Cypro and prostatitus

[Sheldon]

After a couple of years of increasing prostatitus symptons I went on 1,000 mg per day of Cypro. The Cypro completely eliminated my symptpoms. Over a six month period I tried to get off but was mostly on the Cypro. Near the end of the six month period I could control my symptoms with just 250mg per day. Beginning in the new year I went off the Cypro and all symptoms returned within one week. I know from past experience that if I go back on the Cypro my symptoms will be gone within one week,  but I have not done so on my doctor's advice. Other factors are: I reacted badly (allergic?) to the usual other antibiotics and; and I cannot tolerate the blood pressure lowering affect of the prostate relaxing drugs.  I now have an as yet unfilled Proscar presription. One other factor that may or may not be relevant is that my wife is a Strep carrier. I have not had a strep test. I will be 50 years old this year. My prostate is somewhat enlarged but not huge, and I am low on the PSA tests, and ulstrasound is normal. I had a Cysto... last June and report says nothing useful. I am reluctant to use Proscar, and I cannot reconcile what I know (ie.that an antibiotic can eliminate my symptoms) with the use of Proscar. The evidence suggests to me that a chronic infection is blocking my urine and not the enlarged prostate. I am also taking Saw Palmetto (six months) and recently added flower pollin. I also take Mirapex (dopamine agonist) for restless leg syndrome (for 6 years), Lipitor, aspirine, and a steroidal nasal spray that penetrates the blood barrier. I am also considering getting on something to control a toe fungal infection that I had on one toe for 25 years but has recently spread to almost all of my toes. I guess my question is: should I go ahead and start the Proscar or is there some other approach that I should try first? Many thanks.  

[Kevin Pho, MD]

Can't give specific recommendations without evaluation.  

Sometimes an extended course of antibiotics (i.e. 3-6 months) is necessary for cases of chronic prostatitis.  

If the ultrasound is negative, that would make a prostatic abscess a less likely cause of your symptoms.

You can consider prostatic massage and send any prostatic fluid off for culture.  Any bacteria that may be resistant to the Cipro can lead to continuing symptoms.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b

[B_Johnson]

P.S.

I would stay away from saw palmetto and other non FDA approved substances.  Since there have been no official trials we do not know how they interact with perscription meds of any type.

[B_Johnson]

You should express your concerns to your physician. Usually for chronic bouts of prostatitis you would have some kind of biopsy or a urine specimen collected after prostate massage.  This will usually determine if the nature of the inflammation and swelling is infective in nature.

Having passed the the other tests, U/S and cystoscopy it is unlikely that you have and structural problems or malignancy that are contributing.

Proscar is a treatment for Benign Prostatic Hypertrophy.  It is a DHT blocker.  DHT is a metabolite of testosterone which binds more strongly than the original testosterone molecule. But it has the same effect as testosterone in most tissues. Although the mechanism behind BPH is poorly understood at best, it is known that men who do not produce DHT never develop BPH.  The main side effects of this drug are loss of libido and a somewhat desirable effect of reduced male pattern hairloss. However remember that your body still uses the testosterone that wasnt metabolized, and only a minority develop these side effects.

Your doctor is most likely trying a trial of this medication to rule out BPH because confirming bacterial prostatitis can be somewhat invasive and because BPH is more common than chronic bacterial prostatitis.  You should take the medication as perscribed and follow-up with your physician to see if it has helped.  If it hasnt, then once you stop the medication the side-effects will be reversed (if this is your concern).

Is your main problem difficulty voiding?
Have you had a procedure such as TURP which would predispose you to these repeated infections?

Dr. J