Prostate Massage and Rationale
The digital rectal examination (DRE), a physical examination of the prostate, is a diagnostic maneuver. Doctors use physical examination of the prostate to detect nodules as a sign of possible prostate cancer, tenderness as a sign of prostate inflammation, and benign enlargement.
The DRE is not a therapeutic maneuver for prostate cancer or enlargement. However, patients regularly report having had prostate massage as a prostatitis treatment. Exactly how often massage is used to treat prostatitis is not entirely clear. It may be that the frequency of massage ranks third after antibiotics and alpha-blockers.
The rationale for prostate massage revolves its theorized ability to release secretions that may have built up, loosening of any biofilms that may have accumulated, and increasing circulation with attendant better delivery of antibiotics.
Massage is the application of pressure onto the prostate as applied through the rectal wall by a finger or device inserted into the anus. The duration of its application and the pressure used has not been standardized.
Massage is in principle an attractive treatment because it is cheap and safe. Is it effective?
A 2008 systematic review of the medical literature found that it was of generally low quality. Some of this stems from fact that studies used varying treatment protocols and outcomes measures. As importantly, there is a lack of randomization and controls. Admittedly, given the difficulty in designing a sham procedure that a patient could not distinguish from a finger in his anus, it may be difficult to design more rigorous studies of massage that addressed the possibility of placebo effects.
Overall, the methodological features of the massage literature are a barrier to data pooling, validation, and summation. Here are some of the issues that remain essentially unresolved by science:
Patients should understand the limitations of the knowledge about the merits of prostate massage as conveyed by the medical literature. At the same time, given its low cost and relative safety, massage may be considered as a low-risk treatment that may work in individual cases.
- The class of prostatitis that might most respond: Chronic bacterial (type II)? Chronic Pelvic Pain Syndrome (type III)?
- The relative role of massage is not clear: Should it be used alone? Does it add value to antibiotics?
- Can anesthesia facilitate the intensification of massage and improve its effect?
- The frequency of treatment cannot be optimized: Once a day? Twice a week?
- The duration of treatment with massage if symptoms persist?
- The optimal technique cannot be defined