The Prostatitis Foundation

The Allopurinol Cure for Prostatitis

 

Many of the pages on this website consist of edited newsgroup postings from the newsgroup sci.med.prostate.prostatitis. This is such a page. Editor's comments are in red. We begin with an abstract posted by Dr. Jordan Dimitrakov in April, 1999:

Ameliorative effect of allopurinol on nonbacterial prostatitis: a parallel double-blind controlled study

AUTHORS: Persson BE; Ronquist G; Ekblom M
AUTHOR AFFILIATION: Department of Urology, University Hospital, Uppsala, Sweden.
SOURCE: J Urol 1996 Mar;155(3):961-4 CITATION IDS: PMID: 8583618 UI: 96164641
COMMENT: Comment in: J Urol 1997 Feb;157(2):628-9
ABSTRACT: PURPOSE: Nonbacterial prostatitis is a common problem in young men. It is a disease that is often recurrent and each episode lasts for several months. Different causative mechanisms of the disease have been discussed, including identified and unidentified microorganisms, stone formation and psychological factors. We have demonstrated in a previous study that urinary reflux (as shown by a high creatinine concentration in prostatic fluid) occurs to a varying extent into the prostatic ducts, and this reflux has been related to prostatic pain and urate concentration in expressed prostatic secretion.
MATERIALS AND METHODS: We performed a paralled double-blind controlled study of the objective and subjective effects of allopurinol on patients with nonbacterial prostatitis. Twenty patients received placebo, 18 received 300 mg. allopurinol daily and 16 received 600 mg allopurinol daily for 240 days. All patients began medication at the same time regardless of whether the disease was in an active state. No side effects were noted in the treatment groups.
RESULTS: Significant effects were noted on the concentrations of serum urate, urine urate, expressed prostatic secretion urate, expressed prostatic secretion xanthine and subjective discomfort.
CONCLUSIONS: Allopurinol has a significant, positive effect on nonbacterial prostatitis. It is safe and worthy of trial for all at least a 3- month period at each episode to relieve the symptoms of nonbacterial prostatitis.
Doctor Dimitrakov comments:
I think that it could be used in a subset of patients and actuallt some of my patients have benefited from it. Regarding the adverse effects, here's a list of some of them:
The most frequent adverse reaction to allopurinol is skin rash. Skin reactions can be severe and sometimes fatal. Therefore, treatment with allopurinol should be discontinued immediately if a rash develops. Some patients with the most severe reaction also had fever, chills, arthralgias, cholestatic jaundice, eosinophilia and mild leukocytosis or leukopenia. Among 55 patients with gout treated with allopurinol for 3 to 34 months (average greater than 1 year) and followed prospectively, Rundles observed that 3% of patients developed a type of drug reaction which was predominantly a pruritic maculopapular skin eruption, sometimes scaly or exfoliative. However, with current usage, skin reactions have been observed less frequently than 1%. The explanation for this decrease is not obvious. The incidence of skin rash may be increased in the presence of renal insufficiency. The frequency of skin rash among patients receiving ampicillin or amoxicillin concurrently with allopurinol has been reported to be increased.
Most Common Reactions* Probably Causally Related Gastrointestinal: diarrhea, nausea, alkaline phosphatase increase, SGOT/SGPT increase Metabolic and Nutritional: acute attacks of gout Skin and Appendages: rash, maculopapular rash *Early clinical studies and incidence rates from early clinical experience with allopurinol suggested that these adverse reactions were found to occur at a rate of greater than 1%. The most frequent event observed was acute attacks of gout following the initiation of therapy. Analyses of current usage suggest that the incidence of these adverse reactions is now less than 1%. The explanation for this decrease has not been determined, but it may be due to following recommended usage
Respectfully, Jordan Dimitrakov, MD
One prostatitis patient, Eliott, believes the use of the drugAllopurinolis curing him of his prostatitis symptoms. Here is his account:
Hi guys, Looks as though I might be cured. At least if you base that on being almost symptom free while on Allopurinol. I may yet find out that there is an anatomical problem I may have to deal with..............but let's back up a bit.
I guess a brief medical history might be in order for those that have not heard my saga. I am 56 years old, pretty active (although I spend too much time sitting in front of a computer), and in good health, other than suffering from chronic non-bacterial prostatitis for the past 15 years.
    Symptoms that have been with me constantly for the past year include:
  • Frequency of 3-5 times a night, urgency,
  • pain on urination (not a burning, but an aching in the prostate),
  • pain immediately after ejaculation (like a cattle prod touching my prostate every few seconds for 30 seconds or so),
  • lower abdominal pain the morning after sex (not very bad),
  • sitting pain (pain at the prostate (moderate),
  • pain at the coccyx (pretty severe),
  • pain at the left ischiel (knifelike and also pretty severe),
  • every now and then a little pain in the left testicle (no big thing),
  • every now and then pain in the left thigh (also not very bad).
