A brief History of Prostatitis in The 20th Century

It was around the start of the 20th century that Dr’s and Urologists started to note the differences between acute and chronic prostate inflammation (1). And around the same time the early classification of Prostatitis became ‘active,’ ‘latent’ or ‘bacterial’

The first signs of Prostatitis fluid analysis dates back to 1906 (2) But with the birth of antibiotics not being fully established until 1945 and Alexander Flemming’s discovery of the medical benefits of penicillin it was some time before we saw their introduction in the treatment of bacterial Prostatitis

In the 1920’s and 30’s research indicated that the presence of bacteria in the lower urinary tract and expressed prostatitic secretions was the cause of Prostatitis (3,4). This remained the case for decades and it was not until the 1950’s that it was acknowledged that there may be non-bacterial causes for Prostatitis symptoms and inflammation (5)

In the 1953 paper ‘Chronic Prostatitis, a Urologic Quandary’ the condition was described as “refractory to the best of modern methods of treatment” and that all too often patients become “prostatic cripples through injudicious, prolonged and unsatisfactory therapy.” The authors also noted that too little is known about the condition despite the masses of literature (sound familiar?)

In 1963 there was the first recognition that antibiotics may be little better than placebos in the treatment of Prostatitis (6). That was 54 years ago now (the year is currently 2017 if you are reading this)!!! Yet still we seem to be flogging the same horse

In 1967 there are reports of controversy over correlation of histology expressed prostatic secretions (EPS) and white blood cell (WBC) count (7). Further indicating that there are other causes to Prostatitis at play here

In 1968 the Stammey Mears – 4 glass test was born. Considered the gold standard since its invention, this is THE best way to identify the presence of bacterium within the prostate gland. Without this test it is impossible to tell accurately whether the patient should be prescribed antibiotics (nowadays there are 1, 2, 4 and even a 5 glass test. Although they are used so infrequently they still represent the clearest way of identifying the presence of bacterium within the prostate and giving the correct diagnosis, where necessary, of Prostatitis!)

In 1978 the classifications of ‘acute or bacterial Prostatitis,’ ‘non-bacterial Prostatitis’ and ‘prostadynia’ were born (8) and the 1995 meeting of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Institute of Health (NIH) ultimately led to the 1999 classification of Prostatitis into the following categories:

I. Acute bacterial Prostatitis

II. Chronic bacterial Prostatitis

III. Chronic prostatitis (CP)/Chronic Pelvic Pain Syndrome (CPPS)

a. Inflammatory

b. Noninflammatory

IV. Asymptomatic inflammatory Prostatitis

And so we arrive in the 21st Century! Well, much has changed since the insertion of leeches into the rectum and the castration of Prostatitis patients thankfully! But since the introduction of antibiotics for the treatment of Prostatitis we seem to have hit a brick wall. Many practitioners still advocate the use of regular prostate massage combined with antibiotics to reduce symptoms of Prostatitis (first pioneered way back in 1946).

My hope is that the coming century will see accelerated understanding, clear diagnosis and patient targeted treatments for Prostatitis. To date the model is not a successful one, it is not the kind of model you would like to bring home to meet your parents. It is a little embarrassing, it is stuck in the old world, with old world views. It is reluctant to change its traditional, archaic outlook. Quite frankly it is not a keeper.

References