Prednisone for the Treatment of Severe CPP

[MastCells]

I'm pondering this question: If an IC patient has tried all available treatments with little success and is considering bladder removal or suicide to end the misery, would it really be such a bad thing to treat that patient with glucocorticoids as a last resort? I'm thinking no.

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J Urol. 2005 Mar;173(3):841-3; discussion 843.

Efficacy of prednisone for severe refractory ulcerative interstitial cystitis.

Soucy F, Gregoire M.

CHUQ-L'Hotel-Dieu de Quebec, Quebec, Canada.

PURPOSE: We know that bladder inflammation has been noted in some patients with interstitial cystitis (IC). Studies with corticotherapy were performed about 50 years ago. Since that time few studies have been done with corticotherapy. We evaluated the efficacy of prednisone in patients with chronic severe IC with Hunner's ulcers unresponsive to first line therapies. MATERIALS AND METHODS: A prospective study was performed on 14 patients with evidence of ulcerative IC between 1998 and 2003. The patients received 25 mg of prednisone daily for 1 to 2 months and the dose was then tapered to the minimum required for relief of symptoms. Efficacy was evaluated with the O'Leary symptom and problem index and a 6-point pain scale. RESULTS: Of the 14 patients 9 (64%) were still using prednisone at the end of the study with an average followup of 16 months. In these 9 patients a 38% reduction (p <0.005) in the total score of the O'Leary index was observed. Pain was decreased by 88% (p = 0.0001). There were 5 patients who dropped out of the study due to lack of improvement or side effects. Overall results for the whole cohort included a reduction of 22% (p <0.02) of the total score of O'Leary index and a 69% improvement in pain control (p <0.001). CONCLUSIONS: These results suggest that a trial of prednisone should be considered in patients with severe ulcerative IC otherwise unresponsive to conventional treatment. Improvement in pain control was particularly impressive in this group of patients.

PMID: 15711286 [PubMed - in process]

[webslave]

IF, and it's still an "if", IC has the same etiology as we suspect male chronic pelvic pain syndrome to have, then steroids are of the same limited value as intraprostatic steroid injections (Geurcini, Bahn etc) -- IOW, a stop-gap measure.

[MastCells]

IF, and it's still an "if", IC has the same etiology as we suspect male chronic pelvic pain syndrome to have, then steroids are of the same limited value as intraprostatic steroid injections (Geurcini, Bahn etc) -- IOW, a stop-gap measure.

If long-term oral steroid therapy saves a person from bladder removal or suicide, I would not consider that treatment "of limited value." There are, of course, many risks associated with oral steroid therapy, but at least it is not an invasive procedure such as intraprostatic injection that results in bleeding, scar tissue formation, increased pain, etc. At least there is a copious amount of data on the effects (good and bad) of oral steroid therapy. However, there haven't been any long-term (>6 months) studies done on the safety and efficacy of repeated intraprostatic injections. I am strongly against surgery and invasive procedures involving sharp instruments piercing the pelvis as a treatment of CPPS/IC. That is my position.

BTW, Dr. Guercini injects "cocktails" of various antibiotics into the prostates of men with PM in addition to steroids. AND, aside from steroids, Dr. Bahn (a radiologist) even injects a cocktail of antibiotics and ANTIFUNGALS into the prostates of men with CPPS/PM! I'm sorry, but Bahn's radical techniques are very different from oral prednisone therapy, which is well studied.

Excerpts from patients' newsgroup posts:

Subject: Had an intraprostatic injection yesterday.
"I just had sex and...horror: I squirted *pure blood*."
http://tinyurl.com/444n8

Subject: Is anybody ever pain free?
"Recently I was treated with intraprostatic injections which added pain in the tip of my penis and in the rectum to the mix. Good fun."
http://tinyurl.com/67ehv

