Prostate massage

[dshoskes]

I continue to try to refine my indications for prostate massage to maximize the benefits for those it will help and minimize unnecessary discomfort and visits for those it will not. In general, I have not found antibiotics+massage to be helpful unless at least one of the following is found:

1) Positive cultures of EPS and failure of specific antibiotics
2) Large volume of fluid expressed on initial exam
3) Thick clumps in fluid (usually seminal vesicle contents with lots of dead sperm on microscopy)
4) Patient reports that initial massage gave symptomatic relief (at least temporarily)

I am curious to hear from patients outside of my practice. Has prostatic massage helped you, but you didn't have at least one of my 4 criteria? Did prostatic massage not help but you did have criterion #4?

[webslave]

I am a case where:

1) no fluid expressed
2) massage worsened the pain considerably
3) no positive cultures
4) no antibiotics ever helped, and I tried them all

Two exceptions ... the very first massage: during a visit to a family doctor because of a burning, stabbing pain in the perineum towards the end of urination, he gave me a vigorous DRE that left me crippled with pain thereafter, including a swollen knee, making walking difficult (but I did not otherwise fit the profile of a Reiters patient). That's when my chronic prostatitis / chronic pelvic pain syndrome began. The other exception is the second massage I had a few weeks later, which seemed to dislodge some accumulated fluids and helped dramatically with the intense pain for a few days. Sadly, it soon came back, and every massage thereafter caused a nasty flare.

[TK]

In my case, with respect to Dr. Shoskes' Criteria --

1) CULTURES: the only cultures taken were from Semen as opposed to EPS and these were negative. (I have some doubts as to the profficiency of the labwork). ANTIBIOTICS: About 11 weeks of levequin. Helpful to some extent, but I understand that the primary benefit may well have been anti-inflammatory as opposed to antibiotic.

2) NO FLUID EXPRESSED at tip of urethra during exams or subsequent massage. I think that some fluid was probably pushed out into urethra and expelled in subsequent urination

3) CLUMPS. No EPS collected for examination. Ejaculate has some gelatinous clumps. This is normal, no?

4) MASSAGE. First instance was definitely helpful. In terms of pressure and volume, Ejaculation two days following massage was closer to "normal" than any I had experienced since developing prostatitis 8 months previously. There were some red filaments (blood/tissue?) in that first subsequent ejaculation. I took this to be a positive sign that some blockage was being cleared. There was some general improvement in symptoms over the next month.

[off-topic questions removed and posted to general discussion forum - webmaster]

[Nikolaus]

Thank you Dr. Shoskes for this intetion.

1) I had positive cultures but did not try antibiotics alone before
2) The uros could NOT get any EPS on the initial exam.
So I did massages to get EPS two weeks before I started abx,
4) lumps in semen I dont remeber (Do you mean this kind of lumps? Seefoto)
5) Yes I had temprary relief, but the real benefit came after I finished massage+abx two month later.[/url]

[dshoskes]

Thank you Dr. Shoskes for this intetion.

1) I had positive cultures but did not try antibiotics alone before
2) The uros could NOT get any EPS on the initial exam.
So I did massages to get EPS two weeks before I started abx,
4) lumps in semen I dont remeber (Do you mean this kind of lumps? Seefoto)
5) Yes I had temprary relief, but the real benefit came after I finished massage+abx two month later.[/url]

I am not talking about lumps in semen. I am talking about thick clumps in the EPS which under the microscope look like seminal vesical contents with dead sperm in them.

[ourban]

1) Repeatedly I had positive cultures in semen (Enterococci, ß-hem.-Streptococci, Klebsiella, Gardnerella). Antibiotics eliminated only Klebsiella, Gardnerella.
2) The uros could not get any EPS on the initial exam. I got EPS by do-it-yourself.
3) There were no lumps in semen.
4) Yes I had temporary relief. I had longer increasing relief with massage during a 90-day-antibiotic-taking. After I finished with antibiotics all symptoms recured within 7 days.

[Mike]

I had a few massages (in UK) all of which helped but they where wide apart in time and only few (3 massages, around 2-3 weeks apart). I think I am better than before them. Before them my pain was *ridiculous*, those few did bring it down from which I believe I still have some benefit from, although I still have chronic pain. Unfortunately my urologist retired before being able to start massage and abx treatment and any labs, treatment stopped at this point for me sadly around 6 months ago.

