Prostate

Testosterone and Prostate Cancer: An Historical Perspective on a Modern Myth Abraham Morgentaler MD Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

1. Introduction -One of the principles of evidence-based medicine is that concepts that fail to withstand scientific scrutiny are to be discarded. Such a time has come for the belief that testosterone (T) causes enhanced growth of prostate cancer (pCA). This change in perspective is prompted not only by current evidence, but also by critical examination of the historical origins of the belief.

In 1941 Huggins and Hodges [1] established the hormonal responsiveness of pCA by reporting that marked reductions in T by castration or estrogen treatment caused metastatic pCA to regress, and also that administration of exogenous T caused pCA to grow. Many of us learned from our professors to describe the relationship of T to pCA as “fuel for a fire” and “food for a hungry tumor.” To this day, androgen ablation remains a mainstay of treatment for advanced pCA, and the concern regarding T and the risk of pCA has reached to the highest levels of medicine.

In 2001 the then-director of the National Cancer Institute in the United States explained his reluctance to fund a large testosterone replacement therapy (TRT) trial by stating that he was “concerned that testosterone could spur the growth of prostate cancer among some men in the study” [2]. TRT has long been considered taboo among men with a prior history of pCA regardless of disease status, and product information mandated by the US Food and Drug Administration states that “known or suspected carcinoma of the prostate” is a contraindication for T products [3]. Three years ago the US National Institutes of Health temporarily halted all T-related research, in part on the basis of safety concerns related to T and pCA, until the Institute of Medicine pondered how to best perform research in this area. This relationship of T to pCA has come under greater scrutiny over the last decade with the increased interest in the treatment of hypogonadism with TRT, and the growing number of pCA survivors who are symptomatically hypogonadal and requesting treatment. While there is no dispute that castration causes pCA to regress, proof for the second part of Huggins’ assertion, that T causes pCA to grow, has been elusive.

Recent reviews [4], [5], [6] have failed to find any compelling evidence to support this contention. The report by the Institute of Medicine concluded, “In summary, the influence of testosterone on prostate carcinogenesis and other prostate outcomes remains poorly defined…” [7]. The lack of evidence for what has been assumed for decades to be a solid relationship between T and pCA has been confusing for clinicians and the public. As a student once asked innocently, “If testosterone is so bad for prostate cancer, why is it so hard to prove?”

The underlying logic has always been strained and inconsistent. The disease is almost never seen during the peak T years of the late teens and early 20s, and only becomes prevalent when men are older and T levels have declined (Fig. 1). If T were really “fuel for a fire,” then why would the microfoci of pCA noted in young men from autopsy studies [8] not develop into frank cancer at early ages? If the answer is that it may take 30 or 40 yr for T to stimulate pCA to grow into a clinical tumor, then why do we have any hesitation in offering TRT to men in their 60s and 70s?

Fig. 1. Prostate cancer prevalence and testosterone levels with ageing. pCA: prostate cancer, T: testosterone. In the absence of current supporting evidence for the concept that T causes enhanced pCA growth, an investigation was performed of the early literature on this topic to examine the historical origins of this belief.

2. Huggins’ experiment with T injections and pCA In a 1967 review, Huggins [9] provided this perspective on his landmark 1941 work: “Orchiectomy or the administration of phenolic estrogens resulted in regression of cancer of the human prostate whereas, in untreated cases, testosterone enhanced the rate of growth of the neoplasm.” What does the paper actually show? In addition to showing that castration and estrogen treatment caused acid phosphatase levels to decline in men with metastatic pCA, Huggins and Hodges [1] reported that daily injection of testosterone propionate caused acid phosphatase levels to increase. Although three men were injected with testosterone propionate, results were only provided for two. One of these two had already been castrated. In the remaining individual, acid phosphatase levels rose during 18 d of T injection, but fluctuated widely before and afterwards, reaching the same peak levels 3 wk after discontinuation of T. No other clinical information was offered.

The original assertion that T caused pCA growth in untreated individuals was thus based on equivocal acid phosphatase results in a single individual.

3. Additional experience with exogenous T in men with metastatic pCA The largest series of exogenous T in men with metastatic pCA was reported by Fowler and Whitmore [10], who reviewed the experience at Memorial Sloan Kettering Cancer Center in New York from 1949 to 1967. Sixty-seven men, all with a history of bone metastases, received T injections under various protocols, and unfavorable responses were noted, which included subjective symptoms, such as increased bone pain, or objective progression, including a rise in acid phosphatase. Of 52 men with evaluable responses, 45 had unfavorable responses. However, only four of these men had not previously undergone orchiectomy or estrogen treatment. Within this untreated group one man had an early “unfavorable response” (within 30 d of beginning T injections), another had a subjective “beneficial response,” and the remaining two eventually developed unfavorable responses at 56 and 310 d of daily T administration, respectively. Given the advanced stage of pCA in these men and the lack of a control group, we must consider that the “unfavorable responses” seen in this population may have been due to the natural history of their disease.

Largely overlooked by history is the experience of other investigators of that era, who failed to note progression of pCA with exogenous T and even noted beneficial effects in some [11], [12]. For example, Prout and Brewer [12] reported results of daily T injections for a median of 13 d in 26 men with stage C and D disease, of whom 20 had not undergone castration or other hormonal treatment. “Most of these individuals experienced an increase in sense of well being and some noticed vague diminution in pain.” In addition, they reported that the acid phosphatase response to T injection was “extremely variable.” Pearson [13] reported on a previously untreated patient with advanced prostatic cancer with severe bone pain from osseous metastases, who was treated with daily injections of testosterone propionate. “There was prompt relief of pain, and within a few weeks he was asymptomatic.” The patient remained asymptomatic for 9 mo, during which time he received daily T injections.

These various historical reports lack modern standards for determining true progression of pCA, such as a reliable marker (i.e., prostate-specific antigen [PSA]) or control groups. However, no studies within the last 25 yr have replicated these early experiences with T administration in men with pCA. Despite their limitations, these reports thus provide a valuable perspective on the effect of T on pCA progression. The failure to observe rapid clinical progression with T administration even in men with advanced disease argues strongly against the contention that T causes enhanced growth of pCA.

4. T and pCA in the modern era 4.1. Testosterone flare With the introduction in the 1980s of luteinising hormone-releasing hormone agonists that reduced T to castrate levels, it was noted that a transient rise in T occurred over the first 8–10 d. Reports of adverse events occurring during this period of time, such as increased bone pain, urinary retention, and vertebral collapse with paraplegia, have been attributed to pCA growth attributable to this “testosterone flare” [14]. However, in the few studies that measured PSA in men with advanced pCA during the period of elevated testosterone, PSA values never rose above baseline [15], [16] Since PSA correlates well with pCA progression [17], the flat PSA curve noted during the interval of T flare suggests that increased T did not cause pCA to progress in these patients. Is it possible that the adverse events noted during the flare interval may have been due to the natural history of metastatic pCA or to the direct effects of T on bone metabolism?

