Talk:Prostatitis/Archive 1

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The original text of this article was taken from an NIH public domain document NIH Publication No. 00-4553, at http://www.niddk.nih.gov/health/urolog/summary/prostat/prostat.htm

I have my doubts there will ever be subpages on the various types of prostatitis. I've left the links for what they are, but sometimes it's better to delete them before someone writes a stub that has to be merged into the main article later.... JFW | T@lk 14:57, 13 Jun 2004 (UTC)

I am very grateful for this article. tharsaile Oct 2005

The current line of thinking is that Antibiotics resolve most if any, infections in a very short period of time. Further many suffers have no initial trigger other than anxiety. This leaves the balance of the pelvic area in a sensitized condition resulting in a loop of muscle tension and hightened neurological feedback. Hence the newly formed common term, "Chronic Pelvic Pain Syndrome or CPPS." Current protocols largely focus on stretches to release overtensed muscles in the pelvic or anal area (commonly referred to as Trigger Points), physical therapy to the area, and progressive relaxation therapy to reduce causitive stress. Jan 2006.

Jordan Dimitrakov, who worked with Shoskes mentioned that there are as many types of prostatitis as there are patients and said there's a great incongruence between theories and the results of the therapies, but agreed on the idea that whenever a germ is present, the first thing to do is to treat the infection, even if, in his opinion, presence of infection does not always indicate the main cause. He also believes that the future will probably reveal that many diseases have a genetic background, even if is only a "pre-disposition" for some conditions.

Pelvic Myoneuropathy and the Stanford protocol

The material on the pelvic myoneuropathy theory and on the Stanford protocol don't look solid. They were added by an anon, User:216.31.66.130, with no other edits, and they do not seem to be mainstream (Google search on [Stanford-protocol prostate site:edu] or [... site:gov]). I am adding fact tags until these claims can be better sourced. --Macrakis 00:36, 28 February 2006 (UTC)

• The Stanford Protocol is scientifically accepted and published in the best medical journals. See this for starters and there is a more recent study too. I'll review your fact tags and modify if appropriate. Skoppensboer 17:19, 26 October 2006 (UTC)

Bacterial Etiology Theories for CPPS

I have removed comments (mainly speculative and all unsupported) made by persistent anonymous posters trying to relate CPPS to bacterial infection, BPH and prostate cancer. These issues have long been settled in the scientific sphere, although unfortunately many urologists still treat the condition with antibiotics, causing much misunderstanding and confusion. Skoppensboer 17:24, 26 October 2006 (UTC)

Links removed and replaced

• I'm re-adding the links that have been here for years, and which represent the best resources for prostatitis on the web. Why don't you discuss this sort of thing before barging in and making unwise changes to a page I've been developing for over a year? Skoppensboer 21:39, 30 October 2006 (UTC)

Perhaps you should read Wikipedia's External links policy, specifically the part about not adding links to your own site. -- Mwanner | Talk 21:46, 30 October 2006 (UTC)

Let me add that almost every site on the internet has ads today. How do these sites pay hosting fees without it? Please look a little deeper: is the site linked purely selling one product, i.e. a product-specific site, or are the ads diverse and for general revenue? In the case of this disease, I challenge you to find sites with more information than the ones to which I link. Skoppensboer 21:44, 30 October 2006 (UTC)

We don't need any external links in our articles. The information should be fully covered in the article itself. -- Mwanner | Talk 21:48, 30 October 2006 (UTC)

What makes you think they are my sites? Skoppensboer 21:49, 30 October 2006 (UTC)

You're not quite denying that they are yours, are you? -- Mwanner | Talk 21:59, 30 October 2006 (UTC)

Yes, I am. Just curious as to why you are so presumptuous. Skoppensboer 22:03, 30 October 2006 (UTC)

OK, I'll assume good faith. I presumed it was yours because I saw you adding the same site to several articles. I spend a lot (probably too much) time fighting spam, an activity in which one's ability to assume good faith becomes rather strained. And I think almost anyone would agree that http://www.chronicprostatitis.com/ has the look of a snake oil page. Surely there's a better source. -- Mwanner | Talk 22:10, 30 October 2006 (UTC)

If you find a better source, please let me know! I cannot and it's not from want of trying. I know the guy who runs that site and he's the genuine article, a sufferer interested in a cure. The associated forum is the only one of any worth on the net. Skoppensboer 22:38, 30 October 2006 (UTC)

To answer to your other statement, the topic of CPPS is vast and cannot be covered in this one page WP article, it simply cannot. It's an evolving and controversial area. Skoppensboer 21:51, 30 October 2006 (UTC)

OK, I'll buy that, but I'm not at all convinced that there are no sites that cover this material without engaging in retail sales. Ads are one thing, direct sales are another level entirely. -- Mwanner | Talk 21:59, 30 October 2006 (UTC)

