Intraprostatic injections

[Federico Guercini MD PhD]

Dear friends,
I know I am fouling one's own nest, but I want present my opinions about the intraprostatic injections. In first I would clear the field about the permanent side effects of infiltrations: in our experience on thousand and thousand of shots, all over the world at the moment we have only one (the famous riccardo) or two patients with (indemonstrable!)definitive side effects. But, definitively this isn't the reason of this post. I would discuss about the possible reasons of the good effects of the therapy. As years went by I confirm my impression that the real effect of the intraprostatic injection is depending from the presence of the cortisone. I think that it breaks the vicious circle: infection(?)>>>subchronic inflammation>>>autoimmune response>>>>chronic inflammation>>>>autoimmune response. In my experience the first injection could be or not followed by improvement; the second usually does for a shorter or longer period; the third more and more. This is (in my idea) a therapeutic behaviour and not a occasional improvement.

[webslave]

I would agree that it seems sensible to ascribe any improvements gained from intraprostatic injections to cortisone.

My reservations about this form of treatment is that we are treating target tissues at the end of a long cascade of dysfunction, starting in the brain and spinal cord with stress and/or neuronal windup. A more permanent solution would seem to be a treatment plan that addresses the psychological and neuromuscular aspects primarily.

In other words, is this not a semi-surgical solution to a problem that is actually genetic, psychological, and neuromuscular?

As far as autoimmunity is concerned, we have no good proof that a true autoimmune reaction occurs in the prostate in CPPS. More likely we have a chronic mast cell degranulation effect caused by nerves, and the cortisone interferes with this process.

[rider fan]

As far as autoimmunity is concerned, we have no good proof that a true autoimmune reaction occurs in the prostate in CPPS. More likely we have a chronic mast cells degranulation effect caused by nerves, and the cortisone interferes with this process.

Both times I flared with chronic prostatitis / chronic pelvic pain syndrome I was actually on an immune-suppressant called Purinethol (aka Mercaptopurine"¡, aka 6-MP). I was on this because of IBD. So, I doubt the autoimmune reaction theory as well.

"¡ Mercaptopurine is used to treat many types of autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, acute idiopathic polyneuritis, acute idiopathic nephrotic syndrome, psoriatic arthritis, erythroid aplasia, or myelofibrosis; idiopathic hemolytic anemia; macroglobulinemia; idiopathic thrombocytopenia purpura; idiopathic pulmonary hemosiderosis; multiple sclerosis; myasthenia gravis; uveitis; and ulcerative colitis

[Federico Guercini MD PhD]

I definitively agree that the resolution of the prostatic irritative spine is only a part of the therapeutical journey. For this reason in 90% of my patients I add a specific therapy to relax the perineal muscles wall and to desinflammar the pudendal nerves.