As many of you are aware, I have always felt that prostatitis is a multifactorial disease. I think that feeling strongly about this gave me the freedom to search for causes other than the traditional pathogens. That and the fact that I had read about a number of men that had severe prostatitis pain, and when their prostates were removed because of Pca, they still had all their symptoms.
Anyway what prompted my research was an eleventh hour last ditch effort to avoid a biopsy. My PSA last July was 5.5 . Three and a half months later 5.4 . another three and a half months or so and I spike a 6.5 . My new urologist who I feel is pretty cool says "you had a little bump up in your PSA, and I think we should do a TRUS.
TRUS turns up a hypoechoic area. Can't tell if it's a tumor or prostatitis lesion. TRUS also shows a fair amount of stones. Uro who wants to avoid a BX and the possible can of worms it opens as much as I do, gives me 30 days worth of Cipro in the hopes that we can get my PSA down. Lot's of luck Elliott!
If I had a dollar for every Cipro, Floxin, and Bactrim I've had in the past ten years, I could retire now. From previous research I knew that stones are said to sometimes be little warehouses for bacteria, but I wanted to see what else I could find out about them. A little research turned up a paper that said upon analysis many stones were found to be made up of the same ingredients as those found in urine.........interesting.
Decided to do a search and see if I could find a link between urine and prostatitis. Found a clinical trial from Sweden which purported to show that urine refluxing into the prostatic ducts was causing prostatitis in a number of men.
Searched again looking for drug therapy for same, and found that the same investigators had prescribed Allopurinol (half the group got 300 mg day, half got 600 mg day) to lower/neutrilize the serum uric acid levels in these men. I faxed the abstract to my urologist who said "No way, that's very potent stuff". Talks about Steven Johnson syndrome and someone dying on it etc, etc.
Rob Blackburn my Aussie pharmacist E-mails me the complete paper, which I fax to the urologist, and he says.........well it doesn't look too bad, so if you like we can try 300mg per day. I go that route for two weeks and then obtain some more covertly (sorry if you're listening doc) and every other day use 600mg . Several weeks later (and sooner than it should have happened) I am pain free. Pee at last, pee at last, good lord amighty, I can pee at last.............................pain free that is.
Sitting pain, my worst symptom is completely gone. Nyet, nada, nothing. Urgency is completely gone. Frequency is gone. Nocturnal visits are down from 3-5 a night to 1 Pain in left testicle is gone. Pain in lower abdomen the morning after sex is gone. Pain in left thigh is gone. Pain on ejaculation is down 50%-60%. Pain on urination gone. NEW PSA five point one!!!!!!!! A new low for the year!!!!! I think I can bring it down further after being on Allopurinol for a couple more months.
OK, what came first the chicken or the prostatitis??? I have had prostatitis for 15 years, and 8 years ago I noticed my stream was getting weak and in fact had split.
Theory one: The prostatitis caused my prostate to squeeeeeze the urethra causing urine to reflux into the prostatic ducts enflaming the prostate, and a vicious cycle begins.
Theory two: I have some scarring or some kind of stricture which is causing the urine to reflux into the prostatic ducts. We will see what happens when I finish the Allopurinol. I have never been scoped.
SPECIAL NOTE: Allopurinol is not a benign medication. Like many other med's, it does carry a degree of risk. Steven Johnson syndrome among others. If based on your symptoms you feel that Allopurinol may be helpful..................talk to your uro about it, as well as your pharmacist. This posting may be a bit premature, but I have been pretty excited and wanted to share. Most of my excitement comes not from the remission of symptoms, but from the PSA of 5.1 and no BX, with another PSA in 4 months. The specter of Pca sure put things into perspective for me. The worst part is that I promised Marie that if I did not have Pca, I would never again complain about my prostate. On the other hand, the way things are going, it looks as though I won't have to. The lower PSA means that I can resume my life, much of which I had on hold. I will be launching a new business in a couple of weeks, and so probably won't contribute to the group as much as I have in the past. But you guy's have become part of my extended family and I will certainly be around to try and answer any and all questions.
THIS IS NOT A CURE-ALL FOR EVERYONE. I wish it was. But I truly feel that others can be helped.............at least I hope so.
BTW Allopurinol is used for Gout and the diets for gout forbid alcohol, in particular wine. Something to think about. If drinking wine causes flare-ups, you may be a candidate for Allopurinol.
AND OF COURSE YOU ALL KNOW THAT I AM NOT A DOCTOR Very best regards to all....... Elliott
Eliott provided an additional note:
In my case it was my urologists remark (during a TRUS) that I had a fair amount of stones that lead me to the research that turned up "upon analysis many prostatic calculi were found to be made up of the same ingredients as found in urine", which led to (see my post...Allopurinol and me)
In my opinion, you don't really need to have a high level of uric acid to cause a problem, if you do have reflux. BTW my stream is improving too. First time in 8 years. I'm now split only 50% of the time, instead of always. In my mind that translates into less inflammation

