Dr. Jeannette Potts Fights Chronic Prostatitis Misdiagnosis and Label –
If you’ve been told that your pelvic pain is the result of chronic prostatitis, you are not alone. If you’ve spent hundreds if not thousands of dollars on various “prostate centric” antibiotics and other prescriptions, you’re in the company of millions of men who, it turns out, may not have had prostate or infection problems at all.
This Friday, Dr. Jeannette Potts (Vista Urology, San Jose CA) will be directing a class “Real Men Get Real Pelvic Pain” at the 2017 American Urology Association Annual Meeting where she and her fellow presenters return to challenge urologists about the dangers of prostatocentric thinking.
Dr. Potts represents the modern day, cutting edge approach to pelvic pain diagnosis and treatment that requires a thoughtful assessment of structures and functions inside AND outside of the urinary tract, particularly the pelvic floor muscles and nervous system. Her theme: “Pelvic pain does not always equal prostatitis nor even a urological disease.” Pelvic floor dysfunction as well as other neurological disorders may be the underlying problem.
One key concern of Dr. Potts is the overuse of antibiotics and other prostate medications before a thorough diagnosis has been completed. She recently said “Six weeks of Cipro without a localization culture supporting its use” is inappropriate. Physicians should be more thoughtful and accountable as they form a diagnosis and consider treatments rather than quickly labelling that patient with “chronic prostatitis.”
Her interest in pelvic pain began at Glickman Urological & Kidney Institute at the Cleveland Clinic (Ohio) where she served as a special fellow in urology. In the 1990’s, she and a few others noticed a trend.. that many men with pelvic pain were being labeled with prostatitis, urethritis or epididymitis and treated aggressively with antibiotics despite the fact that no infection was present.
One critical obstacle to diagnosis occurred when the National Institutes of Health created a classification system for prostatitis with four categories:
Category I: Acute bacterial prostatitis (ABP) – associated with severe prostatitis symptoms, systemic infection and acute bacterial UTI.
Category II: Chronic bacterial prostatitis (CBP) – caused by chronic bacterial infection of the prostate with or without prostatitis symptoms and usually with recurrent UTIs caused by the same bacterial strain.
Category III: Chronic prostatitis/chronic pelvic pain syndrome – characterized by chronic pelvic pain symptoms and possibly voiding symptoms in the absence of UTI.
Category IV: Asymptomatic inflammatory prostatitis (AIP) – characterized by prostate inflammation in the absence of genitourinary tract symptoms.(2)
Dr. Potts argues that 90-95% of men struggling with pelvic pain are classified in Category Three despite any evidence the prostate is actually involved which, of course, leads to clinicians focusing on prostate centric therapies and unnecessary antibiotic use that are largely ineffective.
In 1997, she followed her instincts and boldly changed her approach to treatment. She wrote ‘I decided to stop prescribing antibiotics … whenever my microscopic analysis of urine was negative. I was seeing about 350 “prostatitis” patients per year so that meant that around 320 or more patients were NOT receiving antibiotics.’ (3) Rather, she began prescribing physical therapy for those patients where she could identify structural abnormalities in connective tissue and/or the pelvic floor muscles.
When she presented her work at a National Institutes of Health meeting in 1997, she faced strong criticism and was subjected to hissing from the so called “prostatitis mafia.” They went so far as to try to bully her at meetings and to try to slander her reputation. It took courage and fortitude to breach the bastion of male prostate health but, in the end, she prevailed and, today, directs THE course on male pelvic pain for AUA.
She recently shared her 20 plus years of experience working with men in a free article “Male Pelvic Pain: Beyond Urology and Chronic Prostatitis.” It’s a fascinating read from one of the most influential clinicians today in the treatment of male pelvic pain. In fact, she and her husband Christopher Payne MD (formerly the Director of Female of Urology at Stanford University) have been championing the sub typing of pelvic pain patients so that the correct therapies can be recommended.(4)
One key point that she emphasizes is that more than 65% of the men that she has worked with have Functional Somatic Syndrome (FSS), now known as Central Sensitization Syndrome. FSS is associated with an unusually sensitive, perhaps traumatized nervous system that causes a variety of systemic effects, such as very sensitive skin, drug sensitivity, food sensitivity, acute smell sensitivity and chemical sensitivity. In these patients, it takes very little stimulation to provoke a painful response. It is the likely link between IC, IBS, vulvodynia, prostatodynia and other common related conditions. She urges physicians to consider the role of FSS in patients presenting with multiple conditions.
While some progress has been made, Dr. Potts is worried that some patients may still be misdiagnosed and that doctors aren’t looking beyond the prostate for potential problems. She wrote “I am finding growing numbers of patients who have been to Physical therapy dozens of times, as prescribed by their urologist, only to discover that they had not been examined properly and that Physical Therapy was never indicated in the first place. “ In these and all cases, she argues that more comprehensive diagnostics should have been performed to consider the role of the nerves, the bowel, psychological support and perhaps even surgery.
- Potts, J. Male Pelvic Pain: Beyond Urology and Chronic Prostatitis. Current Rheumatology Reviews, 2016, 12.27-39
- Krieger JN, Nyberg LJ, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999;282:236–7. [PubMed]
- Potts, J. Beyond The Abstract – Male Pelvic Pain: Beyond Urology and Chronic Prostatitis. UroToday. May 2016
- Osborne J. The New Paradigm For Treatment IC: Do You Know Your Phenotype. IC Optimist Summer/Fall 2015:5-9
Please Share The Article With Your Doctor
If you are struggling with pelvic pain and/or your doctor insists on treating you with antibiotic therapy, we encourage you print out this article and share it with your clinician. She shares, in my opinion, the best diagnostic and treatment approach for male pelvic pain patients.
About Vista Urology – Pelvic Pain Partners
Dr. Jeannette Potts and Dr. Christopher Payne bring 40 years of experience in urology from two of the best institutions in the world, The Cleveland Clinic and Stanford University. They met, ironically, when they were both selected to run clinical research studies by the National Institutes of Health. Realizing that they were both drawn to the complex problem of chronic pelvic pain, they eventually created Vista Urology as a refuge for patients who have struggled to find expert care. Learn more about their practice here!