4.2. Clinical trials of TRT No large, long-term studies of TRT have been performed. However, the pCA rate in published TRT trials is approximately 1% [4]. This rate is similar to the cancer detection rate in prostate cancer-screening trials. Nevertheless, it must also be recognized that the number of men included in studies of =1 yr is quite small.

4.3. Longitudinal studies The relationship of T and other hormones to subsequent development of pCA has been studied in at least 16 population-based longitudinal studies [18], [19], [20], [21], [22]. Not one has shown a direct correlation between total T levels and pCA. Isolated associations with minor androgens [23], calculated free T [19], or quartile analysis of hormone ratios [24] have not been confirmed by subsequent studies [18], [20], [21], [22]. Surprisingly, the largest study [20] of this type noted an increased pCA risk with low T levels.

4.4. pCA rates in men with low T If high T is believed to be associated with an increased risk of pCA, it follows that low T should be associated with reduced risk. However, prostate biopsy in 77 hypogonadal men with normal digital rectal examination and PSA of =4.0ng/ml revealed cancer in 11 men [25]. This 14.3% cancer rate is similar to the 15.2% pCA rate noted by Thompson et al. [26] in the placebo arm of the Prostate Cancer Prevention Trial.

4.5. TRT in a high-risk population Frank pCA has been reported to develop over 3 years in =25% of men with high-grade prostatic intraepithelial neoplasia (PIN) [27]. In one study [28], TRT was provided to 20 hypogonadal men with PIN and 55 hypogonadal men with benign biopsies. At the end of 12 mo, pCA was identified in one man in the PIN group and none in the benign group, which represents a 5% cancer rate in the PIN group and a 1.3% risk overall. These results do not suggest a precipitous increase of pCA growth or development in this high-risk group.

5. Resolving the paradox The paradox of these data can be summarized as follows: Since lowering T causes pCA to regress, why is it that raising T fails to cause pCA to grow? The solution lies in the concept of saturation, in which maximal stimulation of pCA growth is achieved at some relatively low concentration of T. This model for T and pCA was suggested by Fowler and Whitmore [10], who concluded a quarter century ago that “normal endogenous testosterone levels may be sufficient to cause near maximal stimulation of prostatic tumors.”

At T levels below the saturation point, pCA growth would be expected to vary with T concentration, which is consistent with the observation of pCA regrowth with T normalization after androgen ablation. This model is also supported by the observation that exogenous T administered to normal men fails to cause any increase in PSA or prostate volume [29], [30]. In hypogonadal men, TRT results in only modest increases in prostate size, approximately 15% for PSA and prostate volume [4], with volume increasing to match eugonadal men, but rising no higher [31].

6. Conclusions The original assertion that higher T causes enhanced pCA growth has persisted as a medical myth since 1941 despite all evidence to the contrary. Longitudinal studies have repeatedly and consistently rejected this hypothesis. And if T is “food for a hungry tumor,” then why is the cancer rate only 1% for men receiving TRT when one of seven hypogonadal men has biopsy-detectable pCA?

Yet the true nature of this myth is revealed best by its historical origin—an equivocal blood test result in a single patient. Other investigators failed to note worrisome pCA progression with T administration and even reported beneficial subjective responses. Reviewing the relatively benign clinical course of their previously untreated patients, Fowler and Whitmore [10] postulated that near-maximal stimulation of pCA occurs at T concentrations found in normal men. This saturation model is consistent with current data regarding T and pCA. In summary, there is not today—nor has there ever been—a scientific basis for the contention that a higher T concentration causes pCA growth, acutely or long-term.

The danger of belief trumping evidence is that it impairs our ability to behave logically and consistently, and can cause us to disregard awkward data that may ultimately provide promising avenues for research. Can we continue to justify denying TRT to symptomatic hypogonadal men after definitive treatment for localized pCA when history teaches us that T administration failed to cause disease progression even in men with untreated, widely metastatic pCA? Might there also be clues regarding the biology of pCA in the accumulating evidence linking low T with pCA, including associations with high-grade disease [32], higher stage at presentation [33], and worse prognosis [34]? Might it even be possible that androgen administration could prevent pCA [35], [36]? After 65 yr it is time to discard the myth and to entertain new ideas regarding the relationship of T and pCA.

References

1. Huggins C, Hodges CV. Studies on prostatic cancer, I: the effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate. Cancer Res. 1941;1:293–297.

2. Kolata G. Male hormone therapy popular but untested. NY Times 2002.

3. Physician's desk reference. Montvale, NJ: Thomson PDR; 2005;p. 3245.

4. Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med. 2004;350:482–492.

5. Bhasin S, Singh AB, Mac RP, Carter B, Lee MI, Cunningham GR. Managing the risks of prostate disease during testosterone replacement therapy in older men: recommendations for a standardized monitoring plan. J Androl. 2003;24:299–311.

6. Barqawi AB, Crawford ED. Testosterone replacement therapy and the risk of prostate cancer: a perspective view. Int J Impot Res. 2005;17:462–463.

7. In: Liverman CT, Blazer DG editor. Institute of Medicine report on: testosterone and aging. Washington, DC: National Academies Press; 2004;. 8. Sakr WA, Grignon DJ, Crissman JD, et al.. High grade prostatic intraepithelial neoplasia (HGPIN) and prostatic adenocarcinoma between the ages of 20–69: an autopsy study of 249 cases. In Vivo. 1994;8:439–443.

9. Huggins C. Endocrine-induced regression of cancers. Cancer Res. 1967;27:1925–1930.

10. Fowler JE, Whitmore WF. The response of metastatic adenocarcinoma of the prostate to exogenous testosterone. J Urol. 1981;126:372–375.

11. Brendler H, Chase WE, Scott WW. Prostatic cancer: further investigations of hormonal relationships. Arch Surg. 1950;61:433–440.

12. Prout GR, Brewer WR. Response of men with advanced prostatic carcinoma to exogenous administration of testosterone. Cancer. 1967;20:1871–1878.

13. Pearson OH. Discussion of Dr. Huggins’ paper “control of cancers of man by endocrinological methods”. Cancer Res. 1957;17:473–479. =

14. Bubley GJ. Is the flare phenomenon clinically significant?. Urology. 2001;58:5–9. CrossRef

15. Kuhn JM, Billebaud T, Navratil H, et al.. Prevention of the transient adverse effects of a gonadotropin-releasing hormone analogue (Buserelin) in metastatic prostatic carcinoma by administration of an antiandrogen (Nilutamide). N Engl J Med. 1989;321:413–418.

16. Tomera K, Gleason D, Gittelman M, et al.. The gonadotropin-releasing hormone antagonist Abarelix depot versus luteinizing hormone releasing hormone agonists leuprolide or goserelin: initial results of endocrinological and biochemical efficacies in patients with prostate cancer. J Urol. 2001;16:1585–1589.

17. Freeland SJ, Partin AW. Prostate-specific antigen: update 2006. Urology. 2006;67:458–460.

18. Hsing AW. Hormones and prostate cancer: what's next?. Epidemiol Rev. 2001;23:42–58.

19. Parsons JK, Carter HB, Platz EA, Wright EJ, Landis P, Metter EJ. Serum testosterone and the risk of prostate cancer: potential implications for testosterone therapy. Cancer Epidemiol Biomarkers Prev. 2005;14:2257–2260.

