Microsoft word - prostatitis_literature.doc

CHRONIC NON-BACTERIAL
PROSTATITIS AND
THERMAL THERAPY
LITERATURE
Third International Chronic Prostatitis Network
Transrectal thermotherapy of chronic prostatitis
H. Ljungnér

Assistant Professor and Private Practitioner, Halmstad Sweden
Transrectal thermotherapy (TRT) is an effective way to improve prostatitis of a chronic nature.
Its mode of action is not clear but probably works to increase the local blood flow through the
prostatic gland and pelvic muscle area. During Jan. 1990 to Dec. 1999, 2685 men (age 16-61
years) were treated at least two times (range 3-119 treatments). 485 men had to be treated
more than two times.
The equipment was manufrval was 12
minutes at a temperature of +41°C (+106° F) and the interval periods varied between one
week to four weeks. The treatment was performed without any sedation/ anaesthesic. Prior to
the treatment antibiotic Norfloxacin 500 mg x2 was orally given during 10 days. Transrectal
prostatic massage was performed. Carcinoma of the prostatic gland was excluded testing
PSA.
Results
95% of the material were satisfied/cured by this treatment.
Conclusion
TRT is an effective and safe alternative way to treat chronical prostatitis and furthermore, to
prevent recurrency of this disease when used as a prophylactic manner. And most of the
patients did not have the need of any more antibiotic treatment.
J Urol. 1996 Jun;155(6):1950-4; discussion 1954-5. Transurethral microwave thermotherapy for nonbacterial
prostatitis: a randomized double-blind sham controlled study
using new prostatitis specific assessment questionnaires.

Queens University, Kingston General Hospital, Ontario, Canada.
PURPOSE: We investigated the effectiveness and durability of transurethral
microwave thermotherapy in the treatment of chronic nonbacterial prostatitis
using 2 new prostatitis specific assessments in a randomized, double-blind,
sham controlled trial. MATERIALS AND METHODS: Patients with
nonbacterial prostatitis were randomly assigned to receive either transurethral
microwave thermotherapy or sham therapy. Patients were assessed using a
symptom severity index and symptom frequency questionnaire. These 2 new
prostatitis symptom assessment tools were validated by applying them to 30
similar patients without prostatitis. All nonresponders received transurethral
microwave thermotherapy at 3 months and were reassessed at 6 months. Long-
term followup of the responder group averaged 21 months. RESULTS: The
symptom severity index and symptom frequency questionnaire were
confirmed to be valid for symptom assessment in prostatitis patients. The
transurethral microwave thermotherapy group benefited from therapy
compared to the sham group. Of the sham group 50% had a favorable response
after subsequent transurethral microwave thermotherapy. The 7 responders in
the treatment group continued to improve during the subsequent 21 months.
CONCLUSIONS: Transurethral microwave thermotherapy appears to be an
effective, safe and durable treatment for some patients with nonbacterial
prostatitis unresponsive to traditional therapy.
Publication Types:
• Clinical Trial • Randomized Controlled Trial
Clinical experience with transurethral microwave thermotherapy
for chronic nonbacterial prostatitis and prostatodynia.

