Intraprostatic Injection

Intraprostatic injectionIn the early 2000s, the concept of injecting the prostate transperineally with a combination of steroids (betamethasone) and antibiotics (to prevent the steroid-induced local immunosuppression leading to abscess) gained currency through the efforts of European practitioners, and especially Dr Federico Guercini of Rome, Italy. Dr Guercini claimed a high success rate (68% cured at 6 and 12 month follow-ups), and published an optimistic paper on the treatment in 2005.

Other researchers noted that there were some studies 20-30 years ago showing that the availability of antibiotics in the prostate following the intraprostatic protocol is exactly the same as the amount you get when you give the patient an intramuscular shot of the same antibiotic. The success rate in in these old trials was low and the complication rate was higher.

Dr J. Curtis Nickel, writing in his book “Textbook of Prostatitis” has this to say:

Intraprostatic injection of antibiotics

Intraprostatic injection into the caudal prostate was possibly first described in 1983 by Baert et al [who were treating chronic bacterial prostatitis]. … prostatic biopsy is complicated, on some occasions, by life-threatening septicaemia especially with transrectal prostatic [needle] biopsy (unless preceded by colonic washouts and pre-biopsy [intramuscular antibiotic treatment]). …The transperineal route of injection is potentially extremely painful for the patient, anecdotally in the author’s experience (unpublished data). Baert et al report haematuria and haemospermia [blood in urine and semen] lasting for some weeks after their therapy … (Chapter 35, Medical management of chronic non-bacterial prostatitis, Evans DTP, Page 295)

One of the leading American practitioners of this treatment, Dr Duke Bahn, writes (June 2002):

I perform a complete transrectal ultrasound of the prostate to rule out any of the other possible causes, such as prostate cancer or stones in the ejaculatory duct. For the injection, I use trans-rectal approach utilizing 22-g fine needle. The mixture is a combination of Gentamycin, Levaquin, Diflucan, Bethamethasone, Lidocaine and Toradol. All together, it is 10 ml. I infiltrate 3 ml into each lobe of the prostate including the peripheral zone and transitional zone. I also inject 2 ml into each seminal vesicle (if you do not treat the seminal vesicle, the efficacy goes down). I like to repeat the treatment two more times, in two week intervals. I have not encountered any significant complications or side effects so far, even though they may not be known yet. The only expected side effects are hematuria and hematospermia, both of which go away by themselves. Most of my patients have stated that the procedure was quite tolerable with only minor discomfort. It should be noted that this is a rather unconventional way of treating prostatitis with unknown long term effects. I still encourage you to work with your physician. You should not take this method unless all of your other options are exhausted and your situation becomes desperate.

The treatment can therefore be seen as risky and possibly very painful. Is it still worth it, has anyone been cured, and what makes it work (the antibiotics or the steroids?), and is the treatment durable? Patients of Dr Bahn relate their experiences on our chronic prostatitis / CPPS forum. Warning: you are strongly advised to read the patient experiences before deciding on this treatment.

Final word from “The Urology Bible” (Walsh: Campbell’s Urology, 8th ed., 2002):

Intraprostatic Injections

….A number of investigators (Baert and Leonard, 1988; Jimenez-Cruz et al, 1988; Yamamoto et al, 1996) have advocated direct injection of antibiotics into the prostate gland, but this method has never been rigorously evaluated or become popular among urologists.” [The Prostatitis Syndromes by J. Curtis Nickel, page 619]