1...Never had EPS culture so can't comment, sorry.

2...Not on initial exam, 2nd though a large amount was expressed, kind of surprised me actually, and it looked dirty hard to explain the color and texture. This did not make it to the lab....long story. 1st massage extremely nervous this may have effected things, as 2nd the initial shock of the procedure had gone away and I was relaxed. My urologist was aware of the nervousness and talked me through and supported me during the procedure which I found made a BIG difference. This 2nd massage was relief for over 1 week! I could even sit again for the first time in a year!

3....Don't understand enough to comment, sorry.

4...Yes all gave some relief, certainly *no* flares from them.

Hope this helps doctor. I confirm the above data is the truth.

Mike

[webslave]

To all readers: this thread is still open and awaiting further answers to Dr Shoskes question.

[Erik]

Hi Dr. Dshoskes,
I had a massage performed on a regular basis for a year (once a week or every other initially, and then one every three weeks). My EPS's did not "show" anything. I am non-bacterial. I would usually have some fluid expressed upon exam, and probably the most on the initial one (although I don't recall exactly how much and what a "large" amount would be). I don't recall my urologist saying anyting about "clumps" etc. Only signs of infammation in semen. Initially it helped. After a few months of what seemed to be helping it began not to help at all. Eventually I realized that one ejaculation/week was the equivalant of one massage (and a lot easier and less painful to do!). I've tried anti-biotics, but never had any luck. Recently my semen has shown little or no white-blood cells, yet I still have symptoms coming and going. Prostate still hurts a lot when DRE is performed. So it still seems to be there is some inflammation despite no signs of it.

[Ron]

Hi gentlemen,

I am not a chronic prostatitis sufferer but my interests in medicine
for the last 16 years include many topics.

I am attaching a link top another doctor's site so you can read his reports for yourself to prevent your doubting what I might say.
The main reason why many feel that antibiotics do not work is because they are rarely prescribed long enough, or the lab test was inconclusive so
the wrong antibiotic was prescribed.
Ask your doc if an infection with mycoplasma, ureaplasma or chlamydia
can be cultured with standard Agar cultures.

Dr Shoskes should be familiar with the recent studies done by Dr Jeanette Potts (Cleveland Clinic) showing the frequency of Ureaplasma infection
in women with Interstitiial Cystitis.


There are many other reports on various heath topics so feel free to search with keywords. You will notice that all of the reports include the journal referrences in case your doctor wants to look them up

[:: Mirkin links removed by moderator ::]

Good luck to all

[webslave]

Yes, the Potts study is yet another poor piece of science with no randomized placebo controlled group, and therefore worthless outcomes, unimpressive even as they were. What's more, the recent Nickel study puts Potts' results in a different light, since he found similar outcomes in controls and men treated with antibiotics.

[tractor316]

I did have some relief imediately after prostate massage . Was able to walk without pain. As we do not have a uro and it took me 3 mths too see this one (and had to drive 200 miles) I did not get a second massage . Tried myself and only got some clear fluid out once . Relief was only temporary . Hope this helps .

[MickVedder]

Hello, I am 25 years old and have been suffering with CBP for 1.5 years now. My symptoms include decreased urine stream, hesitancy and urgency after ejaculation. Luckily I am pain free with just a little discomfort from what seems to be spasms. Not sure. I had a prostate C & S test performed and tested positive for microbes or bacteria. Anyway, I have been on and off Antibiotics like Cipro and Levoquin with no success whatsoever. My Uro won't massage my prostate because he says he does not want to irritate it any further. I had my bladder scoped and everything looks fine except inflammation of the prostate. I did not have large amounts of fluid expessed on initial exam. Other then that I can't answer the other questions about clumps. Please advise.

[J Dimitrakov]

My Uro won't massage my prostate because he says he does not want to irritate it any further.

Did you experience any relief from the DRE expressing prostatic fluid for analysis?

[MickVedder]

I didn't feel any relief after the DRE and I felt my stream was worsened for about 4 days after.