The Value of EPS Cultures
A December 2001 Conversation from a Prostatitis Forum:"Derek" wrote -
My point was that "bacterial prostatitis" is a class of the disease, and it does occur, so eliminating it from discussion would not be justified. Maybe someone could correct me, but the latest numbers have it at up to 10%.
A urologist answered:
To correct you: Category II prostatitis (CBP) is NOT CPPS. That distinction (CPPS) is reserved for Category IIIa and IIIb. The vast majority of people who post here on this forum have category III.
It still deserves discussion, but probably not by people with category III except in an academic sense. Many men here, including yourself, I believe have category III. What use is it to discuss cat II? Probably not much.
"Latest numbers?" I'm not sure where you get those numbers, but my experiential numbers in a clinical practice once with a heavy emphasis on CP/CPPS with a policy of doing a form of Stamey-Meares localization cultures in a setting of "all men with CP/CPPS symptoms get them" showed NO indisputable positive cultures in over 200 men. I did have one man with negative EPS cultures who showed up subsequently 2-3 times with a positive urine culture, and typical symptoms of a UTI, so MAYBE he had cat II, but not a single man with the standard, garden variety syndrome was ever shown to have X bacteria and thus responded to Y antibiotic. Some men with "non-bacterial CP" as it was called at the time I was doing all this responded to antibiotics, others did not. Ergo, I found that in a clinical setting of "everyday practice" the EPS cultures did the following:
- Did not alter therapeutic decisions (because even after the negative cultures, they insisted on antibiotics anyway)
- Cost a lot
- Created confusion when "commensals" were detected...were these pathogens or innocent urethral bugs?
- Created anxiety during the 7 day wait
- Attracted a bunch of hypervigilant hypochondriacal types who drove me batty and out of the business of a CP/CPPS focused practice.
So, I do not speak off the cuff, I speak from experience. In a research setting or perhaps a tertiary center performing clinical research these studies may still be of value. I found them not to be so.
For what it's worth, when I was a resident we used to do a VB3
and I never recall any of those being positive back then, either.