Swollen Property

Clark Hickman’s problems started one night when he was awakened by a ferocious need to pee and a burning at the core of his penis. The future professor, then just 25 years old, saw a doctor, who checked him for VD, gave him some antibiotics, and told him he was fine. He wasn’t. A nagging backache, a low -grade fever, and a perpetually swollen prostate soon joined his list of symptoms. He was unable to ride a bicycle, sit on a hard chair, or even lean to one side. “The pain was excruciating,” he recalls. Six weeks later, a urologist found pus in Hickman’s prostatic fluid and handed him the diagnosis: prostatitis.

It afflicts as many as 15 percent of men between the ages of 20 and 50, making it the most common ailment to affect a man’s sexual plumbing. It’s also one of the most painful. When prostatitis strikes, the walnut-shaped gland becomes inflamed and swells (not to be confused with benign prostatic hyperplasia, or BPH, in which the prostate literally grows larger as you age). As the prostate balloons in the already tight quarters it occupies, it begins to push against the bladder and the urethra. Crowd your bladder and you’ll need to pee–bad. Squeeze your urethra and you’ll feel as if someone had squirted lighter fluid into your penis and then struck a match.

The worst symptom of the disease? Ignorance. About all that doctors know for sure is that a small percentage of cases are caused by a treatable bacterial infection. The rest–an estimated 90 percent–are labeled “chronic nonbacterial prostatitis,” a condition that ranks right up there with fibromyalgia and chronic fatigue syndrome for sheer misery, mystery, and frustration.

“We’re all over the place with this,” says Jeannette Potts, M.D., a urologist with the Cleveland Clinic Foundation. “Most doctors take the strategy of giving the patient an antibiotic and hoping he’ll go away. Most of these men wind up doctor -hopping because nobody can tell them what’s wrong.”

According to a Journal of the American Medical Association report, some men even give up on conventional medicine: “Patients from across the globe have journeyed to the Philippines and to Ukraine to partake in undocumented cures, mail-ordered powerful magnets to sit on, and drunk gallons of carrot juice, all in hope of lessening pain and restoring a normal sex life.”

But as bleak as things look, don’t write off man’s main gland just yet. There are a handful of researchers out there who’ve had the, well, balls to attack prostatitis with all the academic firepower at their disposal. The result? Two promising new theories that just may lead to a cure.

The X Germs

Somewhere in the not-so-exotic city of Fort Lauderdale, one guy’s feeling remarkably optimistic about prostatitis. Daniel Shoskes, M.D., a urologist with the city’s branch of the Cleveland Clinic, is one of a growing number of researchers who believe the key to solving the prostatitis riddle lies in questioning everyone’s most basic assumption about the disease: that bacteria aren’t to blame. “I believe some of these cases of so-called chronic nonbacterial prostatitis re-ally are due to a bacterial infection,” he says.

Like most urologists, Dr. Shoskes had always fallen back on a diagnosis of chronic nonbacterial prostatitis whenever a patient didn’t respond to a course of antibiotics. But that line of reasoning went out the laboratory window last year with the publication of a study from the University of Washington. Researchers there found the DNA of bacteria they had never seen before in the prostate biopsies of several study subjects–men who had been believed to be bacteria-free. Suddenly, urologists had to consider that the failure of antibiotics wasn’t a sign of a nonbacterial condition but rather an indication that they weren’t using the right drugs for this new strain of bacteria. The next step: identifying the mutant microorganisms and then developing the drugs to quash them. Studies are now under way at the University of Washington and the Cleveland Clinic Florida.

Such stealth bacteria may have been what invaded and inflamed Hickman’s prostate. Even though previous courses of antibiotics had proved ineffective, the last urologist he visited (the ninth in a long string of shoulder-shruggers) decided to put him on doxycycline. It seemed to work. “The doctor stumbled onto something that I was sensitive to, and my symptoms cleared up,” says Hickman, who’s been mostly symptom-free for 8 years. But rather than being the magic bullet, doxycycline was probably just a lucky shot against an unclassified strain of bacteria. “It appears that the urologist just hit on the right antibiotic, but it could also be that the timing was coincidental and symptoms may have disappeared regardless,” says Leroy Nyberg, M.D., Ph.D., head of urology research at the National Institute of Diabetes, Digestive and Kidney Diseases.