Department of Urology, HanGang Sacred Heart Hospital, School of Medicine,
Hallym University, Seoul, Korea.
Chronic prostatitis and prostatodynia are troublesome disorders that are not
responsive to any kind of treatment. Patients with treatment-resistant chronic
nonbacterial prostatitis (n = 61) or prostatodynia (n = 17) for longer than 3
years underwent a single 1-hour session of transurethral microwave
thermotherapy (TUMT) using the Prostatron. Complete symptom
disappearance was obtained in 23% of patients and a partial response in 43%.
Of the patients with prostatitis, 46% showed normalization and 31% an
improvement of the leukocyte count in expressed prostatic secretion. In
patients with prostatodynia, the corresponding figures were 35% and 41%.
Most complications were temporary, but there was one case of epididymitis
and one of reduction in the volume of the ejaculate. TUMT is well tolerated
and safe, and it is effective in relieving the symptoms of many patients with
nonbacterial prostatitis or prostatodynia. The possible adverse effects on
fertility and urinary continence require further study.
Transurethral Microwave Thermotherapy for Nonbacterial Prostatitis: A
Randomized Double-Blind Sham Controlled Study Using New Prostatitis
Specific Assessment Questionnaires.
Journal of Urology. 155(6):1950-1954, June 1996.
Nickel, J. Curtis; Sorensen, Ron
Abstract:
Purpose: We investigated the effectiveness and durability of transurethral
microwave thermotherapy in the treatment of chronic nonbacterial prostatitis
using 2 new prostatitis specific assessments in a randomized, double-blind,
sham controlled trial.
Materials and Methods: Patients with nonbacterial prostatitis were randomly assigned to receive either transurethral microwave thermotherapy or sham therapy. Patients were assessed using a symptom severity index and symptom frequency questionnaire. These 2 new prostatitis symptom assessment tools were validated by applying them to 30 similar patients without prostatitis. All nonresponders received transurethral microwave thermotherapy at 3 months and were reassessed at 6 months. Long-term followup of the responder group averaged 21 months. Results: The symptom severity index and symptom frequency questionnaire were confirmed to be valid for symptom assessment in prostatitis patients. The transurethral microwave thermotherapy group benefited from therapy compared to the sham group. Of the sham group 50 percent had a favorable response after subsequent transurethral microwave thermotherapy. The 7 responders in the treatment group continued to improve during the subsequent 21 months. Conclusions: Transurethral microwave thermotherapy appears to be an effective, safe and durable treatment for some patients with nonbacterial prostatitis unresponsive to traditional therapy. Cooled transurethral microwave thermotherapy for intractable
chronic prostatitis--results of a pilot study after 1 year.
Kastner C, Hochreiter W, Huidobro C, Cabezas J, Miller P.
East Surrey Hospital, Redhill, United Kingdom.
OBJECTIVES: To evaluate the side effects, tolerability, and efficacy of
transurethral microwave thermotherapy with urethral cooling (cooled TUMT)
for chronic prostatitis/chronic pelvic pain syndrome in a prospective feasibility
trial. Cooled TUMT, using the Targis system from Urologix, is an established
treatment option for benign prostatic hyperplasia (BPH) with minimal side
effects. METHODS: Patients with intractable chronic prostatitis/chronic pelvic
pain syndrome and symptoms for more than 3 of the 6 months before
treatment (National Institutes of Health-Chronic Prostatitis Symptom Index
[NIH-CPSI] pain score of at least 8) were randomized to cooled TUMT at an
intraprostatic temperature of either approximately 55 degrees C or
approximately 70 degrees C. Tolerability, side effects, and efficacy were
measured with standard diagnostic tests, including the NIH-CPSI. Subgroup
analysis was performed to evaluate the effects with and without BPH
comorbidity. RESULTS: A total of 42 patients were included in the study; 39
patients successfully completed treatment and 35 completed follow-up through
12 months. The baseline versus 12-month mean NIH-CPSI score was total
score 23.4 +/- 6.4 versus 11.5 +/- 10.2 (improvement in mean value of 51%),
pain score 11.5 +/- 2.8 versus 4.6 +/- 4.9 (improvement in mean value of
60%), quality-of-life impact score 7.2 +/- 2.9 versus 3.8 +/- 3.8 (improvement
in mean value of 47%; all P <0.0001), and urinary score 4.7 +/- 2.8 versus 3.1
+/- 3.0 (improvement in mean value of 34%; P = 0.0079). Treatment
discomfort was within the ranges reported for patients with Targis-treated
BPH. Two patients had reduced sperm motility. Side effects were minimal and
transient, resolved spontaneously or with medication, and were similar
regardless of treatment temperature or BPH comorbidity. CONCLUSIONS:
Cooled TUMT appears to be promising for intractable chronic prostatitis with
or without BPH. Longer follow-up and a larger trial are required to evaluate
the fertility impact and longer term durability further.
Publication Types:
• Clinical Trial • Randomized Controlled Trial
[Transrectal microwave hyperthermia in the treatment of chronic
prostatitis]
[Article in Russian]
Sokolov AV.
The efficacy of transrectal microwave hyperthermia (TMH) was investigated
in 124 patients aged 20 to 55 years. Of them, 75 (60.5%) patients had chronic
noninfectious and 49 (39.5%) patients infectious prostatitis. In addition to
standard pre- and posttreatment examinations the following tests were made:
bacteriological and biochemical tests of prostatic secretion, uroflowmetry,
transrectal color Dopplerographic mapping. The course of the treatment
included 10 one-hour sessions of microwave hyperthermia, drug therapy and
prostatic massage. Patients with both forms of chronic prostatitis exhibited
disorders of prostatic circulation, activated lipid peroxidation, low
concentration of catalase in the organ secretion, defective urodynamics of the
lower urinary tracts. More pronounced changes occurred in noninfectious
process. Microwave hyperthermia produced clinical improvement, recovery of
hemodynamics in the prostate, structure and function of cell membranes in
prostatic secretion, positive response of urodynamics. Thus, TMH generated
on domestic equipment can be considered as one of the methods of
pathogenetically sound treatment of noninfectious and infectious chronic
prostatitis.