Alert reader Kerry wrote in.
That sounds great! There is bound to be considerable interest about Allopurinol because of Elliott Eckhaus's experience. There is information on the world wide web about the drug. I will mention only two pages that I found. Interested readers may wish to do their own searches for further infromation. I used the Yahoo search engine and come up with a description ofAllopurinolat:http://www.ami-med.com/mhc/scr/001673sc.htm
Another reference that I found was at:http://www.karger.ch/journals/eur/eur29-1.htmThis page cited a study titled: "Allopurinol Treatment Results in Elevated Prostate-Specific Antigen Levels in Prostatic Fluid and Serum of Patients with Non-Bacterial Prostatitis" by Persson, B.-E.; Ronquist, G. (Uppsala) , but did not provide a link to a copy of the study.
l also found the following URLhttp://www.wwilkins.com/urology/0022-53473-96toc.html, which mentions a paper "Ameliorative Effect of Allopurinol on Nonbacterial Prostatitis: Parallel Double-Blind Controlled Study." by B.-E. Persson, G. Ronquist and M. Ekblom, but does not provide a link to a copy of the study.

Date: Tue, 1 Oct 1996 18:59:56 -0400

From: BCapstone

Subject: Re: Allopurinol

I read the original article on Allopurinol as a treatment for prostatitis recently. Persson BE, Ronquist G, and Ekblom M: Ameliorative Effects of Allopurinol on Nonbacterial Prostatitis, The Journal of Urology, March 1996, pp. 961-964.

I was struck by a few things.

1) The authors propose that contamination of the prostate by urinary reflux with urinary nitrogen products may cause BPH and prostate cancer.

2) The study used a scale of 1 to 12 and had the patients list their discomfort on the scale prior to starting allopurinol or placebo. The most that anyone improved--on average--was only about 1 and 1/2 points on the scale. This seems disappointing if I am reading the study correctly. This is how I remember it anyway. I think there may be something to the ideas behind this study, and hope that others read the article and comment.


