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April 18, 2020

Finding the Missing Piece -Dr. Mistry and Donna Lee Discuss Chronic Prostatitis Causes and Treatments

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello and welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your host. Really happy to give you guys a great show with my cohost and co partner in crime, Donna Lee.

Donna Lee: 

That’s right, lots of crime.

Dr. Mistry: 

Lots of crime…crime against good radio, I guess.

Donna Lee: 

Maybe.

Dr. Mistry: 

We’re doing our best.

Donna Lee: 

That’s right. You can hear our crime-ridden podcasts, not that we have a theme. Our podcasts are everywhere. We’re getting so many downloads. I’m so impressed.

Dr. Mistry: 

That’s right. We are doing really well. We encourage you to listen to the show or previous episodes if you find the information to be valuable. Some people will find it to be a little, a little thick, like the information is a little thick.

Donna Lee: 

Like molasses?

Dr. Mistry: 

But I decided, you know, when we decided to put the show together that I wasn’t going to try to dumb down people. I was going to try to talk to people on the radio exactly as I talked to them here in the office because I want them to be fully informed. And I think there are more men out there, you know, we kind of make that joke or that generalization that men don’t really like doctors. They don’t really like…I think they don’t like to be simplified and they don’t like to be told something they could have easily learned on the internet. We’re here to distill information, create treatment programs that are personalized for you, and then give you ways of treating things that you never would have thought, whether it be supplements, or nutritional counseling, biomechanical therapy with our physical therapist, or sex therapy with our sex therapists here in the office…

Donna Lee: 

Or dietician.

Dr. Mistry: 

…or any of the number of different resources that we have that you may not even think is a natural part of a urology practice or a urology experience.

Donna Lee: 

You know, what’s fascinating to me is that you guys are fixers. You want to fix it. And when we women come to you and we’re like just complaining and venting and you’re, you go into fix it mode–but when it comes to your health and your penis issues, or your cancer issues…y’all don’t want to fix it. I don’t understand. Help me.

Dr. Mistry: 

Come on, boys. Step up here.

Donna Lee: 

Yeah, fixer, in your own lifes

Dr. Mistry: 

We love your questions. It’s really what drives the show, makes sure that what information we’re providing is pertinent to what the desires of our listeners are. Donna Lee, why don’t you give us a question?

Donna Lee: 

Alright. You can send your questions to armormenshealth@gmail.com. We have a new listener and this is a pretty loaded question, so I want to get through it as best I can. “Dear Dr. Mistry, I have been diagnosed with Prostatitis 3 times in the last 12 months. It originally presented itself as blood in my semen, which freaked me out. I was put on Levofloxacin for 2 weeks and ended up having to take it for a total of 8 weeks last year. Exam of my prostate exhibited no nodules, but it was inflamed. I’ve had a cystoscope through my penis into my bladder.” We know what that’s all about. “While traveling to my bladder, the urologist looked at my prostate and said he had to get through it to the bladder. Stated it looked good but irritated.” His PSA is 1.2 goes on with. He went to the ER. The ER doctor said it was a flare up of his Prostatitis again and treated him with Levofloxacin again. In March his blood levels checked, his hormones were done and his PSA had jumped to 8.3 my from 1.2, in may of 2019. Obviously he was startled. He went to the urologist, was examined again, no nodules on my prostate. Was told it was spongy and felt normal. He was placed on another round of antibiotics for 2 weeks. He’s going in a soon to have his PSA checked again, following up with the urologist again, his question: “Am I missing anything or is something…is this somewhat normal for men who suffer with Prostatitis? He’s only 48 and his father had prostate issues at 59, and his prostate was removed. He said, “I just want to make sure I’m not missing anything.” Sounds like a big old second-opinion kind of email.

Dr. Mistry: 

Totally. It’s a great question. And your approach to a patient with chronic Prostatitis has a lot to do as a urologist [with] where you trained and kind of how you approach the problem. You know, if I could just kind of generalize this experience to other men, Prostatitis is generally experienced by men, some numbers will describe up to 10% of the male population will have at least one episode of Prostatitis in their life. It can present with pain in the groin, pain in the testicles, pain underneath the scrotum. It can present with urinary frequency, urgency, hesitancy. Blood in the semen is a common one, blood in the urine can also occur. Backache, if it’s a bacterial Prostatitis. Usually antibiotics are appropriate. Oftentimes you’ll find a bacteria on urine sampling. Those patients are often treated with antibiotics. They can present fever, high fever sometimes that even requires hospitalization. Usually the antibiotics will knock out a chronic Prostatitis. But, you know, in my practice I generally put people on it for 3 weeks because the prostate is so hard to penetrate with antibiotics. We also will put people on an antiinflammatory. I have gotten away from the use of of Levofloxacin and Ciprofloxacin because of my concern about a joint and ligament damage that they can do. So I use other antibiotics instead. If that’s what’s happening, but you’re getting the same thing happen over and over again, the first thing that we needed to distinguish is is this recurrent infections with the bacteria, or was your first one with a bacteria and now you’re having something called chronic Prostatitis or non-bacterial Prostatitis. So let’s just take this listener’s question at face value and that he really did have 3 times bacteria that infected his prostate. So either he’s got the wrong characters hanging around, like the wrong bacteria, and the bacteria comes from his colon–either the wrong bacteria hanging around, or his prostate is anatomically somehow predisposed to allow this bacteria to sit in there.