Subject: Re: question for serious posters
"YES, and it's a very dangerous therapy. STAY AWAY!! I'm telling this to you, as I would say to my brother or to my best friend. I had an intraprostatic injection on April 2001 and I LOSE FOR EVER PENIS
SENSITIVITY. I had several months of ED 100% following the procedure. Now erection has improved but it is still weak and disturbed, because of the lack of sensitivity problem. Some days after the injection, I developed a very strong pain in the perineum, and it is still there. My penis is cold and very contracted, so contracted to seem "hard" even if it is not erected. No pleasure sensations during sex. During the injection, something went wrong, surely. My prostatitis increased a lot after the injection (after = immediately after, the days following the injection), and, likely, the pudendal nerves were damaged by the needle, and/or by the anhestetic, and/or by the injected fluids pressure. Nobody, till now, was able to help me, and I'm desperate. So: be careful with intraprostatic injections!!"
http://tinyurl.com/53vv5

Quotes from prestigious prostatitis researchers:

From Urologist J. Curtis Nickel, M.D.'s Textbook of Prostatitis:
"Transperineal biopsy as a route of injection is potentially extremely painful for the patient, anecdotally in the author's experience (unpublished data). Baert et al report haematuria and haemospermia lasting for some weeks after their therapy (27)..."


Subject: A Clarification and Disclaimer
Urologist Jordan Dimitrakov, M.D., Ph.D. wrote:
"For the record, I have always opposed intraprostatic
injections:
1) because I have found them ineffective in patients with CPPS
(categories IIIA and IIIB - I don't know about category II)
2) because there is no long-term follow-up on the patients that have
undergone that type of treatment
3) because they almost always aggravate the pain in chronic prostatitis / chronic pelvic pain syndrome patients"

and...

"In fact, patients report a worsening of their symptoms in every single case I have seen following injection therapy."
http://tinyurl.com/64n9y

[webslave]

But then we also have a few like our member James-D, who has had a great improvement from local immunosuppression via injections into the prostate.

I say that steroids are of "limited" value because they treat the symptoms, not the cause. Stop the steroids, & symptoms come back. You're back to square one.

[MastCells]

But then we also have a few like our member James-D, who has had a great improvement from local immunosuppression via injections into the prostate.

A few? Who else? And James-D is on multiple treatments including quercetin.

I say that steroids are of "limited" value because they treat the symptoms, not the cause.

The same could be said of any accredited quercetin product and Prelief.

[webslave]

James-D is on multiple treatments including quercetin.

I wasn't aware that he has taken quercetin for all these months.

The same could be said of any accredited quercetin product and Prelief.

Quite so, although in my case I experienced a permanent improvement after taking Quercetin, which may be as a result of the fact that the removal of prostatic inflammation by any accredited quercetin product allowed a "guarding" pelvic spasm to relax/resolve. If that's true, steroids can be seen as fulfilling the same role as Quercetin, and even Ultram should be included here then (that's a good flare breaker for some people too).

Interesting ... I guess I need to requalify this and say that anything that removes/subdues pelvic pain symptoms may help to resolve the actual root cause of the pelvic pain. That's why we recommend taking things like any accredited quercetin product IN ADDITION to pelvic trigger point work.

I still think steroids are a last resort though, only to be contemplated if you are one of those unlucky people not helped by all the other remedies we discuss here.

[MastCells]

I wasn't aware that he has taken quercetin for all these months.

I'm too tired to search his history, but despite the fact that he strongly believes the intraprostatic injections have alleviated his symptoms, I know he's been on multiple treatments while he's been receiving injections. Therefore, it's difficult to draw any conclusions from his one case. And I know he said he was on quercetin in at least one of his posts.

Quite so, although in my case I experienced a permanent improvement after taking Quercetin, which may be as a result of the fact that the removal of prostatic inflammation by any accredited quercetin product allowed a "guarding" pelvic spasm to relax/resolve. If that's true, steroids can be seen as fulfilling the same role as Quercetin, and even Ultram should be included here then (that's a good flare breaker for some people too).

I cannot disclose my source, but one urologist told me that the only time he was able to "cure" (permanently) a chronic prostatitis / chronic pelvic pain syndrome patient with medication alone, was with extended therapy with steroids (months worth). Of course, this was only ONE case, and I WOULD NOT ADVISE THE MEMBERS OF THIS FORUM TO GO OUT AND BUY PREDNISONE! It causes many nasty side effects (often permanent) and is quite dangerous if a physician is not monitoring its usage very carefully!

