The Prostatitis Foundation

Response to Dr. Russel Kerschmann's 1996 lecture on the pathological understanding of prostatitis.

 

In 1996, Dr. Russell Kerschmann of the University of California-San Francisco gave a lecture summarizing current pathological understanding of prostatitis. The complete lecture text was available on-line, but is no longer.

What follows on the remainder of this page is a collection of patient comments on the pathology of prostatitis collected from the newsgroup sci.med.prostate.prostatitis.

Ptyr Vanesek has pointed out an excellent paper by a medical pathologist on prostatitis, which can (sometimes) be found on the web at http://kersch.ucsf.edu/Prostate.Lecture/Prostatitis.html
I'm going to do what I can to get this material on the prosatitis website with permission. Unfortunately the author must be written by snail-mail, since he does not seem to have E-mail. The server at UCSF seems to be a bit slow at times.
A few points and responses from me personally:
1.The author, Russell Kerschmann, MD, cites a number ofther papers and points out that there are three main anatomical zones in the prostate, the perperal, transition and central zones. "The common site of both prostatitis and carcinoma in the peripheral zone also hints at a causative association between chronic prostatitis and carcinoma."
  Response: Yikes! We've talked about this on a more theoretical level, but here and at other points in his paper, Kerschmann establishes sound links that prostatitis could be causative to cancer. Maybe that is what is needed to get research attention more focused on prostatitis.
2. The author talks about bacteria in acini and about calculi containing bacteria. "This reservoir or organisms, the alkaline environment in the prostate, and the conditions of an immunologically priviledged site due in part to the poor lymphatic system in the gland, work together to produce suboptimal conditions for antibiotic therapy, which generally must be given for weeks, and then with variable success."
  Response: This is written in "scientific," a difficult dialect of English. But it confirms what we have been discussing here. It is darn difficult to kill bacteria in the prostate gland! Antibiotics alone cannot alwas or even often do the job. What I read in this section of the paper confirms for me the value of "drainage" at the same time as antibiotics to help them work.
3. "Prostatic mycosis may occur with any of the well known systemic fungal oganisms."
  Response: This says that fungal organisms can infect the prostate. Anybody who says otherwise is ill-informed. The author lists blastomyces, histoplasma, paracoccidiodes and candida as species of fungi that infect the prostate gland. From the point of view of the scientific literature, we don't have to debate these points any more.
4. Further on in the same section on fungi, the author notes that "organisms are present in the duct lumens and in the cytoplasm of the lining cells, which are destroyed..."
  Response: We've talked several times in this newsgroup about the prostate gland changing once you've had an infection, making it unlikely that it will ever by as good as it once was. Here and in several other places in the paper, Kerschmann confirms that on a cellular level, infection causes changes -- non-reversible changes -- which make the gland more susceptible to future infection and or inflammation.
5. "Prostates biopsied after transurethral resection or needle biopsy may show distinctive areas of necrosis surrounded by palisaded histiocystes, resembling rheumatoid nodules."
  Response: I translate this as "If a prostate has had a needle biopsy or TURP, the cells surrounding the place where the needle went in or tissue was removed are dead or damaged." The nodules he describes could be enough to cause prostatitis symptoms, including all the urine problems like burning, dribbling, urgency, frequency etc. I draw from this the conclusion that as much as we want a firm diagnosis of what is causing prostatitis, we should not submit to a needle biopsy or a TURP, because it may lead to problems ever after. Instead we should try to diagnose and cure infections with the least-invasive methods possible.
 
  One final response (not to this paper but in general). Why can't ultra-modern imaging techniques such as CAT scans and MRI's be used in prostatitis diagnosis? The answer may be simply that nobody has tried. For the images to be of use, medicine must know what is healthy and what diseased tissue looks like on the images produced. Most likely these simply haven't been developed for these modern imaging techniques. (Also they are expensive, I know. But we all know what the true cost of prostatitis is.)
Ken Smith (writing as a patient, not as webmaster)

 

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