Donna Lee: 

Huh. How do you test for that?

Dr. Mistry: 

Well, we do test…the cystoscopy is one test. We do something called a post-void residual measurement to see how much urine is left in the bladder afterwards. Then here we do the microbiome testing and we look at the bacteria that’s in the rectum and make sure that they are not you know the real bad actors. These are the people that we put on real strong probiotics or a, kind of like a personalized probiotic program. Almost all of our patients that have been on antibiotics will need to take probiotics because we want them to have bacteria that are easy to kill and nice for the body to kind of interact with. And that’s what probiotics are.

Donna Lee: 

Oh, I though probiotics were just for gut health, but that’s not true.

Dr. Mistry: 

No, probiotics for gut health, probiotics for urinary health is very important because, what did they say? Nature put the sewage plant right next to the pleasure center or something? But most of the bacteria that affects us…

Donna Lee: 

Sounds like Lockhart, Texas.

Dr. Mistry: 

…in our urinary system, you know, comes from the colon, and comes right out, you know, and kind of covers our body from that. So, what I would say is that if, so I would almost always say that patients who’ve had 3 episodes of Prostatitis in 12 months, those patients should be put on a medicine to relax their prostate, usually Flomax or also known as Tamsulosin, to kind of relax the prostate and have the urine go through the prostate with less pressure. I think that has less urine that gets kind of pushed into the interstities of the prostate and less likelihood of this bacterial colonization. Absolutely, most patients that I have, if you get 2 within a year I’d put you on it, but certainly 3. And then you know, there are, there may be some value in doing some advanced imaging of the prostate, like a prostate MRI. In this particular case, the elevated PSA is almost completely unrelated to cancer. It’s almost overwhelmingly likely to related to an infection of the prostate. And then, on the other hand, you start thinking about patients that don’t really have bacteria, called non-bacterial Prostatitis. This makes up a big part of our practice, because our approach to non bacterial Prostatitis is a lot very similar to how you would approach Irritable Bowel Syndrome in a GI clinic. You’re looking at dietary modification, supplements, you’re looking at inflammatory testing. You’re also looking at using biomechanical trainings such as our pelvic floor physical therapist, and prolonged use of low dose antibiotics or prolonged use of medicines like Tamsulosin. So, that’s really, you know, for this this question, I just want to make sure that–they’re wondering if something’s getting missed. And the answer to me is if you’ve had your third one in a year, something’s probably getting missed. And so, I think that getting a second opinion, getting somebody to really delve into this problem, because right now you’ve gotten away with not getting too sick. These things can actually make you quite sick.

Donna Lee: 

Quickly.

Dr. Mistry: 

Yes. And you’re missing work.

Donna Lee: 

Well, and his Dad was really young to have his prostate removed.

Dr. Mistry: 

Yeah. You may feel uncomfortable about having intercourse or ejaculating. This prostate problem can really kind of move on to other parts of your life. And certainly there’s nothing super healthy about taking 8 or 12 or 16 weeks of antibiotics. It can really mess with lots of parts of your system. As I mentioned, there’s risks to ligament and cartilage development and Achilles rupture can occur. And so for that reason, we really try to rely on a preventative strategy here with making sure we know what bacteria are going to be likely the cause of your Prostatitis, and we want to make sure that the antibiotic is really what you need because if you don’t have a bacterial Prostatitis, you don’t need to be on antibiotics. We need to find a different way of treating it. And so I think that’s a great question.

Donna Lee: 

Yeah, there was a lot of information. I hope that he tunes in. Well we’re open for second opinions.

Dr. Mistry: 

That’s right, we are open for second opinions.

Donna Lee: 

You love you a good second opinion.

Dr. Mistry: 

I do love it, I do love…

Donna Lee: 

Unless it’s your patient’s going…

Dr. Mistry: 

Well, that’s OK.

Donna Lee: 

That doesn’t happen very often.

Dr. Mistry: 

I don’t mind. I don’t mind my patients going for a second opinion. They come back. They had the good home cooking already.

Donna Lee: 

They had the meatloaf and they left for a generic hamburger. You can reach us during the week at (512) 238-0762. Please send us these amazing questions and we will answer them anonymously. I’ll respond to the email so you know. Our email address is armormenshealth@gmail.com. That’s armormenshealth@gmail.com. Our website is armormenshealth.com and you can check out our podcasts anywhere you listen to podcasts. They are free and amazing and have a wonderful rest of your day. Bye!

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The Armor Men’s Health Hour is brought to you by Urology Specialists of Austin. For questions or to schedule an appointment, please call (512) 238-0762 or online at armormen’s health.com.

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