Repetitive Prostatic Massage Therapy for Chronic Refractory Prostatitis: The Philippine Experience

JC Nickel, J Downey, AE Feliciano, Jr, B Hennenfent

Queen's University at Kingston, Canada; Manila, Philippines; Atlanta, USA

Objective To prospectively evaluate the response of patients who traveled to Manila to undergo repetitive prostatic massage combined with antibiotic therapy.

Patients and Methods Twenty-six (26) patients were evaluated prior to and following treatment. Evaluation at baseline and after treatment consisted of standardized history and previously validated prostatitis specific Symptom Frequency Questionnaire (SFQ) and Symptom Severity Index (SSI), International Prostate Symptom Score (I-PSS) and Quality of Life (QoL) questionnaire, the O'Leary Sexual Function Inventory (SFI), and a Subjective Global Assessment (SGA). Treatment in Manila consisted of tri-weekly prostatic massage combined with specific culture directed and/or empiric antimicrobial therapy for 6-12 weeks.

Results Twenty-two (22) patients completed at least one follow up assessment, and 12 patients completed a 2- year assessment (average follow up in 22 patients was 17 months). There was a significant decrease in average symptom severity (SSI) by

4 months that continued for 2 years, but less improvement in symptom frequency (SFQ) and Quality of Life (QoL) and no significant improvement in voiding symptoms (I-PSS) or sexual function (SFI) at time of last assessment. Forty six percent (46%) of the 22 evaluable patients had >60% decrease (significant improvement) in symptom severity (SSI), while 27% had similar significant improvement in frequency of symptoms (SFQ) when last assessed. Thirty-three percent (33%) reported marked subjective improvement (SGA) at last evaluation. Of the 12 patients who completed the 2-year follow up, 5 (out of the original 26) had a significant and sustainable improvement in objective and subjective measurements of frequency and severity of symptoms.

Conclusions The combination of prostatic massage and antibiotics for treating difficult refractory cases of prostatitis may be promising, but its ultimate value needs to be confirmed. Studies in patients with less refractory and shorter duration disease may allow us to predict who will respond to this therapeutic approach.