John Garst

Chronic prostatitis: a patient's perspective - 1999 (Google Books)

August 18th 1996

Many of the patients who correspond here report having had partial relief of symptoms from antifungal therapy. I am one of those, and over the years I experimented with going on and off Nystatin a sufficient number of times to convince me that this was a real effect, not an accident or a placebo effect.

For many years, I thought that I probably suffered from a "yeast hypersensitivity syndrome" that was described by Dr. C. Orrin Truss 25-30 years ago. The hypothesis is that people can become sensitized to metabolic products of intestinal yeasts (perhaps to acetaldehyde, in particular).

Yeast overgrowths are promoted by several factors, one of which is antibiotic therapy. Antibiotics kill off beneficial bacteria as well as pathogens. Ordinarily, bacteria and yeasts live together in competition and the yeasts are excluded or kept to an insignificant level. When the bacteria are killed, this competition is destroyed, yeasts can invade or expand, and they often do.

Once established, an intestinal yeast overgrowth might perpetuate itself, and the patient might suffer in any of very many ways from the consequences of toxic metabolites being carried in the blood stream all over the body. In principal, the prostate could be affected in this way, and prostatitis could result.

As far as I know, every effort to substantiate Truss' hypothesis in controlled scientific experiments has failed. Several professional medical bodies have issued statements to the effect that it is "unproved." Therefore it enjoys a poor reputation in mainstream medicine.

Mainstream urology, it appears to turn out, isn't all that clean, either, though. Several urologists have told me that yeast infections of the prostate, though possible, are extremely rare, and this appears to be the mainstream view.

Yet, Dr. Feliciano reports that he "frequently" sees yeasts in the expressed prostatic fluid of patients who have had several weeks of antibiotic therapy. When Brad Hennenfent visited Dr. Feliciano in Manila for a couple of weeks, he verified this statement by his own observations of yeasts in the prostatic fluid. Thus, it appears that mainstream urology has been negligent, to a great extent, of prostatic yeasts.

Dr. Feliciano ends his therapy by administering antifungals (Sporanox or Diflucan) whether or not yeasts are seen in the EPS. Evidently, he believes that there are frequent false negative results in both microscopic examinations of Gram stains and yeast cultures. I completely agree, based on my own personal experience.

For years, I have had yeast balanitis, inflammation of the head of the penis by yeast infection. This correlated remarkably with my prostatitis symptoms, so I thought there must be a connection. Despite my urging, until recently my urologists have not associated this with my prostatitis. They have seen it as a separate problem.

I believe that I have had yeast prostatis and that it has been carried from the prostate to the glans penis in urine or semen, where it has "cultured" under the foreskin and presented as balanitis. Thus, I think that I've got a better culture medium than the laboratories, who have never found yeast in any of my specimens!

As far as I know, yeast prostatitis can involve the same kinds of symptoms as bacterial prostatitis. However, I remember from back in 1965, when I first got prostatitis, an interesting sequence of events.
    (1) Several months of a "ping-pong" external yeast infection shared with my wife.
    (2) Onset of prostatitis symptoms (pain) and balanitis.
    (3) Bacteria found in EPS.
    (4) Antibiotic therapy.
    (5) Bacteria disappear from EPS, but pain continues.
    (6) More antibiotic therapy.
    (7) Eventual surgery (modified TUR) (no cure). Etc

What I remember, in particular, is that the first round of antibiotics, which cleared my EPS of bacteria, also resulted in a "change in the nature of my pain". I told my urologist this, but of course, it meant nothing to him. What it now means to me is that the nature of my infection had changed, probably from bacteria (or a combination of bacteria and yeast) to yeast.

Later, in 1985, following stricture surgery, I had similar experiences. Antibiotics were administered as a matter of course with the surgery. At the time when I should have been healed, my pain approached the "thoughts-of-suicide" level. Eventually, I took an antifungal (at my own suggestion, not my uro's or his consultant infectious disease expert's - I had heard of Truss' theory) and my pain was greatly alleviated.

Therefore I now believe, contrary to many urologists, that prostatic yeast infections are common.

What are yeasts? How do they differ from bacteria? Well, someone else, with more expertise, ought to answer that. All I can say is that they are one-celled fungi. Some of them are ubiquitous. One of the most common pathogenic yeasts is Candida albicans, which is often responsible women's vaginal yeast infections. Yeast thrive on sugars. Diabetics and immunocompromised people tend to have trouble with yeast infections.