20. Statin P, Lumme S, Tenkanen L, et al.. High levels of circulating testosterone are not associated with increased prostate cancer risk: a pooled prospective study. Int J Cancer. 2004;108:418–424.

21. Chen C, Weiss NS, Stanczyk FZ, et al.. Endogenous sex hormones and prostate cancer risk: a case-control study nested within the Carotene and Retinol Efficacy Trial. Cancer Epidemiol Biomarkers Prev. 2003;12:1410–1416.

22. Platz EA, Leitzmann MF, Rifai N, et al.. Sex steroid hormones and the androgen receptor gene CAG repeat and subsequent risk of prostate cancer in the prostate-specific antigen era. Cancer Epidemiol Biomarkers Prev. 2005;14:1262–1269.

23. Barrett-Connor E, Garland C, McPhillips JB, Khaw KT, Wingard DL. A prospective, population-based study of androstenedione, estrogens, and prostatic cancer. Cancer Res. 1990;50:169–173.

24. Gann PH, Hennekens CH, Ma J, Longcope C, Stampfer MJ. Prospective study of sex hormone levels and risk of prostate cancer. J Natl Cancer Inst. 1996;88:1118–1126.

25. Morgentaler A, Bruning CO, DeWolf WC. Incidence of occult prostate cancer among men with low total or free serum testosterone. JAMA. 1996;276:1904–1906.

26. Thompson IM, Pauler DK, Goodman PJ, et al.. Prevalence of prostate cancer among men with a prostate-specific antigen level =4 ng per milliliter. N Eng J Med. 2004;350:2239–2246.

27. Lefkowitz GK, Taneja SS, Brown J, Melamed J, Lepor H. Followup interval prostate biopsy 3 years after diagnosis of high grade prostatic intraepithelial neoplasia is associated with high likelihood of prostate cancer, independent of change in prostate specific antigen levels. J Urol. 2002;168:1415–1418.

28. Rhoden EL, Morgentaler A. Testosterone replacement therapy in hypogonadal men at high risk for prostate cancer: results of 1 year of treatment in men with prostatic intraepithelial neoplasia. J Urol. 2003;170:2348–2351.

29. Bhasin S, Woodhouse L, Casaburi R, et al.. Testosterone dose-response relationships in healthy young men. Am J Physiol Endocrinol Metab. 2001;281:E1172–E1181.

30. Cooper CS, Perry PJ, Sparks AET, MacIndoe JH, Yates WR, Williams RD. Effect of exogenous testosterone on prostate volume, serum and semen prostate specific antigen levels in healthy young men. J Urol. 1998;159:441–443.

31. Behre HM, Bohmeyer J, Nieschlag E. Prostate volume in testosterone-treated and untreated hypogonadal men in comparison to age-matched normal controls. Clin Endocrinol. 1994;40:341–349.

32. Hoffman M, DeWolf WC, Morgentaler A. Is low serum free testosterone a marker for high grade prostate cancer?. J Urol. 2000;163:824–827.

33. Massengill JC, Sun L, Moul JW, et al.. Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy. J Urol. 2003;169:1670–1675.

34. Ribeiro M, Ruff P, Falkson G. Low serum testosterone and a younger age predict for a poor outcome in metastatic prostate cancer. Am J Clin Oncol. 1997;20:605–608.

35. Prehn RT. On the prevention and therapy of prostate cancer by androgen administration. Cancer Res. 1999;59:4161–4164.

36. Algarte-Genin M, Cussenot O, Costa P. Prevention of prostate cancer by androgens: experimental paradox or clinical reality. Eur Urol. 2004;46:285–295.

Abraham Morgentaler
Beth Israel Deaconess Medical Center,
Harvard Medical School,
Boston, Massachusetts, USA
Accepted 26 June 2006 published online 13 July 2006.

Dr. William Wong
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Patient's Stories

My Experience with Prostatitis, Severe Urinary Obstruction and Dr. Antonio E. Feliciano's Treatment in Manila, Philippines 

September 3, 2003
  
Prostate sufferers from all over the world find their way to Maria Orosa Street in the Ermita District of Manila. The sign above the entrance to Dr. Antonio Feliciano, Jr.’s medical center reads, “Manila Genitourinary Clinic.” The day I first attended the clinic was on Monday, March 17, 2003 at 9:30 a.m.

Greeting me, the wary patient, are the smiling faces of two English speaking ladies of the clinic’s staff behind a small counter to my right just as I enter through the door. Straight ahead and in front of me I notice a door leading to an examining room with a desk inside. The entrance to Dr. Feliciano’s private office can be seen on the right. To the left of the waiting room, I notice a glass enclosure behind which lies the pathology laboratory. The olive green color of the comfortable leather couch along sides the wall matches those of two armchairs opposite the main entrance. A wooden planter with colorful flowers creates a friendly atmosphere. I am being given a questionnaire to fill out, and then introduced to Dr. Antonio Feliciano, a pleasant and friendly gentleman in his fifties. He leads me into his office, and proceeds with the initial consultation.

Dr. Feliciano studies my filled-in questionnaire and explains in fluent English, “In thousands of patients suffering from Prostatitis and/or BPH (benign prostatic hypertrophy) we have observed bacterial infections to be a contributing if not the causative factor of the disease. Therefore, we will first check you for various pathogenic bacteria (the bad guys) by taking swabs and cultures from the body secretions. We will then examine you rectally and feel the prostate gland and to have a baseline to work from we suggest an ultrasound be taken in the nearby hospital. Following our laboratory work up in this clinic, we will then decide on a plan of action and when to begin your treatment.”

He continues, “The majority of our patients will need to stay for about 21 to 30 days. Do you have a comfortable accommodation?” I agreed and thanked him for his concern. When I telephoned from Australia regarding my arrival date, his accommodating staff had already made room reservations for me at a nearby hotel. He tears a sheet from his prescription pad, write a few words on it and hands it to me. He explains, “The Philippines have a long and interesting history. To stay in a foreign city for a few weeks may become boring. To make it more entertaining for you, you may wish to visit some of the following places of interest,” and with these comments, he hands me the sheet of paper. He elaborates, “The Ayala Museum, the monument of Dr. Rizal (the famous Philippine national hero), Corregidor (the island on which General Douglas MacArthur fought for Philippine Independence against the Japanese), the Manila Hotel (General MacArthur’s residence for 6 years), Subic (the former American base) and Tagaytay (the city of the Volcano) are a few of the worthwhile places to see while you are here.”

I was pleasantly surprised. Here was a man, not only planning to treat my physical complaints, but he was also concerned about my wellbeing during my stay in Manila. I was then ushered into the adjacent room to prepare for an examination. A digital rectal examination was carried out by two of his younger English speaking medical colleagues followed by a gentle prostatic drainage lasting no more than 30 seconds. A drop of prostatic secretion was transferred unto glass slides. The attending physicians said, “You are all done now and we will see you again this afternoon at 2:30 p.m. for our initial findings. But before you leave you will need to give us a urine sample.” So far so good, I thought and returned to my hotel around the corner for a rest.

