I have noticed that recently there has been quite a bit do discussion on
this Newsgroup concerning whether so-called "chronic" prostatitis (CPPS,
Types II. and/or III.) is an acute disease or a chronic disease.

If I can find the time in the next week or so, I will write a brief
paragraph or two about so-called "acute" prostatitis (CPPS, Type I.). At
this time, I would like to add that "acute" is an uncommon clinical
disorder whereas "chronic" prostatitis is quite common.

At this time, I would like to re-post a second paper (see below) which I
wrote a "few" years ago.  This paper points out the clinical paradox
that patients with "so-called" chronic prostatitis (CPPS, Types II. and
III.) have a clinical presentation consistent with a chronic disease,
and yet they have cytologic laboratory findings consistent with an acute
inflammatory process.

I would welcome and constructive discussion.

Yours,
John Polacheck, M.D.
Medical Director
Prostatitis Center
Tucson, Arizona

Preferred E-mail address:   jpolach@dakotacom.net

Telephone:   520-622-4599

****************************************************************

A Great Medical Paradox
         or
The Prostatitis Oxymoron

The great French writer Marcel Proust (1871-1922) embodied
contradictions.  His prose was among the most graceful of his age.  Yet
Proust understood inconsistencies, including those in medicine.  The son
of a distinguished French physician, Proust once wrote that medicine is
“a compendium of the successive and contradictory mistakes of medical
practitioners …”

A century later, a pair of Arizona-based physicians finds singular merit
in Proust’s observations on contradictions.  Dr. John Polacheck, an
internist, and Dr. Eduardo Vega, a pathologist, struggle with a modern
medical incongruity:  Can an infectious disease be simultaneously
chronic and acute?

The distinction between an acute and a chronic infection is usually
self-evident.  Acute infections generally have an abrupt onset and a
rapid progression.  Examples are:  strep throat, pneumococcal pneumonia,
and bacterial meningitis.  If successful, their response to treatment is
usually relatively rapid also.  By contrast, chronic infections
generally have an insidious onset and a gradual progression.  Examples
are:  tuberculosis, AIDS, and Lyme disease.  Moreover, their response to
treatment is most often gradual.

Furthermore, the body responds quite differently to an acute or a
chronic infection.  The pathologic response to an acute infection is
with white blood cells that are specialized to fight bacteria:
polymorphonuclear (PMN) cells, commonly referred to as pus cells.  On
the other hand, the body uses very different types of white blood cells
to fight chronic infections: lymphocytes and monocytes.  A pathologist
can readily distinguish acute cells from chronic ones when examining
tissue under the microscope.

Chronic vs. acute:  It should be an “either/or” situation.  Webster’s
Third Edition Dictionary goes as far as defining “acute” as the opposite
of “chronic.”  But could there be a disease that simultaneously
manifests signs of both?  A contradiction incarnate?

Drs. Polacheck and Vega have focused their attention on the prostate, a
mere walnut-sized pelvic gland located between a man’s bladder and his
penis.  When infected acutely, a true acute illness, properly called
“acute” prostatitis, occurs.  Acute prostatitis has an acute clinical
course and demonstrates an acute pathologic picture.  However, that is
not the prostate illness which has puzzled these two physicians.  The
mysterious illness which is the subject of this story is the so-called
“chronic” prostatitis.

“Chronic” prostatitis is a true medical malady!!! It is quite common and
afflicts young and old men alike.  The symptoms can be quite minimal or
they can become most severe and even disabling.  Often, the severity
fluctuates – a patient will have good periods alternating with bad ones.
 The scourge can last for decades.  It is a most ill-defined disease
medically.  “Prostatitis” means simply that the prostate is inflamed.
Often, there is pain, varying widely from mild irritation to searing
pain that prevents one from sitting down, urinating properly, or even
experiencing normal sexual pleasure. Yet this disorder has received
precious little attention.  Its more ominous cousin, prostate cancer,
overshadows prostatitis and siphons off large amounts of the available
clinical and research funds.  Scant little is actually known.  In a
recent urology book devoted entirely to the prostate, only ten pages out
of 312 were dedicated to prostatitis.  And yet, as Dr. Charles Brendler,
chief urologist with the University of Chicago medical school, said, he
cannot find normal prostate tissue in patients over forty years of age.

Embracing the concept that the study of a disease begins with pathology,
Drs. Polacheck and Vega examined the rudiments of so-called “chronic”
prostatitis.  “Something wasn’t fitting right,” said Polacheck.  “We
needed a fresh approach to its pathology.” As a diagnostic tool, they
used the fluid called Expressed Prostatic Secretion (EPS). It is a
clear, goopy fluid that comes out of the tip of the penis when the
prostate receives a vigorous massage (done by a physician with a finger
in the rectum).  Dr. Polacheck provided EPS samples (from Prostatitis
Center, Tucson, Arizona patients) to Dr. Vega, who examined them
microsopically, using the same methods as those for PAP smear for women.
 The clinical findings for all of these patients are most consistent
with so-called “chronic” prostatitis.  In fact, Dr. Polacheck exclaimed,
“these patients are the most chronic of the chronic!”

When Dr. Vega examined the EPS from these patients under the microscope,
he observed that the fluid was teeming with clumps of white blood cells.
Furthermore, when he looked at the details of the cells, he found
predominately PMNs, acute-inflammatory (pus) cells.  Drs. Polacheck and
Vega decided to call these clumps “Prostatic Acute-Inflammatory
Aggregates (PAAs). What a surprise to find acute-inflammatory cells
under the microscope in a disease which manifests itself chronically.
Thus, Drs. Polacheck and Vega have found a disease which is most
“chronic” in its clinical presentation, yet most “acute” in its
pathological picture!!!  They are unaware of any other such
chronic-acute disease.

HENCE, A GREAT MEDICAL PARADOX …
THE PROSTATITIS OXYMORON: CHRONIC-ACUTE PROSTATITIS

Dr. Polacheck and Vega have proposed re-naming the disorder, up to now
called “chronic” prostatitis.”  They propose:  “persistent
acute-inflammatory” prostatitis (PAP).  (The name “chronic-acute”
prostatitis is simply too grating to one’s “logical” ears.) They believe
that a more accurate name will serve as a better foundation for
understanding the disease and that, in turn, will lead to the
development of improved clinical treatments.

Two other possible names have been proposed: "chronic active
prostatitis" and "persistent active prostatitis".  These names are
reminiscent of names used for persistent or active hepatitis (but please
note that the cytopathology of this disorder is that of a chronic
inflammatory process).