Category III chronic prostatitis/chronic pelvic pain syndrome (CPPS) is a common debilitating condition of unclear etiology. Patients often have prostatic calcifications seen on transrectal ultrasound (TRUS) but their link to symptoms is controversial. Nanobacteria are implicated in stone formation in the urinary tract, thus, therapy aimed at eliminating them and the stones that nanobacteria produce might have an impact on CPPS symptoms. Nanobacteria are gram-negative, small size, slow growing and have the ability to form calcium phosphate crystals at neutral pH. Their growth in vitro is best inhibited by tetracycline.
A total of 16 men with recalcitrant CPPS refractory to multiple prior therapies and who had prostatic calculi seen on TRUS were chosen to be included in a study whose aim was to examine the effectiveness of therapy aimed at nanobacteria. The study was performed by D. A. Shoskes and colleagues from Cleveland Clinic of Florida and the results reported in the February, 2005 issue of the Journal of Urology. All men were treated with comET, which consists of 500mg tetracycline orally, nanobacOTC supplement (a proprietary blend of Vitamin C, selenium, EDTA, coenzyme Q10, bromelain, grapeseed extract, hawthorn berry, quercetin, L-arginine, vitamins B3, B6 and B9, L-lysine, L-ornithine, trypsin and papain), and a rectal suppository containing 1,500 mg EDTA. The nanobact OTC purportedly allows the antibiotic to penetrate the stone and the EDTA allows for stone dissolution. Therapy duration was 3 to 4 months.
A closer look at the study population revealed that the mean age of the patients was 44.6 years, and mean symptom duration was 6.3 years. Using a definition of expressed prostatic secretion inflammation of at least 10 white blood cells per high power field, 7 men had category IIIa (inflammatory) and 8 had category IIIb disease. The initial mean NIH-Chronic Prostatitis Score Index (CPSI) was 25.7 at baseline. Nine men (60%) had nanobacterial antigen or antibody detected in the blood, 6 (40%) had nanobacterial antigen in the urine.
Results revealed that the mean NIH-CPSI total score improved from 25.7 to 13.7 while the pain index decreased from 11.3 to 4.9. A total of 12 patients (80%) had at least a 25% improvement on NIH-CPSI and 8 (53%) had at least a 50% improvement. In 10 patients who underwent transrectal ultrasound after therapy, prostatic stones were decreased in size or resolved in 50%. Seven patients who were examined at least 3 months after completing therapy had no recurrence or worsening of symptoms.
In conclusion, therapy designed to eliminate nanobacteria resulted in significant improvement in the symptoms of recalcitrant CPPS in the majority of men, whether due to the treatment of stones producing nanobacteria or through some other mechanism. As with urinary tract calculi, the key factor in symptoms may be obstruction. Calcification within ducts draining prostatic glands could cause obstruction, secondary inflammation and increased intraprostatic pressures. This comET therapy warrants prospective placebo controlled trails due the paucity of alternative treatments for this chronic condition.
From Uro Today.
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