I routinely took Saw Palmetto, Epilobium and other herbal mixtures over the past 10 years, which helped to ease a slowing urination. Three medical examinations and two ultrasounds taken in Australia confirmed BPH and large bladder diverticula in my case. Options given to me were biopsy, catherization, TURP (transurethral resection of the prostate) and eventual prostatectomy (removal of the prostate), all of which are known to have the potential to cause serious side effects and were not an option for me if I could help it. My wife searched for an alternative solution for the treatment of Prostatitis or BPH on the Internet. In our search in January of 2003 we became aware of the Manila Protocol, as Dr. Feliciano’s work is known. His scientific approach made sense to me and I was willing to give it a try as soon as I could arrange for a chiropractor to take over my clinic during my absence.

In March of 2003 my condition reached a critical point and I had to restrict my eating and fluid intake dramatically as my urinary obstruction was nearing 98%. Two weeks prior, before flying to the Philippines, in order to stay out of the hospital, I had discovered that lying on my back and doing stretching exercises with legs over my head followed by hot sitz baths several times a day had helped to release a few drops of urine easing the pressure on my bladder diverticula. The constant straining to void urine had caused my lower abdomen to bulge out (also known as bladder diverticula). Now I was hoping that my trip to the Philippines and commencing treatment in this clinic would offer the solution to my worsening condition.

I returned at 2:30 p.m. to Dr. feliciano’s clinic and was informed that I was suffering from bacterial infection. “We need to see you daily for the next three days to assess the anticipated changing leukocyte count following prostatic drainage before we can begin treatment. In the event that you should obstruct completely during the next three nights, I give you my personal phone number and the number of the hospital close by just in case,” were Dr. feliciano’s reassuring words to me. On the fourth day of the prostatic drainage and bacterial examination the leukocyte count had risen sharply. (It was later explained to me that this is what usually happens. During the first and second drainage only a few of the leukocytes are being released and without subsequent proper drainage false readings can be obtained.) In addition to several other hostile bacteria I was found to have a serious Chlamydia infection. The question in my mind arose, where do we get these infections from? I was told that they could be passed from one partner to another who carries the bacteria such as mother to child in birth, sexually transmitted diseases, wounds, surgical and dental procedures and pathogenic bacteria in the oral cavity.

Treatments began after the fourth day with target specific antibiotics, directional specific prostatic drainage, and the advice to be present in the clinic every second day for a routine check including a urine sample. Within three days, to my delight and relief (although first slowly), I was able to void urine again and come back to the land of the ‘urinators.’

In order to assess the ongoing bacteriological changes as a result of the treatments, a urinalysis including cultures taken were performed routinely. The good news was I was free of all bacterial infections on the 17th day of treatment with marked improvement in my condition of 85% to 90%. To relieve my bladder diverticula of any pressure it was suggested that I continue with two specific medications for four months after my return to Australia. So far I have done well; I am working as a chiropractor again in my clinic. I can drink and eat what I like and with the occasional glass of wine with my meal life have become good again.

One may wonder what is the difference between Dr. Feliciano’s treatment of prostatic disorders in Manila, and the treatment by urologists outside of the Philippines. Prostatitis and/or BPH can have its cause in severe infections of the prostate. Therefore, a thorough laboratory analysis is done ‘in house’ by qualified laboratory staff immediately after the swabs and cultures are taken. (This is not possible in the USA or Australia because the pathology laboratories are a separate entity).

It is interesting to note that the leukocyte count continues to increase with subsequent prostatic drainages. In other words at the fourth prostatic drainage the leukocyte count can be three to four times higher than at the initial drainage stage indicating that the directional specific gentle pressure against the prostate gland assists in opening up the small sacs allowing trapped bacteria and their infection causing residue to release. To my knowledge this type of treatment is not carried out in the western world.

Not too long ago stomach ulcers were said to be cause by stress and other psychological stressors. Scientific research has now provided the evidence that stomach ulcers are caused by bacteria (helio-bacter pyolorum), and not as previously thought or claimed by stress. Improperly treated stomach ulcers have the potential to become degenerative (cancerous) with devastating consequences. It would stand to reason then to deduct logically that if bacterial infection in the prostate gland is allowed to flourish for years, inflammatory degenerative conditions could result in organs such as the prostate gland as well. The suffix ‘it is’ means an ‘inflammation of’ as in arthritis, hepatitis or Prostatitis. In today’s medical literature there is clearly an association made between chronic inflammation and degenerative conditions (cancer).

An interesting study done in the USA revealed in 100 consecutive autopsies on men who died suddenly in automobile accidents and from other causes, the prevalence (or amount) of histologic signs of Prostatitis increased with age and was greatest when there was benign prostatic hyperplasia (enlargement of the prostate gland). Prostatitis was present in 22 percent of men younger than 40 years and in 60 percent of those over 40. Also thirty percent of normal asymptomatic (they think there is nothing wrong with them) males of military age have purulent pus filled prostatic secretions – The Principles of Surgery by Schwartz, 1979.

While in Manila I had a lot of time to think, and the thought came to me that if male sufferers from Prostatitis and/or BPH, and his laboratory analysis is positive for Chlamydia and other pathogens, could his partner, in the case of my wife, also be expected to be positive, even in the absence of symptoms? I approached Dr. Feliciano with my concern and he assured me that the tests conducted in the past on partners indicated that this is usually the case. That means if a partner is not also cleared of the pathogenic bacteria, he/she could re-infect their partner. Arrangements were made for my wife to fly to Manila a week later. A complete pelvic examination was performed on her followed by a 4-day bacteriological work up. The examination proved to be a ‘positive’ experience as she was found to be harboring the same bacteria as myself. Target specific antibiotics were also used in my wife’s case and by the end of the second week all of her readings were negative. Today we are both free of the multiple infectious pathogens (the bad guys) that could have had a negative long-range effect on our health.


Carsen Tannberg
DC., ND. 

My Experience with Doctor Feliciano 

March 8, 1996
  
I just recently returned from a 2 month stay in the Philippines being treated by Dr. Feliciano which RESULTED IN A CURE. I will tell you my story and what led up to me taking the trip: I developed prostatitis about a year ago. I went from doctor to doctor around here and I just couldn't believe the lack of concern and complete ignorance they had of this disease. I was in a tremendous amount of pain and couldn't work, I lost my job, I was facing financial ruin but nothing was worst than the pain I was experiencing. I practically begged these doctors and urologists for help.

In return I was screamed at there is nothing wrong with me, go to work, try yoga, try meditation, this is all in your head, see a psychiatrist, your tests show nothing, you're in perfect health, etc, etc. and than I was handed a big bill for their services when they did nothing except throw antibiotics at me indiscriminately and see what happens. These were recommended doctors connected with prestigious hospitals and teaching hospitals here. BUT THEY WERE ALL NOTHING MORE THAN FRAUDS!!!!!!! ALL JUST HAPPY TO STEAL MY MONEY AND SHOW NO CONCERN AT ALL ABOUT MY WELL-BEING!!!!!!!!!!! I even called an 800 number which advertises on TV they will find the right doctor for you. Well I told them my story and they gave me the name of a doctor they said could help me. When I called there they did not seem to know anything about prostatitis and a few days later that doctor was on the front page of the newspaper being accused of medical insurance fraud and under surveillance by the FBI.

