graminex or cernilton) have anti-inflammatory properties, and this feature has proven beneficial in helping patients with prostatitis. For example, 70 men who had chronic prostatitis/chronic pelvic pain syndrome were given cernilton while 69 men with the same condition received a placebo. After 12 weeks, the men who took cernilton reported significant improvements in their symptoms and quality of life and no severe side effects. (Wagenlehner 2009)

• Pygeum is a derivative from the Pygeum africanum tree whose long history of use as a folk cure for bladder problems has been joined by its use to manage prostatitis. Studies indicate that pygeum contains several compounds that make it a good candidate for prostatitis patients.

• Quercetin is a phytonutrient that reportedly “provides significant symptomatic improvement” in men who have chronic nonbacterial prostatitis/chronic pelvic pain syndrome. (Shoskes 1999) Other studies have also uncovered quercetin's anti-inflammatory and antioxidant properties.

• Saw palmetto has been used for centuries to manage prostate and urinary tract problems. And that tradition continues today. For men who have prostatitis, saw palmetto may offer relief from symptoms when combined with other ingredients.

• Stinging nettle root has anti-inflammatory and diuretic properties, which make it a good candidate for management of urinary tract and prostate health.

• Turmeric (Curcuma longa) is a perennial plant with anti-inflammatory abilities. The active ingredient in turmeric is curcumin, which has been shown to effectively manage chronic nonbacterial prostatitis. (Zhang 2010)

• Vitamin D has been shown to be helpful in relieving symptoms of another prostate condition, BPH, which suggests the vitamin may be useful in managing prostatitis as well.

• Vitamin E is a group of eight chemically related substances called tocopherols and tocotrienols. The anti-inflammatory abilities of one of the substances, gamma-tocopherol, may prove helpful in men who suffer with prostatitis.

• Zinc is a mineral found in large concentrations in the prostate gland. Researchers have found lower concentrations of zinc in men who have prostatitis than in healthy controls, indicating that zinc supplements may be recommended for men with prostatitis. (Gomez 2007)

Probiotics should be considered as long-term therapy. A recent report from South Central University in China suggested that probiotics may be a treatment option for men who have chronic prostatitis. The authors hypothesize that urethral bacteria may be a primary cause of chronic prostatitis and that widespread use of antibiotics may be contributing to the risk of developing this disease. Therefore they believe probiotics could be a viable treatment for chronic prostatitis. (Liu 2009) However, no clinical work has been done thus far to support this idea.

Other Helpful Natural Methods
Acupuncture

In one study, 89 men who had chronic prostatitis/chronic pelvic pain syndrome were randomly assigned to receive 20 sessions of real or sham acupuncture over 10 weeks. After the 10 weeks, the men who had received the real acupuncture experienced a 6-point or greater decline in their National Institutes of Health Chronic Prostatitis Symptom Index score (NIH-CPSI), compared with only 47% in the sham group. The men who received the real treatment also were 2.4 times more likely to enjoy sustained relief than those in the sham group. (Lee 2008)

Prostate Massage
The small sacks inside the prostate gland can become blocked and accumulate prostatic fluids, which are a breeding ground for microbes that can cause more inflammation and prostatitis. The fluids cause the prostate to become enlarged and irritate the nerves, and cause pain and tightness. Therapeutic prostate massage may milk out the accumulated fluids, open up the passages in the prostate, and allow the gland to shrink back to normal size.

Biofeedback
Biofeedback can help men improve relaxation and proper use of pelvic floor muscles.

Trigger point release
Myofascial trigger point release with relaxation training is based on the idea that chronic pelvic pain may be the result of instinctively trying to protect the genitals and pelvic area from harm by contracting the pelvic muscles. This instinct causes some people to continuously tighten their pelvic floor muscles, and over time chronic pain sets in. Myofascial trigger point release and relaxation involve a series of exercises to desensitize the trigger points of the pelvic muscles.

One of the most recent studies of this treatment approach involved 200 men who had suffered with type III prostatitis pain for an average of 4.8 years. The men participated in a series of 3-to-5-hour daily sessions that included pelvic floor exercises, self-treatment training, and paradoxical relaxation training for 6 days. The men were followed for a median of 6 months. Overall, 82% of the men reported an improvement in symptoms: 59% had a marked to moderate improvement, and 23% reported a slight improvement. Pain, urinary dysfunction, and quality of life showed significant improvement. (Anderson 2011)

Conclusion
In conclusion, the successful treatment of CP/CPPS requires a multi-modal approach. According to Dr Espinoza, A Naturopathic Urologist, In his clinical experience, short-term relief comes from some sort of physical therapy, ie. Acupuncture and trigger-point release coupled with a strong anti-inflammatory lifestyle that includes the above mentioned nutrients and stress management. Long-term benefits are acquired by healing the GI system and the continuation of an anti-inflammatory lifestyle and the application of stress management techniques.

Raphael Obu
Men's Health Foundation Ghana
Msc Prostate Cancer Care
Msc Radiotherapy & Oncology, Breast Cancer Radiotherapy Module

Sheffield Hallam University, UK
E-mail: [email protected]
Tel: 0541090045
Reference:
Natural Ways to Treat Prostatitis. DECEMBER, 1ST 2013 BY PROSTATE SUPPLEMENTS EDITOR