Here is food for thought, a hypothesis based on the above: "Antibiotic therapy causes prostatitis."

Most of us get antibiotics for various conditions that have nothing to do with the prostate (sinus or chest infections, preventive antibiotics accompanying surgery, infected wounds, etc.) This allows yeasts to proliferate (where they are) and sometimes to invade (where they were not). Sometimes they invade the prostate. Somehow this "opens the door" for bacteria (the bacterial infection is secondary here, backwards from the usual scenario in which bacteria are followed by yeasts. The bacteria take over and the yeasts are suppressed to a low level.
When the bacteria are eradicated by antibiotics, the yeasts emerge again and have to be treated separately. If there is anything novel here, it is in the supposition that the primary infection of the prostate can be a yeast infection, with a secondary bacterial infection following and taking over.

October 31st 1996
Many members of this list, including myself, are convince that yeast has some role in our cases of prostatitis.  One possible role was proposed some years ago by C. Orrin Truss (yeast hypersensitibity syndrome). Another seems to be supported by Dr. Feliciano's reports.  I don't think that anyone knows, at this time, whether or not either or both of these proposed roles of yeast is valid.

In the Truss hypothesis, the culprits are metabolites of intestinal yeast, which are carried in the blood stream to organs where they cause trouble. The prostate is one such organ.  As far as I am aware, this hypothesis has never been verified, although a large alternative-medicine industry has built up around it.

In Feliciano's picture, yeasts are prostatic pathogens that take over when the bacteria are killed off.  He claims to see yeast in the EPS on some occasions, and Brad verified this during his visit to the Philippines. Nonetheless, yeast are not seen in most cases, apparently, nor are they cultured.

In my own case, I have frequent balanitis (inflammation of the skin of the glans penis) that appears to involve yeast because it responds to antifungal drugs (Nystatin, Diflucan, Sporanox, etc.) and it "looks" like yeast to my uro.  Even so, attempts to culture yeast and to detect it by biopsy have all failed.

Dr. Nyberg, in a recent e-mail, told me that he expects to have the first prostatitis RFP issued within a month.  I see that as very good news.

I hope that the someone, and the NIH, will take an interest in tracking down the "yeast connection" in prostatitis.

December 3rd 1996
FMAG = Feliciano Method in Athens, GA.

It has now been 3.5 months since I finished a 3-month local version of the method of A. E. Feliciano, Jr., here in Athens, GA. My symptoms (pain, mostly) have not abated. However, the treatment did result in remarkable changes in my prostate and EPS. A "fibrous nodule" that was biopsied in the summer of 1995 simply disappeared during my FM treatment and my EPS went from milky cloudy to crystal clear and water white.

At the end of my treatment, I was having what appeared to be yeast balanitis, a yeast infection of the glans. I took two 5-day courses of Diflucan (100 mg /day), which did nothing for either my pain or my rash. We switched to Sporanox (9 days, 200 mg/day) and my rash quickly disappeared. My pain remained.

For a full month after ending the Sporanox, my rash stayed away. Then it came back. My wife often breaks out with a vaginal yeast infection at the same time that my rash comes, following sexual contact. Therefore I'm getting it from her or she's getting it from me. I often break out when there has been no recent sexual contact (and she, of course, doesn't break out). Therefore I'm not getting it from her. Consequently, I believe that I am the reservoir. This hypothesis also accounts for the slow return of the rash after stopping using an antifungal. It gets killed back to a small core reservoir, and it takes it a month or so to re-emerge. I've made the observation many times that the rash returns at least a month after stopping an antifungal. If this were not due to re-emergence from a reservoir, then I would expect that the rash would sometimes return after a few days, but it never does.

I conclude that the 9-day Sporanox treatment was insufficient to eliminate the prostatic (? or SV?) yeast completely. However, my uro was not willing to prescribe it for a long term without consulting an infectious disease specialist (IDS).

Yesterday I saw my IDS. He considered all the facts, thought it plausible to try a couple of months of Sporanox, and brought up Reiter's Syndrome. He treats psoriasis, a related condition, with the cancer drug methotrexate. He proposed a methotrexate trial for me if the Sporanox fails.

A. N. Feliciano wrote me recently that he believes that regular drainages are just as important during antifungal therapy as during antibacterial therapy. I think I'll try DIY.