I also tried this magnetic therapy. For $100 I was sent this cheap looking plastic thing. I did what I was suppose to do with it and my prostatitis just continued getting worse. The device did nothing for me! I started contacting other places that seemed to have a interest in prostatitis.

I sent a prostatitis clinic in Washington state my history and in return I was told there was nothing they could do for me, I should look in the phonebook for a doctor near me and call around to see if anyone can help me - I COULDN'T BELIEVE THAT RESPONSE!

Another place in Maryland never bothered replying. I got phone books from all over the USA and started calling everywhere and nobody could help me, nobody could even care! I went thru books in the bookstore. I would read one book and the next book would say something completely
different. One book by a doctor connected with a well-known university said if you have chronic prostatitis you should learn to adjust yourself to a new lifestyle - WHAT GARBAGE!

I came across something written on prostatitis by a doctor who heals by natural methods. I phoned him and explained my problem. He told me what to do (which didn't work) and referred me to a doctor in my area whom he claims is an expert and knows this field better than him and would put together a homeopathic remedy which will cure me. Well, I went to see this doctor and again explained my story to him. He looked completely confused and got out books on natural healing methods - the same books I've gone thru in the bookstore! He would look up prostatitis and recommend for me to try this or try that - and I would say I already tried that until he came across something I haven't tried but of course that wouldn't work either and I was handed a bill of $200 for his services!

I also sent a microbiologist in the Dakotas specimens and he told me I had micrococcus and should be on Augmentin longterm. I was on Augmentin for 2 months and I got some relief but everything than become even worse. I looked at another doctor's web page and asked around about him but the response I received did not seem very promising or offer much hope. I felt he was still experimenting.

I than read about Dr. Feliciano on the web page. He claims a 100% cure and I immediately was very skeptical. I corresponded with him by e-mail and telephone with my case history. He seemed to be VERY CONCERNED about me and truly wanted to help me. Everything he said seemed to make sense to me, I was totally impressed. A 22 hour plane trip would not be easy for a prostatitis patient but I decided to take a gamble and give it a try.

When I arrived my treatment was began immediately. Dr. Feliciano found thru his extensive culturing techniques 5 bacterias - (spelling?) chlamydia, neisseria, coccobaccilli, staph epidermis, staph aureus in addition to fungus.

He believed in his patients taking an active approach to treatment and I was allowed to see everything being done in the lab and my spec. under the microscope. I was shown slide shows, a clay model and complete explanations were given to me and as much time was taken as necessary to explain everything throughout treatment. I was never left in the dark.

I was given his home number, pager, and cellular phone number so I can contact him anytime just to be sure I would be totally relaxed. This was a REALLY BIG CHANGE from the other doctors who would have me in and out as quickly as possible and not explain anything to me and when I
would call after office hours I would receive the answering service and wouldn't be called back until days later if at all. I would often spend weekends with Dr. Feliciano at his home and on sightseeing trips. He was totally into the prostate - he would speak mostly on the prostate and he showed me all the extensive research he has done on it. He loved his work and was MOST IMPORTANT interested in his patients and truly cared about them.

Whenever I would experience something that would cause me to panic he would totally explain exactly what was happening and I felt much relieved.  The normal time for treatment is 16 days but my treatment took 2 months due to the long-term use of antibiotics prescribed by the other doctors
which resulted in the bacteria becoming very resistant. In fact, 1 of the bacteria was sensitive to Augmentin. Even though I was on Augmentin by the microbiologist for 2 months the medicine NEVER REACHED the organism.

Dr. Feliciano explained to me that without the drainages done every other day that even if you take the right medication it will never reach the organisms. The other bacteria I had was sensitive to minocin. I was much impressed with how well Dr. Feliciano knew his way around the prostate
with his finger. He would tell me there is a blockage here and said he was going to clear it. I could even feel him clearing it. I felt very little discomfort associated with the drainages - he knew exactly where to place his finger and the prostatic fluid would come up within a second - I hardly felt
anything. The previous doctors I had would push and push on me and I felt like they were killing me and nothing would come out.

I would observe patients coming in and out of Dr. Feliciano's clinic all day long with prostatitis. He was able to help all of them. He has seen over 4000 patients and has helped everyone of them. He talks about a few failures he has had but I don't consider them failures - they all reinfected themselves. It's like saying if you clean a car and than throw dirt back on it you have a failure because the car is dirty again.

My stay in the Philippines was most enjoyable.His entire staff was very friendly. All that bacteria has now been eradicated from me and I am free of pain and feel like a new person.

While I was there Dave Trissel called me every week to see how I was doing. When he saw things were coming along fine he decided to fly there for treatment. It was a pleasure to meet him and I am happy to say HE IS NOW ALSO CURED AND TOTALLY PAIN FREE and should be back soon.

I feel that Dr. Feliciano could completely end all this prostatitis suffering. If it wasn't for the Prostatitis Foundation I would never have known about Dr. Feliciano and I hate to think where I'd be today if that happened. DR. FELICIANO SAYS HOW IMPORTANT IT IS TO STOP INDISCRIMINATE USE OF ANTIBIOTICS AS THIS MAKES PROSTATITIS MUCH MORE DIFFICULT TO TREAT. THIS
SHOULD BE EMPHASIZED TO EVERYONE! I hope my posting is of great help to somebody.

Ron 

Prostatitis is simply cured

All it takes is good laboratory analysis of pathogens and a simple drainage procedure done on the prostate every other day by a physician. Dr. Feliciano, Jr. defines a cure as

A)  No more pathogens seen in prostate/seminal fluid culture
B)  All symptoms are permanently gone
C)  Stop taking antibiotics

Your prostatitis is caused by pathogens hiding away in the prostate. One primitive way of viewing the situation is that the prostate is like a sponge with many small chambers where bacteria can hide. Taking antibiotics without draining the prostate of its fluid does not allow the antibiotic to enter the prostate. Worse, if a small amount of antibiotic does get to the bacteria sites, there can be insufficient antibiotic to kill the bacteria and the bacteria then grow to become insensitive to it. This means that there is a chance that you will be making the antibiotic ineffective for future treatment when you eventually have proper drainage done to cure your prostatitis.

Proper drainage of the prostate is like squeezing the sponge. It forces the fluid out so that it is replaced with new fluid containing the antibiotic. There are also blockages that occur in the ducts that keep antibiotics from reaching the pathogens and this will be described in future postings.

I learned more in 60 minutes with Dr. Feliciano, Jr. about the prostate than months of Internet searching, reading urology textbooks, and speaking with urologists had accomplished. Just one diagram he showed me of the prostate cleared up questions I had about its anatomical design and enabled me to clearly see how prostatitis is caused and how proper treatment clears up the problem. (I will be posting my own rendition of that diagram so you can see for yourself.)

