Repetitive prostatic massage therapy for chronic refractory prostatitis: the Philippine experience

Nickel JC, Downey J, Feliciano Jr. AE, Hennenfent BR:
Repetitive prostatic massage therapy for chronic refractory prostatitis: the Philippine experience. Tech Urol. 1999 Sep;5(3):146-51.

Patients frustrated with failure of traditional therapy for prostatitis have traveled to the
Philippines and elsewhere for repetitive prostatic massage combined with antibiotic therapy.
The aim of our study was to evaluate prospectively the response of patients who traveled to
Manila to undergo this treatment. Twenty-six patients consented and were registered by the
Prostatitis Foundation (B.H.) and subsequently evaluated (J.C.N., J.D.) prior to and following
treatment (A.E.F.). Evaluation at baseline and after treatment consisted of standardized
history and previously validated prostatitis-specific Symptom Frequency Questionnaire (SFQ)
and Symptom Severity Index (SSI), International Prostate Symptom Score (I-PSS) and Quality
of Life (QoL) questionnaire, the O'Leary Sexual Function Inventory (SFI), and a Subjective
Global Assessment (SGA). Treatment in Manila consisted of triweekly prostatic massage
combined with specific culture directed and/or empirical antimicrobial therapy for 6 to 12
weeks. Twenty-two patients completed at least one follow-up assessment and 12 patients
completed 2-year assessment (average follow-up of 17 months in 22 patients). There was a
significant decrease in average symptom severity (SSI) by 4 months that continued for 2
years, but less improvement in symptom frequency (SFQ) and quality of life (QoL), and no
significant improvement in voiding symptoms (I-PSS) or sexual function (SFI) at time of last
assessment. Forty-six percent of the 22 evaluable patients had >60% decrease (significant
improvement) in symptom severity (SSI), whereas 27% had similar significant improvement in
frequency of symptoms (SFQ) when last assessed. Thirty-three percent reported marked
subjective improvement (SGA) at last evaluation. Of the 12 patients who completed the 2-year
follow-up, 5 of the original 26 had a significant and sustainable improvement in objective and
subjective measurements of frequency and severity of symptoms. The combination of prostatic
massage and antibiotics for treating difficult refractory cases of prostatitis may be promising,
but its ultimate value needs to be confirmed. Studies in patients with less refractory and
shorter duration disease may allow us to predict who will respond to this therapeutic
approach.