I don't think they have direct sales, I'll check. BTW, there is a dearth of sites covering this topic on the net, because it's controversial and icky. Skoppensboer 22:03, 30 October 2006 (UTC)

Update: no direct sales. Not even Google ads! Skoppensboer 22:48, 30 October 2006 (UTC)

You're right, though it carries three prominent ads linked to Farr labs that is a direct sales site. Worse, though, is that its lead "item" in the article space, under the headline "Potent New Prostatitis Remedy" is yet another link to Farr labs. This stands in stark contrast to sites such as http://www.clevelandclinic.org/health/health-info/docs/1900/1962.asp http://www.mayoclinic.com/health/prostatitis/DS00341 http://www.urologychannel.com/prostate/prostatitis/index.shtml http://www.aafp.org/afp/20000515/3015.html http://www.urologyhealth.org/adult/index.cfm?cat=09&topic=115 http://www.med.umich.edu/1libr/aha/aha_prostati_crs.htm http://www.nlm.nih.gov/medlineplus/ency/article/000519.htm http://www.mtsinai.on.ca/mkuwc/Programs/Prostatitis.htm which carry few or no ads (and hardly a dearth of sites). -- Mwanner | Talk 00:30, 31 October 2006 (UTC)

With all due respect, those sites are mostly one page thumbnail summaries of the problem, and contain in most cases less information that the WP article. This is exactly the dearth to which I was referring! The site you disparage has over 73 pages on the topic, as well as the only active forum on the internet on the topic. Farr Labs, the advertiser you cite, is a pharma company devoted to this particular disease, and has funded several published (in urology journals) studies into prostatitis treatment. Their products have peer-reviewed, published studies behind them. So where's the "snake oil"? Skoppensboer 18:06, 5 November 2006 (UTC)

And one more thing, of which you are probably unaware: the field of prostatitis/male chronic pelvic pain syndrome has undergone rapid and sweeping change scientifically in the last ten years. Most of the links you provide go to sites that are mired in the past, providing inaccurate information. If you want to get into a scientific debate with me about this, you are very welcome. It is an area in which I am quite knowledgeable. :) Skoppensboer 18:15, 5 November 2006 (UTC)

I disagree; they are contemporary, accurate, and not commercially led. And I am also quite knowledgeable (being a urological surgeon) but not associated with any of the sites listed. I'm not bothered, but I think it would be unjust to denigrate these sources. Jfbcubed 20:04, 5 November 2006 (UTC)

Again, with all due respect, urological surgeons are the very last people CPPS patients should be consulting. In fact I know several prominent urologists researching in this area who concur with me on this issue. I quite understand your support for websites promoting the status quo opinions with their urological/surgical/infectious/alpha blocker bias. However, if you can find me a site that references the impressive latest (2005/6) myofascial, psychological and trigger point research, I'll be surprised. Skoppensboer 06:19, 8 November 2006 (UTC)

I am seeking to learn from this Wiki article and would like to understand why a urological surgeon is not the right sort of specialist to deal with *potential* CPPS. (I emphasise potential in order to say that it is not yet firmly diagnosed and that one of several alternative disgnoses may become chosen instead.) I am in the UK and seeing a urological surgeon who is in the process of diagnosing my condition. Is this the right way to go about it and then to change specialist depending on the diagnosis or should the actual diagnosis be done by someone from another speciality? I should add that the reason I am seeing the urologist is because there are several symptoms which recur from time to time causing discomfort but seeming without pattern. ----Viston

I don't feel strongly enough about this to have an argument over it but your criticism of these sites, and your assertion that "your" (while recognising it is not under your control) site should be referenced, is based on the assumption that your view of prostatitis is correct, and thus sites that do not reference work you approve of must be out-of-date. I would contest this position. A scientific view would be to have a neutral viewpoint, and look for evidence that, if anything, contradicted your hypothesis. Not championing websites that support your view, while denigrating sites on the basis that they do not conform to your construct of a poorly understood disease. But most patients with this condition have firmly held beliefs about its causology and effective treatments, and it rarely helps, and never works, to have their physician challenge these. I presume the same is true for people who edit these pages.Jfbcubed 20:18, 12 November 2006 (UTC)

Ok, to end this debate, I randomly chose one of the sites you would fain see cited (urologychannel.com), and looked up its definition of "treatment" for Prostatitis Type III(b). I quote: "Analgesics and warm baths are recommended to alleviate symptoms of prostatodynia and nonbacterial prostatitis." That's it. Not only are these recommendations grossly inadequate to the point of uselessness, they are also so cryptic and outright wrong (analgesics are shown to be only marginally effective in recent studies) that the site itself should not be referenced at all. I could repeat this exercise with each of the sites, but hopefully this effort will suffice. QED. Skoppensboer 21:51, 12 November 2006 (UTC)

"Non -specific prostatitis"