Finally, as a U.S. citizen let me say that I am embarrassed at the present inability of the U.S. healthcare system to treat this trivial disease. I have come across some early studies that may partially explain this ignorance and will be presenting my own ideas on how our Western cultural attitudes toward disease may have been thwarting proper care in this area.

Finally, let me say that prostatitis has been easily cured for decades in the Philippines and Dr. Feliciano, Jr. was shocked to recently receive an Internet connection and find that this disease was essentionally considered non-treatable by the rest of the world.

Dave Trissel
Autin, Texas

 Manila Report #2 - What Causes Prostatitis?
(Originally posted at www.prostatis.org w/ diagrams)

March 22, 1996

In this second report I will give information from Dr. Feliciano, Jr. that explains what causes prostatitis and how it is easily cured. Then I will contrast this with current medical attitudes which act in a manner to not only limit the understanding of this disease but also prohibit its effective
treatment and cure.

To understand prostatitis let's look at a primitive diagram cross section of the prostate (Figure 1.) at one of the ducts. (To view the diagram properly you will need to be using a computer font with all characters having the same screen width.) The prostate is a walnut-sized gland that surrounds
the urethra just outside of the bladder. Here we are only concerned with presenting one of the ducts that contribute to fluid during ejaculation. This diagram only shows the left half of our cross-section and only a single duct. There are around fifty of these ducts in all.

The acini are bulb-like sacs that open into the duct. In the above diagram picture the duct as being about half the height of a computer text line and the acini as being in the form of rounded elongated lightbulb shapes.  Prostatic fluid is generated in them. During ejaculation the prostate is contracted by muscles and the compressive force drives the fluid into the urethra for expulsion. Prostatitis is caused when a pathogen like a bacteria or fungus makes its way into the urethra and then into the duct and settles into the acini and then causes a blockage to form trapping fluid and pus there. The acini bulbs expand causing inflammation and pushing on major urogenital nerves that are next to the prostate thus indirectly causing most of the pain symptoms experienced by prostatitis sufferers.

As an engineer, I can use this model of prostatitis to explain the many guises that prostatitis symptoms present such as some sufferers having symptoms that come and go while others have them constantly. According to Dr. Feliciano, Jr. men can be carrying pathogens in their prostates for years or even decades before symptoms appear and it is possible that this leads to the problem of BPH. I hope to do a future report to illustrate how this model can be used to explain the many various symptoms reported by prostatitis sufferers.

Dr. Feliciano, Jr. cures the prostatitis by simply pushing on the prostate such as to drain it every other day while the patient takes the proper antibiotic to kill the pathogen(s) present. Eventually the physical pressure of the drainage causes the blockages to break up and give way to be
flushed on out. The body heals itself as new prostatic fluid with antibiotics is introduced into the acini and flow through the ducts on later drainages.

Isn't that simple? All very logical. Now let's go into the reasons why coming up with such a simple treatment is unlikely by the best brains in our medical community.

First, Dr. Feliciano believes that there should be no flora (bacteria and other microorganisms) in a man's urogenital system. He considers these as pathogens. On your first visit to his clinic he drains the prostate (by pushing on it with his finger) and has cultures done to uncover the live pathogen(s)
found. You are then prescribed antibiotics which are shown to be effective on the pathogen(s). You are cured when ALL pathogens (and symptoms) have been totally eliminated.

Believe it or not, I understand that our medical community is taught that IT IS NORMAL to have flora living here. I would love to ask why. Sure, we have live bacteria in the alimentary tract to help digest food and as a result bacteria in the colon/rectal system. But why should live bacteria be present in the urinary tract?

Second, many urologists around the world have a belief that the prostate is a delicate organ and that massage or stronger manipulation should not be done to avoid traumatization. However, as Dr. Feliciano explains the prostate.

"It is a tubuloalveolar gland surrounded by fibro-muscular stroma. It is an elastic tissue with abundance of smooth muscles."

He has explained to me that pushing hard on the prostate is no more damaging then pushing hard with your finger on your arm. And the over 4,000 patients successfully treated by prostate drainage in the Philippines would seem to prove his point. I can tell you that after 20 such drainages I
do not feel my prostate has been damaged in any way and neither does the other American patient who was cured right before me.

It is obvious that many urologists here are frustrated about prostatitis and would love to cure it if they only knew how. But this does not excuse the ignorance and inhumanity of some doctors who tell their patients that "it is all in your head" or "you'll just have to adjust your lifestyle and learn to live with this pain for the rest of your life." Yes, these are actual quotes to prostatitis patients.

It is imperative that we assist the Prostatitis Foundation to get the word out on Dr. Feliciano, Jr.'s successful cure for prostatitis and have his treatment immediately investigated and implemented in local areas. Just imagine the possibility of a year from now having a physician near you who can cure any prostatitis sufferer with a simple few week treatment.

Questions and Dave's answers:

I'm sure you can probably write a book. A few questions on #2. Ron, described the draining of his prostate by saying something to the effect that Dr. Feliciano was much better at draining this fluid
than other doctors he had seen. I believe he indicated that other doctors caused him discernible pain but expressed very little fluid while Dr. Feliciano expressed significant amounts of fluid with little or no pain. Did you have a similar experience?

My case was different. The two Austin urologists I saw and Dr. Krieger in Seattle never had trouble getting prostatitic fluid out of me. However, Dr. Feliciano got larger amounts out.

I hope that in future reports you will share the specifics of your treatment including what pathogens were found, what antibiotics were used to eradicate them, the duration and cost of your treatment.
Thanks for the continued info.

Yes, one of my reports will be a complete log of each treatment day along with the events and results found at each.

Did you ever have a transrectal ultrasound conducted, and if so, did it show any calcifications? While Dr. Feliciano's method of cure (draining the prostate) makes perfect sense to me, I'm concerned that (1) it will not solve the problem of someone with calcifications and (2) it could exacerbate the problem by causing some damage to someone with calcifications. Correct me if I'm wrong, but I believe this second concern is shared by Dr. Tarfusser.

Yes I had a rectal ultrasound and it did show calcifications. They were said to be "located near the urethra".

Since a significant percentage of men have calcifications then if these caused problems curing prostatitis Dr. Feliciano would not be having such a high success rate. If you read my earlier reply post on this topic you would understand that he believes stones are the result of the body's
natural defence mechanism against pathogens from the urinary tract reaching the prostate. If this is true the it is no surprise that so many men have them.

Let me add that I spoke at length with Dr. Tarfusser during the NIH conference and I have a high regard for his capabilities and the work he is doing in the area of prostatitis treatment. In fact before I found out about Dr. Feliciano, Jr. I was planning to see him in Italy this summer. However,
I now believe that Dr. Tarfusser is mistaken about his concerns that the prostate is a delicate gland.

