Prostatitis Center |
Tucson, Arizona |
The Bird in The Bush and The Needle in the Haystack |
By Nick Jones |
| Old phrases about The Bird, The Bush, The Needle, and The Haystack come to mind when you talk about Prostatitis. To patients, it seems many doctors are always beating around the bush, looking for why the patient has such disturbing symptoms. |
| To physicians, looking for a cause of prostatitis seems like searching for that proverbial needle in a haystack. Sometimes when searching for that needle in the haystack, you need the metaphorical equivalent of a metal detector or x-ray machine. |
| The bird in the hand, of course, is what both patients and doctors would have if only they had some way of identifying the disease and to be able to tell whether patients are making progress. |
| When The Prostatitis Center in Tucson, AZ, opened in August, 1997, medical director Dr. John Polacheck faced these same problems. Although his mentor, Dr. Antonio E. Feliciano of Manila, The Philippines, had innovated many diagnostic steps and pushed a practical method of treating prostatitis to a high stage of development, better tools for identifying prostatitis and for monitoring patient progress were needed. |
| In the course of his first year of operation, and in collaboration with pathologist Dr. L. Eduardo Vega, Dr. Polacheck has identified exactly what he needs look for in a prostatitis patients' Expressed Prostatic Secretion (EPS) to identify the disease and monitor how well treatment is progressing.
| | EPS is the fluid obtained when a doctor pushes on your prostate gland with a gloved finger. Semen is a different fluid which combines fluids from several glands, including the prostate. EPS can easily be obtained from patients during an office visit. |
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| The target of Dr. Polacheck's attention are clumps of pus cells which he calls Prostatic Inflammatory Aggregates (PIA's). In patients with prostatitis, PIAs are made in the small glands (acini) of the prostate. Pathologists can readily identify these PIAs in the EPS from prostatitis patients. |
| Both Dr. Polacheck and Dr. Vega believe that these PIAs are clear signs of prostatitis activity. They have noted that the PIAs decline in number during treatment and eventually disappear when the disease is cured. |
| Pathologists easily identify PIAs on slides of EPS, Dr. Polacheck says. PIAs are directly linked to an on-going inflammatory pathological process. Dr. Polacheck and his associates believe that they are caused by bacteria or by a bacterial-like organism.
| | "The presence of glandular-shaped PIAs in the EPS from patients with symptoms of prostatitis may prove to be a specific clinical test of disease activity," Polacheck says. "If so, this simple non-invasive test will be most useful in the diagnosis and management of patients with prostatitis." |
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| The Bird in The Bush |
| Prostatitis patients and their loved ones are all familiar with the insidious nature of prostatitis. Possibly beginning with an acute infection and fever, or perhaps just slowly developing without an initial crisis, prostatitis gradually robs men of many normal urinary and sexual functions and causes enough pain to seriously erode their quality of life. |
| Patients go to the doctor, but the average physician does not do much more than prescribe an antibiotic. Referred to a urologist, the patient will face many more standard urological exams, such as a cystoscopy, a minor surgical procedure during which a telescope-like medical instrument is inserted up the penis to see inside the urethra and bladder.
| | The Prostatitis Center in Tucson is dedicated entirely to medical non-surgical protocols. it is the only such facility in the United States with such a focus. The medical director, Dr. John Polacheck, in an internist, not a urologist. His approach to an Infectious Disease problem is quite different from that of urologists, who, after all, are trained as surgical sub-specialists. |
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| After another course or two of antibiotics, the Urologist may somberly announce that thanks to the many antibiotics the patient has taken, there couldn't be any bacteria left in the prostate gland. Then, in some cases, surgery is suggested. In other cases, the patient is referred to a psychiatrist. But, in most cases, the patient is simply told that he will "learn to live" with his symptoms. The doctor is beating around the bush !!! |
| The Needle in The Haystack |
| "That's why looking for these PIAs is so useful. We've never seen aggregates of pus cells such as these except in prostatitis. The PIAs in the EPS of prostatitis patients are remarkably similar to those seen in inflamed prostate tissue itself, Dr. Polacheck explains. In order to learn more about pathology of prostatitis, we decided to study inflamed prostate tissue surgically removed by urologists from patients with other conditions. |
| What Polacheck refers to as "Glandular-shaped cohesive aggregates (PIAs) of polymorphonuclear leukocytes (PMNs) within a proteinaceous matrix" have been observed in the EPS smears of patients with symptomatic prostatitis. Polacheck says that means "they have an active process." In other words, when a pathologist looks through a microscope, signs of infection can readily be seen.
| | Polymorphonuclear leukocytes are your body's white blood cells (commonly called pus cells) that are formed to fight the infection of disease-causing bacteria. Such cells indicate an inflammatory process, most usually bacterial |
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| The Bird in The Hand |
| With only a year's experience with prostatitis, Dr. Polacheck has already learned how to use the new test he and collegues have described. "We now use the PIA Test in men quite like the PAP is being used in women," Dr. Polacheck added. "It can be used to 'meter' how patients are doing." |
| For example, prostatitis in Americans is proving to be a lot different from that which he observed while studying in the Philippines under Dr. Antonio E. Feliciano. Dr. Polacheck remarked that, in Manila, most patients were cured in three weeks with only ten treatments. |
| "Here in Tucson, our patients have been much more difficult to cure. Most patients have required a longer course of treatment. And, I have found it most helpful to be able to monitor that with a specific test, a 'meter' so to say," Polacheck elaborates. |
| "We reason that because EPS is directly expressed from the prostate gland, the prostatic inflammatory aggregates (PIA's) found in EPS are a direct reflection of inflammation in that gland," Polacheck asserts. "Furthermore, in preliminary observations, we have noted that the PIA's observed in the EPS smears of prostatitis patients decline in number or disappear as the patients are treated with repeated prostatic massages and antibiotics." |
| Polacheck cautions other physicians and laboratories who want to look for PIAs that care must be taken in examining the EPS. Only glandular-shaped, glandular sized aggregates of PMNs are true PIAs. Non-aggregated PMN's , etc., may be derived from other sources such as the urethra. |
| Dr. Polacheck added that the proverbial Needle in The Haystack, the root cause of prostatitis, still had not been found. He hopes, however, that the Bird, now in The Hand, the new clinical test for PIAs, will serve as a useful tool for locating that elusive needle. |
| E-mail Dr. John W. Polacheck, M.D., at the Prostatitis Center at jpolacheck@ibm.net (Just click on the link to use your browser's E-mail function.) |
Contacts
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- Mail
- 1701 W. St. Mary's Rd.
- Suite 102
- Tucson, Arizona 85754
- USA
- E-mail:
- jpolacheck@attglobal.net
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- Phone :
- 520-622-4599
- Answering Service:
- 520-570-6011
- Fax:
- 520-903-9972
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