Arthritis of the Prostate

But what about those men whose lab samples show no sign of infection whatsoever? Even in these cases, bacteria may be to blame, albeit in a roundabout way. In a recent study published in the journal Urology, researchers discovered elevated levels of cytokines–a classic marker of autoimmune response–in the prostatic fluid of some men. This finding, combined with prostatitis’s resemblance to other autoimmune disorders like rheumatoid arthritis, has prompted researchers to theorize that the condition may also be the body’s lingering response to an infection that was knocked out long ago.

“A lot of men are fixated on the idea that they have an infection and will stay on antibiotics for years,” says Dr. Shoskes. “But their problems might be because their bodies are acting as though there is still something to fight.”

If it turns out that some men’s immune systems are swinging at bacterial ghosts, then medications used to treat rheumatoid arthritis should also work against prostatitis. This theory is being tested at the University of Maryland in a clinical study of Enbrel, a new anti-arthritis drug that works by “capturing” the excess cytokines believed to cause runaway inflammation.

“All of us are starting to realize that this disease is really several different diseases,” says Richard Alexander, M.D., a urologist with the University of Maryland medical center.

In some cases these diseases may not be diseases at all, but bad habits and bad coping strategies. One is known as dysfunctional voiding, an unconscious tensing of the sphincter muscles when you pee. This ill-timed pressure pushes urine back up through the urethra and into the prostate, where it causes irritation and inflammation, says Dr. Nyberg. Another theory is that prostatitis is essentially a “headache of the pelvis” caused by stress and pent-up aggression. And then there are a number of doctors who think that slight symptoms can escalate into big ones after the patient worries about them too much. In other words, it’s all in their heads. “I don’t think patients create the pain,” says Dr. Potts, “but treatment frustrations or the fear of underlying serious disease can magnify their perception of it.”

In the Meantime, Some Relief

Don’t even think about telling Rich Ellenberger that the pain that pushed him into an emergency room was something he worried into existence. “It felt as if someone was stabbing my left testicle with a knife,” says the 35-year-old NASA engineer from Houston. After a series of urologists brushed him off, Ellenberger flew to Arizona, where he’d heard a doctor was having success performing “prostatic massage,” a procedure in which prostatic fluid is drained in an attempt to remove problem-causing substances–be they bacteria, cytokines, urine, or something else yet to be discovered.

When the massage was over, Ellenberger’s symptoms abated, if only temporarily. But it was enough relief to convince him to stay in Arizona and telecommute to work for 3 months in order to continue to receive treatment. Today, back in Houston, he still goes for prostatic massages while he waits for a more permanent solution.

“I’ve gotten it to a manageable stage,” says Ellenberger.

And that’s the trick, isn’t it? Figure out a way to keep the pain at bay until you hear the researchers scream, “Eureka!” Prostatic massage is one way to go. “A lot of men say they’re miserable on the drive home, but then report the first pain-free days they’ve had in a long time,” says Dr. Shoskes. (Go to www.chronicprostatitis.com/clinics.htmlto find a list of qualified urologists.)

Of course, there are less invasive methods you can try, like popping quercetin. A Scrabble-winning “Q” word, quercetin is an antioxidant that’s been shown to have anti-inflammatory properties. In a study published in Urology, prostatitis sufferers who took 500 milligrams of quercetin twice a day for a month reported a 35 percent reduction in symptoms, compared with those who took a placebo. You can buy it in most drugstores.

Or you can ask your urologist about the prescription drug Proscar. Traditionally used to treat BPH, Proscar is showing promise against prostatitis. It’s believed to lower levels of dihydrotestosterone, a hormone that can make your ever -expanding gland grow even bigger.

The simplest and cheapest remedy of all? Masturbation. This is essentially a DIY version of prostatic massage: You drain out some fluid, you get some relief. When Turkish researchers had men with chronic prostatitis masturbate twice a week for 6 months, they found that it improved the symptoms of roughly half the study subjects. Also works if your wife lends a hand.