Prostatitis Q&A with Professor Richard Hindley


IS DIFFERENT MEDICATION NOW BEING PRESCRIBED? 

RH: 'I would say amongst the urologists I work with and reading the literature. Arguably a newer option than five years ago would be to look at drugs like Cialis - the drugs normally given to improve erections.

'The theory is that they improve blood flow to the penis but actually they may also improve blood flow to the prostate as well.

'It's not in the British National Formulary that we would give Cialis to men with prostatitis but an increasing number of urologists faced with patients - that are often just looking for help - are desperate to try and give them something.'


THE LINK BETWEEN BENIGN PROSTATIC HYPERPLASIA (BPH) AND PROSTATITIS 

RH: 'BPH and prostatitis in my view are very intertwined. I see men with BPH symptoms that have some symptoms that may suggest prostatitis. But, you know, what's going on inside the prostate is still ill-understood.'

CHANGES IN TREATMENT 

RH: 'Over the past decade what's made the biggest difference to me, in my routine clinical practice, it would be that there is some evidence that an extended course of antibiotics out to six weeks helps. Before that, I'd been giving up to four weeks.

'The first port of call is tamsulosin - an alpha-blocker for some possible obstructive element - and antibiotics for their antibacterial and anti-inflammatory effect.

'The thing that is so frustrating is that what will work for one person won't work for another. When you go on the internet one person will say I had garlic capsules and it definitely worked for me. They'd made this link with the garlic capsules and it's probably something else.'


THE UPOINT CLASSIFICATION 

RH: 'It was around five years ago I discovered the UPOINT system. I've always felt that prostatitis needs a bespoke treatment tailored to the needs and symptom complex of each individual patient.

'This UPOINT system asks you what is the patient troubled with? Is it urinary symptoms? Is it psycho-social? Is it very organ-specific? Is it that they've got skeletal-muscle issues and tenderness? Have they got referred pain and neurological symptoms? Or are they getting symptoms that sound very much like they're infection dominating?

'Of the different domains, which ones apply most to this individual? I try and address each one of the components by throwing everything I can at it whether it's medication for the bladdercounselling or antidepressants or behavioural therapy for the psycho-sexual side of things, stress reduction, or getting a pain specialist involved for the neurological type symptoms.

'If I see a man in his 30s, 40s or 50s with vague symptoms in the pelvic area it's almost always prostatitis until proven otherwise. I think some of my colleagues, more generally, miss the queries that some of our patients give us and [prostatitis] can manifest in so many different ways.

'You chase after the symptoms and try and make them better but also try to get to the root cause of it which is the most difficult part.'


CAUSES

RH: 'It's got to either be infection, trauma, allergy or drugs I guess. What's happening within that prostatic environment?

'Some men with urethral stricture get prostatitis and the theory there is that you've got downstream obstruction to the flow and you might get some concentrated urine refluxing up into the ejaculatory duct causes a chemical injury to the prostate glandAnd if you deal with that stricture then it's less likely to be prostatitis flare-ups in the future.'


PROSTATIC MASSAGE 

RH: 'I think the data on prostatic massage isn't that impressive but I still have a low threshold for offering it to men. I will certainly go for antibiotics initially.'


AWARENESS 

RH: 'Awareness of BPH gets prostatitis sufferers coming out of the woodwork as well. The prevalence of prostatitis is huge. I think the literature says 3 to 9 per cent. For me, as a urologist, I almost wonder if all men have an element of prostatitis but it's often subclinical. Symptoms are so mild that you dismiss them and describe them as something else and they are so fleeting. But in others, they are far more severe.

'Sadly, as urologists and health specialists we don't have all the answers and that's depressing and frustrating. And men are understandably driven to go onto blogs and chatlines and exchange ideas. It can be quite scary going off onto the internet for the first time with these sort of symptoms but equally, it can be helpful if you're picking the right places to go.

'I think there is more awareness. We've all got our phone and social media and it's so easy to Google everything. There aren't any major breakthroughs. We do need to have more articles about it. There is an increased awareness among the public about it but we can do better on that front.'

Published on October 10, 2020


RELEVANT LINKS:
👉 Prostatic massage interview with Dr Julian Shah

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