David Trissel
Austin, Texas

 Manila Report #3 - Relating Prostate Blockages to Symptoms
(Originally posted at www.prostatis.org w/ diagrams)

[Disclaimer: These reports are from a series of notes taken by me during my cure of prostatitis by Dr. Feliciano, Jr. in Manila during six weeks in February 1996. I had severe symptoms of prostatitis such that I rarely left my home and was completely unable to work. Much of this information was given to me verbally and at a time before the painful effects of my prostatitis had subsided. Many times I only made the notes after returning to my hotel room. Dr. Feliciano, Jr. had much more information than I captured in my notes. He has not reviewed this material for correction.  Due to all these factors the material here should not be considered necessarily accurate representations of Dr. Feliciano, Jr.'s beliefs. Any and all errors and misrepresentation are soley my responsibility.]

Report #2 touched on the role blockages play in creating prostatitis and its symptoms and should be reviewed before reading this report. In this third report I will discuss prostate blockages in more detail and show how they can manifest so many symptom variations. The fundamentals of blockage and ditritous are from Dr. Feliciano, Jr. The extrapolations into symptom variations and infection stages are my own thoughts derived by using his blockage model as a base.

Now let's take a closer look at blockages. Diagram #1 in Report #2 shows an overall view of the prostate with one duct illustrated. The duct consists of a long tube starting with bulbs of acini connected at one end and ending at the urethra. Fluid fills the acini and during ejaculation muscles compress the prostate causing the fluid to be expelled.

Now lets look at closeup of an acinus. Diagram #2 shows a normal uninfected sac containing prostatic fluid. The - marks in the diagram indicate normal prostatic fluid.

Figure 2. (Graphic pending)

Normal prostatic fluid is somewhat transparent. After doing a drainage Dr. Feliciano, Jr. collects a few drops of the fluid on a slide for his microbiologists to examine. They immediately check its PH and perform microscopic analysis of its contents. Simply viewing the fluid by eye you can quickly learn to see the difference between normal fluid and that from an infected prostate. Infected fluid will be cloudy and have visible precipitates in it. (The precipitates looked to me like tiny thin strips of plastic.) These precipitates are the result of the body's defense mechanism
fighting infection.

Now lets look at an early infected state of our acinus. Figure 3. shows the sac now containing bacteria (indicated by * ) some which have attached themselves to the acinus wall. The bacteria are surrounded by white blood cells (shown as W ) as the body attempts to fight back. Notice that the duct is still clear to pass fluid.

Figure 3. Early Infected Acinus Sac(Graphic under contstruction)

As the battle rages white blood cells are killed. These and other byproducts of the war create clumps of waste (pus.) If the infection is great enough then this detritus can build up to totally clog the passageway between the acinus and the duct as shown in Figure 4. Here @ is used to represent detritus.

Figure 4. Blocked and Infected Acinus Sac.  After the acinus is blocked it swells (not shown) and eventually the pressure becomes so great that further fluid build-up is impossible.

The resulting symptoms of prostatitis can be explained from this model. The swollen acini make the prostate tender causing the deep anus sitting pain common to many prostatitis patients. The combination of multiple swollen acini can push on major urogenital nerves that pass directly around the prostate thus causing phantom pain (referred pain) where areas other than the prostate appear to have significant pain. Typically these areas are the penis, testicles, back, legs, etc.

Note that the prostate doesn't have to show up as enlarged on examination for these symptoms to occur. Rectal ultrasound on my prostate showed a totally normal size. Another unhappy fact is that the color ultrasound totally failed to show up these blocked acini in my prostate. I know I had blocked acini because I actually felt two of them unclog during the very first drainage done on me by Dr. Feliciano. It was truly amazing! I felt two quick pops in succession. (When he was through he told me that he had managed to undo some blockages and I told him that I had felt them opening up.) My pain was reduced to around half of its previous level just by that first drainage.

The acini blockage probably acts in very complex ways depending on many factors such as the location and size of the acini, amount of detritus produced, pressure on that part of the duct, etc. As can well be imagined, once the blockage is in place there is little or no chance for antibiotics to reach the pathogen hidden in the acini. The pressure there prohibits any new antibiotic carrying prostatic fluid from being added.

THIS IS WHY IT IS IMPORTANT NOT TO TAKE ANTIBIOTICS UNTIL YOU ARE HAVING PROPER DRAINAGE DONE! To the extent that antibiotics do get into infected areas they are probably not going to be sufficient to kill off the pathogen(s) and you are just allowing the pathogen(s) to evolve to be immune to the antibiotic. Thus could be threatening the ability for you to be cured in the future. Dr. Feliciano, Jr. told me again and again to stress this point.

In much the same way that the geysers and hot springs in thermal areas of the world such as Yellowstone National Park exhibit wide multitudes of phases and eruption variations, so can some complex symptoms of prostatitis be accounted for by taking into account the many ways that fluid flow can be obstructed in prostate duct blockage.

Geysers between eruption stage appear totally calm on the surface for minutes to years at a time before erupting. Likewise, acini ducts may remain blocked for various periods of time, only to unclog when sufficient pressure builds to forcefully eject the detritus on through the duct.

For some patients the acini never unblock and symptoms are experienced continuously. For others breakups occur but perhaps only for a portion of the blocked acini thus causing only a reduction in symptoms. If any live pathogens remain in the acini after the unblocking the entire sequence of blockage and opening can repeat. Cycles of clogging and unclogging can make symptoms come and go. And just like geysers, the periods between flare-ups can range anywhere between minutes to years.

One month into my prostatitis I had a solitary instance of an unblockage that left me with the only pain free period I had during my prostatitis.  Unfortunately, 12 hours later the pain slowly came back as the duct(s) reclogged, never to recover again until Dr. Feliciano's drainage treatments.  I understood none of this at the time. During my prostatitis I had asked every urologist I had seen about my 12 hour pain-free episode but all I got back were blank stares. When I told Dr. Feliciano about my pain-free period he immediately had an explanation that fit the scenario.

Just as thermal activity in geyser areas changes over time, so have some prostatitis patients experienced changes in their symptoms. I myself started with severe testicular pain which later diminished only to be largely replaced by deep anal pain from the prostate itself. I have heard one prostatitis sufferer say he has had so many changes in his symptoms that he has lost track of their number. This is not so surprising when you consider that minor changes in the locations and spread of infection in the prostate can have major consequences on prostate fluid dynamics and how the urinary nerves that surround the prostate are irritated.

Other symptoms, such as blood in urine and the presence of sand or stones during urination can be explained by this model also. Prostate calcifications (stones) deserve enough coverage that they will be explained in a later report, but let's look at blood in the urine (red blood cells.) This can be caused by things other than prostatitis so it is important to investigate those other things while checking out prostatitis. White blood cells are carried by the blood to get to infection sites so it is no surprise that blood may be present where infection fighting is an ongoing activity.  After proper treatment is started the blood disappears.

At times Dr. Feliciano will find blood in the prostatic fluid of a patient where there had been no blood before. This is considered normal and the blood will soon stop making its appearance in future drainages. What is happening is similar to the popping of a pimple. At first pus is released and this is commonly followed by blood. Then both pus and blood disappear as healing commences.

Prostatitis patients not being treated by drainage may have blood either continuously or sporadically. This is understandable because there can be multiply infected acini with various phases of those that are contributing blood and pus to the prostate fluid.