I've removed this recent addition because 1) it is not part of the NIH classification system and 2) it is not a recognized entity with any scientific support. If it belongs anywhere, it is as a footnote to possible causes of Type III(b) prostatitis. Skoppensboer 18:10, 5 November 2006 (UTC)

Infertility and sectioning according to research type

• AFAIK it is not standard practice to divvy up pages on diseases and medical conditions in a non-standard manner according to type of research. It is also not acceptable to discuss unrelated topics such as infertility on this page based on thin or no evidence. Please note that linking Type IV prostatitis to cancer/BPH/infertility is speculation at best. The study "The Influence of Chronic Inflammation in Prostatic Carcinogenesis: A 5-Year Followup Study" was based on biopsies, not WBC counts. Skoppensboer 09:03, 24 November 2006 (UTC)

Actually, it is completely standard practice to discuss evidence based therapy according to the level of evidence (large randomized placebo controlled trials, small trials, unblinded trials, anecdotal). Furthermore, to say "no therapy required" when some men with category IV do get therapy that has evidence behind it is misleading, as is your statement about free:total PSA ratios. Finally, since category IV is defined by inflammation in EPS, semen OR biopsy, the quoted study was completely appropriate. —The preceding unsigned comment was added by 70.239.5.75 (talk • contribs) .

• 1) Point me to other WP pages that divide research based on design. 2) Provide here (on discussion page) links to mainstream web pages that state Cat IV should be treated and how. 3) From the seminal paper by John Krieger et al (NIH Consensus Definition and Classification of Prostatitis Krieger JN, Nyberg L, Nickel JC): "Patients included in category IV have no history of genitourinary pain complaints, but leukocytosis or bacteria have been noted during evaluation for other conditions." Notice he does not mention histological inflammation seen through biopsy. He goes on: "Asymptomatic prostatitis may have important-as yet, unknown-ramifications in benign prostatic hyperplasia (BPH), prostate cancer, or infertility." When the "unknown ramifications" become known, we can continue to include them here. 4) My statement about PSA is fully cited with recent research, and not misleading.

On another matter, you have no idea how to conduct a discussion here (missing indentation, missing signature for your comments, etc). Please do some study on WP protocol before continuing. Skoppensboer 15:12, 24 November 2006 (UTC)

You are correct. I know more about medicine than WP and so will limit my remarks to answering your questions and editing the page for factual data. Category IV has always included biopsy inflammation in asymptomatic men. See BJU Int. 1999 Dec;84(9):976-8. Whether or not other WP pages have divided evidence based on the strength of data is irrelevant, as many are written by laymen such as yourself. The medical literature relies on evidence based medicine in making treatment recommendations. A nice review of the pros and cons of this approach are here: http://en.wikipedia.org/wiki/Evidence-based_medicine. Why are you defensive about categorizing the data this way? Are you personally promoting a therapy that doesn't meet level 1 evidence? Free:total PSA ratio has only been found to be useful to discriminate between prostatitis and prostate cancer in the one study you quote, while several others find it not to be useful since a low ratio is often seen with both conditions. Antibiotics for men with category IV is standard urologic therapy although evidence is weak Hum Reprod Update. 1999 Sep-Oct;5(5):421-32.

I have removed your remark about lack of sufficient study on the Stanford Protocol inhibiting physicians. The lack of definite proof has already been noted, to go further and state your POV about how this should/may inhibit doctors is a tautology, and probably false. After all, they've been prescribing antibiotics without any evidence for decades. Yes, the WP is written by laymen in some instances, although this page has had input from several urologists already, not all of whom see themselves as arbiters of truth, fortunately. But that does not give you the right to restructure disease-oriented pages to your own liking. This is not Campbell's Urology. The WP follows a style, look it up. I know all about evidence-based medicine, thank you. I also know that if we relied strictly on properly controlled and blinded studies we'd still know precious little about this malady. In real life, the Stanford Protocol is proving remarkably successful, although you seem to have limited experience with it. I don't know any urologists who still treat Cat IV with antibiotics, but I'll let it stand as it's a bagatelle. Skoppensboer 23:38, 24 November 2006 (UTC)

• Please learn how to properly reference the studies you cite or face reversion of all your changes. See WP:REF Skoppensboer 23:44, 24 November 2006 (UTC)

• Please learn how to edit wikipedia. Your references and citations do not follow the Manual of Style. You are making spelling errors. You are not discussing controversial changes - USE the discussion page and build consensus before re-ordering a long-standing page, edited with care over many months. Skoppensboer 16:59, 25 November 2006 (UTC)

Evidence-Based Medicine - Tabulate results

• To the physician who is keen to see treatments for Cat. III listed according to the categories of Evidence-based medicine, I urge you to submit an excel spreadsheet in which you tabulate each treatment and cross-ref it to type of evidence collected for that treatment. This table can then be converted to a wikitable and added to the document, and will make a nice addition. If you need help, go to my talk page to discuss. Skoppensboer 22:50, 25 November 2006 (UTC)