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Q: Prostate cancer & prostatitis
asked by: DoctorQuestion on January 24th, 2007
Doctor Question
Two years ago I was hospitalized for several days with a severe abdominal bacterial infection. Afterwards I had pain in the lower abdominal area that lasted well over a year. As the symptoms improved I began to notice that I had pain in my genitals and just above them behind the pubic bone. I was diagnosed with a prostate infection and given antibiotics (Biaxin). The pain began to subside several days after starting the antibiotics, but returned about three weeks later (while still taking the drugs). I switched to a different antibiotic (Cipro), and the same thing happened: the pain began to subside, only to return 3-4 weeks into the treatment. With my third antibiotic (Levaquin) the same thing happened again, only more quickly: 3 days after beginning the pain was much better; a couple days later it was back. A fourth antibiotic (Doxycycline) did nothing, and I discontinued its use after about ten days. So, after almost three months of antibiotic treatment I was back where I started.
I began to pursue alternative treatments, including supplements, acupuncture, and homeopathy. This seemed helpful, as at one point my symptoms were gone for about three weeks. But then they returned again.
The pain is improved with rest, restorative yoga, and becomes more intense with stress and exertion. It is still located behind the pubic bone, and I sometimes also feel it in my testicles. I do not have any urination problems, no discharge. Seminal discharge seems low. I had a PSA screening (0.93), and several digital rectal exams by a urologist and other MDs, and nothing was found to be abnormal. Occasionally I feel slightly feverish, and often depleted of energy.

So, after all these months and all these treatments, I still live with chronic pain in the prostate area.

What else can I do?

Thank you.


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DoctorAnswer replied on January 29th, 2007
Doctor Answer
Urinary & Bladder Disorders Answer A2219
According to the symptoms you report (pain behind the pubic bone in the last 3 months), you could be experiencing chronic inflammation of the prostate (chronic prostatitis). A major symptom of chronic prostatitis is pain. Other symptoms could include frequent urination, slow urination, impotency ,or premature ejaculation. An occasional fever and lack of energy (weakness) can be also present during prostatitis.
Discharge from the urethra, prostate and seminal vesicles, sperm and urine can be examined microbiologically to isolate a possible infective agent, if there is one present. 50% of all cases of chronic prostatitis, however, show no evidence of infection. In these cases, a rectal examination often shows a normal prostate.
Antibiotics are not always helpful, but treatment of prostatitis usually begins with them. Massaging the prostate twice a week over a period of six weeks can be very useful. In case of recurrence, a surgical intervention can be performed during which a surgeon can complete a transurethral resection or a subtotal prostate removal.
You can consult a urologist for an expert opinion.



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