Laparoscopic Prostate Removal
for Severe, Treatment-Resistant
Chronic Prostatitis

                                                                            

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Injections

prostate injection antibiotics prostatitisThis page deals only with injections of antibiotics directly into the prostate. It does not deal with injections of other medications into the prostate and/or oral and intravenous delivery of antibiotics.

The Theory of Intra-prostatic Antibiotic Injections

The idea of injecting antibiotics into the prostate comes from thinking that:

• bacteria cause prostatitis
• adequate concentrations of antibiotics cannot be delivered by oral and/or intravenous routes

The first assumption is valid in many cases, as it is with most cases of acute, febrile prostatitis. However, one should not that the prostate is a host for other infectious agents, including viruses.  These agents, along with non-infectious factors such as radiation and trauma, are perhaps also responsible for some cases of prostatitis. Overall, the first assumption is true in many, but not all cases.

If one accepts the assumption that bacteria are behind a case of prostatitis, then by convention the first attempt to eradicate the bacteria is to deliver antibiotics by the oral route. This is certainly therapeutic in many cases. In severe, urgent cases, especially those complicated with potentially life-threatening sepsis, a more immediate delivery is possible through an intravenous route. This, too, is often effective. The idea of delivering antibiotics by direct prostatic injection is meant to augment delivery such that the highest theoretical concentrations of antibiotic are achieved.

The History of Intra-prostatic Antibiotic Injections

Intraprostatic antibiotic injection has been around for more than 30 years. Various specific medications have been injected to varying doses. By and large, the populations being treated have been loosely characterized. Moreover, in some studies the clinical endpoints were symptom relief and in others they were sterilization of urine and/or semen cultures; varying endpoints potentially complicate application of the data to any new patient.

Anecdotes of Men Who Have Had Antibiotics Injected Into Their Prostates


The internet and rumor mill present stories of patients who have had intraprostatic antibiotic injections. We are aware of a number of patients with chronic prostatitis whose conditions have been made substantially more symptomatic with intra-prostatic injections. The potential downside of intraprostatic injections is serious and, as of today, poorly defined.

We are also aware of patients who have initially found relief with injections but later had serious symptomatic relapse. For example, Nick M has written a story that is posted on the internet in which he states that 
antibiotic injections provided him with relief. The problem is that this relief was relatively short-lived, which he relates in a subsequent online report. Nick M subsequently had surgery for his chronic prostatitis, about which he talks in the video posted on the home page.

Without followup, we are potentially blind to the limitations of specific treatments, including intraprostatic injections. In other words, there is little substitute for science as we evaluate a proposed treatment strategy.

Research About Prostate Injections of Antibiotics

As with so many other treatments for prostatitis, there are precious few scientific data by which to judge the risks and benefits of intraprostatic injections. Perhaps the most serious study to date was published in the Italian urological literature in 2002.


A study population was 320 patients seen between 1999 and 2002 at several centers; each patient had failed previous therapeutic attempts with antibiotics. Their average age was 38 years. Each had DNA-based testing (this is not available in most doctors’ offices) for such micro-organisms as Chlamydia trachomatis, Mycoplasma, Gonococcus, and Human Papilloma Virus, along with conventional cultures for bacteria, yeasts, and protozoa. Antibiotic cocktails were mixed depending upon the specific findings.

This study is slightly hard to follow because of technicalities in its presentation. For example, it refers to Chronic Prostatitis Symptom Index (CPSI) symptoms scores in a table, but this table does not actually provide the scores. Instead, the table makes reference to a PSS score, which is probably the CPSI. Still, how reliable is a report that is unclear with reference to its central measure? It’s a nagging feeling that cannot be assuaged.
Equally annoying is the omission of the 12-month scores in the same table. One wonders if the table is labeled improperly. Again, this kind of technical confusion, which is exceedingly rare in this sort of report, leaves the reader wondering about the precision of the report.

Leaving aside the technicalities, the study finds a CPSI average score of 25 before treatment; a score of 25 is comparable to what is seen in many other studies. At 6 months (one cannot be sure this is not really 12 months), the CPSI mean score has dropped by 8 points. This kind of symptomatic reduction is more than what is seen in many studies of oral antibiotics and alpha blockers. The drop reaches statistical significance.

Is a CPSI 8-point drop from 25 clinically meaningful? This is a question only an individual patient can answer. And is the drop also associated with a drop in associated complaints: Chills, back pain, fatigue? No answer here.

Was the drop uniform or did some patients have a rise in symptom severity? This cannot be answered when the data are grouped, and are left blind to individual response. And without an unequivocal statement, it is not clear at all that some patients did not get worse. Finally, the data were not presented by type of cocktail administered, leaving open the question of whether or not this approach may be more effective against some micro-organisms than others.

Overall the study finds that injections of antibiotic cocktails were -- on average -- associated with mild, incomplete relief of symptoms. It leaves open questions that can perhaps be answered in future periods.

Summary

Antibiotics are a mainstay of prostatitis treatment. In the acute phases, oral and intravenous antibiotics work well. In the chronic phase, they work poorly. It may be that in individual cases, intraprostatic injections of antibiotics provide durable relief, but if so, this is poorly documented. It may also be, based upon anecdotal reports, that injections actually worsen symptoms. The study referenced above suggests that for some patients mile relief may be possible for some time.

Patients who have failed oral and /or intravenous antibiotic injections may consider prostatic injections of antibiotics with the understanding that current knowledge about their benefits is incomplete. 
  • The observations suggest at best a mild response
  • There have been few studies of this strategy
  • It is not known how durable the responses are
  • And there is apparently a risk of clinical deterioration
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