Chronic prostatitis/chronic pelvic pain syndrome in elderly men:
toward better understanding and treatment.
Pontari MA.
Department of Urology, Temple University School of Medicine, Philadelphia,
Pennsylvania 19140, USA.
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most
common of the prostatitis syndromes. It is characterised by pelvic pain, with
or without voiding symptoms. CP/CPPS accounts for 2 million office visits in
the US alone. Recent epidemiological studies have shown that CP/CPPS can
affect men at any age, including those in their 80s. The aetiology is unknown
but proposals include infectious, autoimmune, neurologic and psychiatric
causes. Men with CP/CPPS are much more likely to have had a past medical
history of cardiovascular, neurologic, psychiatric or infectious disease
(particularly sinusitis) as compared with asymptomatic individuals. Although
leucocytes are commonly found in the prostatic fluid of these men, they do not
correlate with the symptoms.The clinical evaluation now includes a validated,
self administered symptom score, the National Institutes of Health Chronic
Prostatitis Symptom Index (NIH-CPSI), which was designed as an outcome
measure for treatment trials. This can aid in diagnosis and follow-up of
patients' response to therapy.Treatment for CP/CPPS is empiric and limited by
a lack of randomised, placebo-controlled clinical trials. Antimicrobials are
commonly used to treat the symptoms of CP/CPPS. However, the finding that
asymptomatic men have equal or greater numbers of bacteria which localise to
the prostatic fluid, compared with men with CP/CPPS, has raised doubts about
the contribution of infection to the symptoms. Other commonly used drugs
include alpha-adrenoceptor antagonists, anti-inflammatory drugs, tricyclic
antidepressants and anticholinergic agents. The adverse effects of these
medications are a concern in older men with CP/CPPS. Other therapies
available include minimally invasive procedures such as microwave
thermotherapy and transurethral needle ablation, and now neuromodulation
devices.Although much progress has been made, particularly in the last 7
years, considerable work still remains to be done to determine the aetiology
and pathogenesis of CP/CPPS, and to develop mechanism based therapy that
is shown to be effective in controlled trials.

