Antibiotics and Prostate Massage
History of the procedure
Repetitive prostatic massage has a long history. Once the most popular therapeutic maneuver used to treat prostatitis, it was abandoned as primary therapy in the 1970s. It made a short-lived comeback in the late 1990s, based on isolated stories of cures emanating from the Philippines, and by the relentless promotion of the technique by the website prostatitis.org (the “Prostatitis Foundation”).
Then in 2003 a study found that antibiotics, in the end, are no better than placebo for men with CP/CPPS. Finally in 2006 another study showed that patients who had prostate massage in combination with antibiotics did no better than patients who took antibiotics alone, thus invalidating the whole idea.
The “Manila Protocol”
The Manila Protocol, so-called because it started in Manila in a clinics run by the late Dr A. N. Feliciano and his son Dr A. E. Feliciano, is an outmoded form of treatment that used antibiotics in conjunction with prostate massage to effect improvement in some patients. But recent studies showing that antibiotics are ineffective in chronic pelvic pain suggest that the intrarectal massage component of this protocol was actually the helpful element of the protocol. Intrarectal massage functions inadvertently as a form of physical therapy to the intrapelvic trigger points identified by Wise and Anderson.
One of the men behind the Prostatitis Foundation, Bradley Hennenfent, teamed up with the younger Feliciano to publish a study promoting this form of treatment in a low quality journal (the “Digital Journal of Urology”). This non-peer-reviewed, cash-for-comment PR-type journal went bust after a few years.
So during the late 1990s and early 2000s, demand for “antibiotics + prostate massage” treatment expanded significantly after the (non-urologist) Filipino doctors claimed a 100% cure rate on postings to Usenet and on their websites. They called their “cure” the Manila Protocol. Many sufferers, eager for an answer, any answer, latched onto this claim. Word spread like wildfire thanks to the efforts of the Prostatitis Foundation. This foundation was (and still is, circa 2017) in cahoots with the younger Filipino doctor, touting his methods as “the answer” for CP/CPPS. The inference was that corrupt Western doctors had deliberately ignored this simple cure because of they profited from patients remaining unwell. The proponents of this “new” technique overlooked the fact that doctors had frequently used this method in the pre- and post-War era to help relieve symptoms, although it had fallen into disuse because it is labor-intensive and ultimately ineffective. Very few durable cures using this method were verifiably reported, and as time passed more and more men posted their disappointment to the Usenet newsgroup (now defunct) after attending the Manila clinics, effectively killing off the popularity of the protocol.
What little success the protocol enjoyed was almost certainly a combination of the placebo effect, the anti-inflammatory effect of many antibiotics, and the unintended myofascial release aspects of prostate massage. However, massaging deep muscles adjacent to the bladder and prostate, such as the insertions of the levator ani muscles, is best accomplished by using the Wise-Anderson Protocol Massage Wand, rather than by travelling to Manila or Tucson AZ (where one of Feliciano’s acolytes, Dr Polacheck, used to run a similar clinic until it closed ~2009) in the view of this website.
This protocol is not used in the Western world today, although some doctors in China still massage the prostate as a form of treatment.
If you are confused about the worth of this treatment, consider joining the Prostatitis Network forum where it is extensively discussed and dissected.