Chronic prostatitis can cause great discomfort which varies but can include pelvic pain, pelvic pressure, a vague sense of discomfort, a feeling of malaise and fatigue, fever, burning on urination, pain on reaching orgasm, and bleeding. The disease can be ruinous, interfering with work, intimacy, and other things. Only few reports in some carefully selected patients can a radical prostatovesiculectomy be proposed as the ultimate therapeutic measure, without randomized studies that support the results of this aggressive treatment (Davis and Weigel 1990; Alexander 2003; Krongrad and Lai 2011, Chopra et al. 2016, Schoeb et al. 2017).
We present a 56-years-old male with medication refractory chronic prostatitis treated with a radical prostatectomy. A review of the literature are performed.
In 2006, a 56-year-old male was referred by a urologist colleague. The patient had a 5-year history of severe, treatment-refractory chronic prostatitis/ chronic pelvic pain syndrome (CPPS) characterized by an inability to comfortably urinate, ejaculate, perineal pain, chronic testicular pain and sit without a donut cushion.
He also had irritable bowels, depression, and social isolation. He had diligently but ineffectively sought relief elsewhere.
IPSS score 22. Chronic Prostatitis Symptom Index (CPSI) score 35. Uro-flowmetry: Q max 15ml/sec.
DRE demonstrated an enlarged adenomatous prostate without signs of malignancy. PSA 3.74 ng/ml. Negative urine and sperm cultures.
In urethrocystoscopy a median prostate was observed with congestion of the bladder neck. The bladder did not show lesions. Urine cytology was negative for malignant cells. His prior treatment had included many of the forms of therapy: antibiotic therapy, alfa-bloquers, saw palmetto, nonsteroidal anti-inflammatory drugs, benzodiazepines and narcotics.
In March 2007, a transrectal prostate biopsy was performed. Histological study: high-grade PIN in left side.
In May 2008 the transrectal prostate biopsy was repeated. Histological study: BPH.
October 2011, PSA 7.01 ng/ml. Prostate biopsy: prostate adenocarcinoma Gleason 3+3, 10% in one of the cylinders located on the left side.
A radical prostatectomy was performed with preservation of neurovascular bundles was performed. Pathological stage: PT2c Gleason 3+3 prostate adenocarcinoma with apical and left positive margins and multiple foci of chronic prostatitis.
Two months after surgery, CPSI scores declined until 5 and he reported resolution of perineal and testicular pain, urinary symptoms, associated fatigue, irritable bowels, generalized aches, and impaired cognition. The patient was continent. Postoperative PSA <0.01 ng/ml. He related absence of spontaneous erection. IIEF-15 score: 15.
PSA at 2016 0.38 ng/ml. 46 Gy of external radiotherapy was performed on prostate bed.
Currently, PSA <0.01 ng/ml, he maintains good erections using 500 mcg intraurethral alprostadil and vacuum erection device. IIEF-15 score: 61. The patient does not have symptoms attributable to chronic pelvic pain syndrome (CPSI 1).
Only 21 cases of patients affected by chronic prostatitis treated with radical prostatectomy have previously been described. Resolution of symptoms has been reported in up to 95% of cases (20/21), but with secondary side effects such as urinary incontinence and erectile dysfunction.
Radical prostatectomy is an ultimate treatment option that can be used in highly selected patients with chronic prostatitis. However, prospective studies are needed to generalize this technique with standard treatment..