[Treatment of external RF hyperthermia combining with alpha 1-
adrenergic receptor blocker for patients with prostatodynia and
chronic non-bacterial prostatitis]
[Article in Chinese]
Wang J, Li J, Lu R, Wang JM.
Department of Urology, People's First Hospital of Yuxi, Yuxi, Yunnan
653100, China.
OBJECTIVES: To evaluate a new effective treatment for prostatodynia (PD)
and chronic non-bacterial prostatitis (CNP). METHODS: One hundred and
thirty-six patients suffered from PD or CNP were divided randomly into
experiment group (n = 76), which were treated with external RF hyperthermia
(ERFH) combining with alpha 1-adrenergic receptor blocker Terazosin for 12
weeks, and control group (n = 60), which were only treated with ERFH.
Symptoms scores, urodynamic indexes and expressed prostate secretion were
recorded pre- and post-treatments. RESULTS: MFR and AFR were
significantly improved and symptoms scores significantly decreased in both
groups (P < 0.05). The efficacy was better in experiment group than that in
control group. The combination treatment also led to a significantly decrease
in MUP and MUCP (P < 0.05). Additionally, the leucocytes in expressed
prostate secretion were also reduced in experiment group (P < 0.05).
CONCLUSIONS: Treatment of ERFH combining with alpha 1-adrenergic
receptor blocker for patients with PD or CNP was effective and had little side-
effect, while the future curative effect should be observed furtherly.
Publication Types:
• Clinical Trial • Randomized Controlled Trial Cochrane Database Syst Rev. 2001;(1):CD002080. Interventions for chronic abacterial prostatitis.
McNaughton C, Mac Donald R, Wilt T.
General Medicine Unit, Massachusetts General Hospital, 50 Staniford
Street, 9th Floor, Boston, Massachusetts 02114, USA.
mmcnaughtoncollins@partners.org
BACKGROUND: Chronic abacterial prostatitis is a common disabling
but enigmatic condition with a symptom complex of pelvic area pain
and lower urinary tract symptoms. The scope of treatments
recommended for chronic abacterial prostatitis is a testament to how
little is known about what causes the condition and how to treat it. As a
result, chronic abacterial prostatitis often causes physician frustration,
patient confusion and dissatisfaction, variable thresholds for referral,
and potentially inappropriate antibiotic use. OBJECTIVES: Examine
the evidence regarding the effectiveness of therapies for chronic
abacterial prostatitis. SEARCH STRATEGY: Studies were identified
through a search of MEDLINE (1966-2000), the Cochrane Library,
bibliographies of identified articles and reviews, and contact with an
expert. SELECTION CRITERIA: Studies were eligible if they: (1) are
randomized controlled trials (RCTs) or controlled clinical trials (CCTs)
(2) involve men with chronic abacterial prostatitis (3) control group
receives placebo, sham intervention, active pharmacologic or device
therapy for chronic abacterial prostatitis and (4) outcomes data are
provided. Eligibility was assessed by at least two independent
observers. DATA COLLECTION AND ANALYSIS: Study
information on patients, interventions, and outcomes was extracted
independently by 2 reviewers. The main outcome was the efficacy of
treatment for chronic abacterial prostatitis vs. control in improving
urologic symptom scale scores or global report of urinary tract
symptoms. Secondary outcomes included changes in the prostate
examination, uroflowmetry, urodynamics, analysis of urine, expressed
prostatic secretions and seminal fluid, and prostate ultrasonography.
MAIN RESULTS: The 15 treatment trials involved: medications used
to treat benign prostatic hyperplasia (n=4 trials); anti-inflammatory
medications (n=2 trials); antibiotics (n=1 trial); thermotherapy (n=5
trials); and miscellaneous medications (n=3 trials). The disparity
between studies did not permit quantitative analysis. There were a total
of 600 enrollees (age range 38-45). All but one of the trials were done
outside the United States. REVIEWER'S CONCLUSIONS: The
treatment trials are few, weak methodologically, and involve small
sample sizes. The routine use of antibiotics and alpha blockers for
chronic abacterial prostatitis is not supported by the existing evidence.
The small studies examining thermal therapy appear to demonstrate benefit of clinical significance and merit further evaluation. Additional treatment trials are required and they should report important patient characteristics (e.g., race), study design details and utilize clinically relevant and validated assessment measures.

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