Date: Wed, 2 Oct 1996 15:41:15 +0100

From: Chris

Subject: Allopurinol

Hello again,
Someone asked people to relate their experiences with allopurinol.
Here's *my* story.
I have been suffering from non-bacterial prostatitis for nearly a year now, I have had been given the usual anti-biotics (no effect), alpha blockers (made me giddy) and have tried many of the herbal remedies such as zinc, pumpkin seeds and cranberry juice (all to no effect, except maybe the cranberry juice). In my desperation I did a web search for prostatitis and found the Prostatitis Foundation. Here I learned that there *were* other things that could be tried, but my specialist was sceptical about the Feliciano method.
When I saw Elliot's article about Allopurinol it got me thinking. Throughout the entire history of my symptoms, I have had dozens of urine tests and a DRE in order to analyse some prostatic excretion, but at no time were there any signs of infection. In fact my specialist had started mentioning reflux of urine as a possible cause, but I did not pick up on this as I was sure, as has been stated in the discussion groups many times, that the lack of bacteria in my tests did not mean that bacteria were not present.
I got a friend of mine to copy the articles (no medical section in our library at work) which I read and took to the specialist. He said that in the UK this drug had not been approved for treatment of prostatitis, but he was willing to give it a go with my consent.
I have been on 300 mg daily for the last three and a bit weeks and I am quite optimistic. The constant 'feeling' down there has subsided, and if I do have a bad piss, the feelings of cystitis subside a lot more quickly.
I think my troubles started as a result of cycling into work. I am 6'4" and weigh 14.5 stone. That combined with an 18 mile round trip on my softish saddle gave my prostate a hard time I think! I went about 6 months over last winter where I couldn't cycle, but now I am back on the bike at least 3 days a week (I've made 3 out of 3 days so far this week!).
I now have a Brookes Conquest saddle, which is a hard leather saddle that achieves it's suspension through two outsized springs underneath. It may look and weigh like something out of the last century, but it's the best saddle I've *ever* had!
ANYway, back to the specialist at the end of the month. I am the first he's treated with allopurinol and he said if it worked, it may change the way he deals with his NBP patients.
A word of caution however, according to the medical papers, in the trials, the effects of allopurinol appeared to wane after about three months. Whether this is due to the subjective nature of 'feeling better' or whether it is a real effect is not clear.
All I can say is that three weeks into the treatment I am not cured, but when I feel good these days, I feel within a hairs width of being back to normal.
I agree with Elliot's statement that prostatitis can be caused by many different things. I only hope that this treatment helps a significant portion of NBP sufferers.
All power to the prostatitis foundation by the way! Without you guys I'd still be drinking caffeine and wondering why I couldn't leave the bathroom!
I'll let you know how I get on. Please use this document in anyway you feel appropriate, it's the least I can do (a quantity I specialise in as Spike Milligan would say).
Thanks again,

Chris.

The usual disclaimers apply: I am not a doctor, (well, I am actually, but not in anything nearly as useful as medicine)


From:Joe Kostermanjkosterman@baan.nl>
Subject: Allopurinol for Protatitis
Date: Thu, 24 Sep 1998 11:14:43 +0200
MIME-Version: 1.0
Hi
I have just read your page regarding the Allopurinol Cure for Prostatitis .
I have done a search and came up with the following web page which describes
in great detail about Allopurinol.http://www.rxlist.com/cgi/generic/allopur.htm
Myself I have currently a lot of discomfort and have also just been told by an urologist that I just have to live with it. I am going to try the Chinese herbs and hope that this will work. I have had in the past trouble with kidney stones and believe that there is a correlation. I am also going to try the allopurinol cure if the Chinese cure is nor successful
The only reason why I decided to start with first the Chinese Prostate pills
is that it offers a permanent cure. Acomment from Chriswas the deciding factor.
Good luck to all fellow Prostatitis sufferers. I hope that this helps in your research.
Joe Kosterman
Galvani St 9
6717 AE Ede
The Netherlands
Tel : 31(0) 318-691763
Fax : 31(0) 318-691889
Email :jkosterman@baan.nl

 

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