I still think steroids are a last resort though, only to be contemplated if you are one of those unlucky people not helped by all the other remedies we discuss here.

I agree completely.

[latte]

About a year into my chronic prostatitis / chronic pelvic pain syndrome I took 20mgs of prednisone for a few weeks. I think it helped quite a bit with the inflammation. I would say it improved my condition by 20-40%. These were oral steroids. I would not try the injections, sounds quite painful to be sticking needles in the prostate. The steroids did nothing for the associated pelvic pain but my prostate felt better.

[james-d]

Well - Since I was refrenced several times in this thread - I thought it appropriate to answer.

I have no way to know what elements of the "cocktail" defined my remission (stroid, abx, anti-fungal, xylocaine, etc.)

But - my remission is VERY REAL and very long lasting.

Yes my regimen includes querciatan, grape seed extract, and avodart as well as VERY LOW DOSE levaquin (83 mg now - 1/3 of a 250 mg pill).

I beleive that this treatment can be of great benefit to the "hard-core" afflicted.

Why not try it if all else has failed you (i.e. if you try Wise's approach and are still suffering - then why not? - the side effects are minimal and short lived)

Your ranting about the side effects are WAY OVERSTATED - take it from someone who has lived through it - I am not sure why you think they are that bad - granted - ANY MEDICAL procedure has risks - and this one DOES HAVE RISKS - but its all a balance about what you want and expect from your body.


And why would you bad mouth Dr. Bahn?

Read his web site - http://www.pioa.org/bahn.html

he is not some radical Dr. - just a guy treating prostate cancer - his treatment of prostatitis is a small sideline.

I have never met him - but he worked remotely with my urologist to develop my protocol and I am very greatful to him.


So - balance, choice, and above all - no one treatment works for everyone - so lets all please be tolerent of everyone's differences and treatment choices.

[webslave]

I think my objection to the intraprostatic injection protocol, James, is that it's a never-ending thing and not, therefore, the best choice. Our "ranting" about steroids had more to do with oral steroids, which really do have some very nasty side-effects.

By the way, how many injections have you had at this point, and how many more are planned?

[james-d]

I have "only" had to have two rounds of injections - but each round is a series of 5 injections at two week intervals. Each injection is actually several injection (each lobe of the prostate and each seminal vesicle).

And yes - it does hurt - but it is a minor and fleeeting pain compared to the CP pain that I endured prior to the injections.

I am "overdue" for a third round of injections.

What I mean by that - is that everyone (myself included) beleived that I would need another round by now - but I have not - and I am doing great!

Granted - I wouldn't tempt fate by going a week at work without my "pillow" but - I do feel damn near 100% in that area (granted I am older, fatter and in worse shape now - since I stopped basicily all acticvity when I first came down with this disease and now have two kids that require all my attention and this leaves no time for the gym....)

[MastCells]

I have no way to know what elements of the "cocktail" defined my remission (stroid, abx, anti-fungal, xylocaine, etc.)
<snip>
Yes my regimen includes querciatan, grape seed extract, and avodart as well as VERY LOW DOSE levaquin (83 mg now - 1/3 of a 250 mg pill).

As a scientist, I cannot conclude that the intraprostatic injections of (steroids, antifungals, antibiotics, lidocaine, "etc.") are the cause of your symptomatic improvement. Why? Because you were taking oral levofloxacin, quercetin, grape seed extract, dutasteride, et cetera, when you were receiving these two rounds of injections. Furthermore, as this post relates to the discussion between me and Mark, the injection of antifungals (which have anti-iflammatory properties), antibiotics (which have powerful anti-inflammatory properties), and lidocaine (which is an anesthetic) could account for your "remission," as opposed to the steroids. We have no clue what helped you.

Your ranting about the side effects are WAY OVERSTATED - take it from someone who has lived through it

Excuse me, sir, but your one experience with intraprostatic injections does not override the experiences of numerous other men whose pain was increased by intraprostatic injection.

[MastCells]

It should be noted that this [intraprostatic injections] is a rather unconventional way of treating prostatitis with unknown long term effects. I still encourage you to work with your physician. You should not pursue this method of treatment unless all of your other options are exhausted and you situation becomes desperate.

http://www.pioa.org/prostatits.html