Finally let's discuss an obvious problem that prostatitis causes. With pathogens constantly living in various acini, these pathogens can continue to propagate on out into the rest of the urinary tract causing cycles of infections and reinfections as a result. This is one reason why treatment with an antibiotic may seem to work for a spell one time, but not another.  The prostate can be the cause of a re-infection at any time depending, as we've seen, on a number of complicated conditions which may themselves even change over time.

Seeing the complicated symptom patterns that can arise from infected acini, an attempt to scientifically discover what prostatitis is by studying its symptoms would probably be a Herculean task.

Dave takes a question:

In one of your posts, you mentioned an American was cured after (or before) you during your time in Manila. How are these American men knowing about Dr. F.? Is anyone in the US referring them to Dr. F?

It all happened because of the Internet, more specifically because of the Prostatitis Foundation's web site. The original North American patient saw some information on Dr. Feliciano, Jr. posted there and made follow-up contacts with Dr. Feliciano. Fortunately, he also contacted me asking about some medication I had taken and telling me about his pending trip to Manila. That led to me giving Dr. Feliciano a second look.

I had initially put Dr. Feliciano aside as a possibility because of the 100% cure rate claimed (too unbelievable.) But as it turns out, this posted literature was originally done for local patients in Manila. After all, if you were in Manila and reading this brochure in his office it wouldn't take long for verification of this success rate. Unfortunately, when posted over the world-wide Internet this same brochure doesn't have the same viability when read by people thousands of miles away.

The 100% cure rate should be interpreted as follows: If you have prostatitis and you come to the clinic and completely follow the treatment proscribed you will be cured. The cause of prostatitis is simply understood and treatment simple to apply. (As explained by the postings I'm doing.) There is no reason why ANYONE can't be easily cured of this dreaded disease because its etiology is simple and modern medicine easily affords the tools and medications to eliminate it.

You have bacteria or some other pathogen, you eliminate the pathogen and the disease goes away, that's all there is to it. As I've already indicated, here in North American doctors are not culturing what's there, and they consider draining the prostate to help eliminate pathogens
inadvisable. Because of these two facts the medical community here is totally helpless to either understand or treat prostatitis.

David Trissel
Austin, Texas

 Manila Report #4 -   Prostate Calcifications (Stones)

April 25, 1996

Last November I was informed by the University of Washington Department of Urology clinic in Seattle that my prostatitis showed only two anomalies: slightly increased blood circulation in 5 out of the 7 prostate zones and some calcifications (stones) in the prostate near the urethra. Dr. Krieger's research nurse said that ten years ago prostate calcifications would have been a matter of concern but seeing as how so many men seem to have them with no adverse symptoms they are now presumed benign.

The idea of prostate stones always bothered me and before I went to Manila I had no idea what they were, what caused them or why stones wouldn't be a negative thing to have in the prostate. Why wouldn't they cause problems? Wouldn't they block the small ducts leading from the
prostate into the urethra where they come out in the area of the veru? Couldn't stones be causing my extreme pain episodes, especially during and after ejaculation? Would Dr. Tarfusser's technique of clipping the veru remove such blockage?

The ignorance I had about prostate stones was eliminated with just five minutes from one of the many talks I had with Dr. Feliciano. He told me that it is believed that the stones are caused by the body's defense mechanism trying to isolate pathogens.

Let's go back to a figure from report #3 showing the infected acinus sac filled with infection being fought by the body. The pathogen is indicated by *, white blood cells by W. Notice that some of the bacteria have attached themselves to the acinus wall.

Figure 1. Early Infected Acinus Sac

As the battle rages the body can also counteract by surrounding the bacteria with calcium to isolate it. Figure 2. shows the effect of the body's defense successfully covering the bacteria with calcium represented by ( and ).

Figure 2. Infected Acinus Sac with Calcifications

The small calcified entities are now stones. In the above diagram we still show the duct as open and cleared but keep in mind that it could be clogged with detritus (see Figure 4 from my Report #3). Notice that white blood cells remain present even with the pathogen encased in calcium. This
may be the body's way of keeping its guard up in case any of the pathogen frees itself or reactivates. Could this be why so many men have a high white blood cell count on average? (In the U.S. 12, Europe 22, in the Philippines 10-18.)

David Trissel
Austin, Texas

 Why I am no longer skeptical about Dr. Feliciano's treatment.
By John Garst
note: John Garst has never been a patient of Dr. Feliciano

May 06, 2001

Elliot posted why he was skeptical. I once was, too . Here is why I am no longer skeptical.

(1) Most of my questions have been answered satisfactorily.
(a) Is Dr. Feliciano legitimate?
Certainly. Ron's, Dave's, and Brad's reports make that clear. Dr. Feliciano is not a charlatan working miracle cures.
(b) How could microbes that he finds be missed in the U.S.?
First, some of them require specific tests.
You don't find them if you don't look for them. Dr. Feliciano casts a broad net that includes some of these specific tests routinely. U.S. doctors that didn't suspect them would not find them. Moreover, they might not see other indications and might not suspect them as prostatic infections.
Second, contamination is not a likely explanation.
The possibility that his laboratory has a contamination problem, resulting in "finding" spurious things, is obviously eliminated by the fact that his cultures show the effects of the therapy that his patients have undergone, that is, patients who have been cured are found to be pathogen-free. If there had been some peculiar contamination problem, this would not have been true.
Third, U.S. Doctors generally only do urine cultures.
It is my impression that standard urological practice in the U.S. is to concentrate on urine cultures, in the belief that prostatic infections will show up there. Only relatively rarely are EPS or semen cultured. No one in the U.S. uses Dr. Feliciano's technique of repeated, increasingly vigorous massages (drainages) that may break up pockets of infection and release their contents for culture. Thus, Dr. Feliciano does much more comprehensive and careful sampling than urologists in the U.S. do.
(c) How can Dr. Feliciano and Dr Tarfusser both be right? Dr Tarfusser often finds that the problem is with clogged seminal vesicles. How can Dr. Feliciano have such a high success rate without dealing with seminal vesicles? There is still something to be answered here, but there are several plausible possbilities.
First, they could be dealing with different patient populations.
Second, since Dr. Feliciano's cultures probably reveal the pathogens that infect the seminal vesicles (same as those infecting the prostate), he chooses the right antibiotics, and they are effective on both organs. Perhaps the seminal vesicles often don't need massage in order for symptoms to resolve, once the right antibiotic is found.
Third, Dr. Feliciano may reach the seminal vesicles, or part of them, in his drainages, thereby helping unclog them just as he does with the prostate.
(2) Brad's 2 weeks of observation, detailed analysis of 35 recent cases, and highly favorable report are very significant to me. Brad is an MD, and I've seen from his earlier posts that he is inherently skeptical. Taking his father's case as a clue, he studied the prostatitis literature, found it lacking in logic, and openly challenged conventional wisdom (favoring a bacterial hypothesis for "nonbacterial" prostatitis and prostatodynia) before (I think) he became aware of Dr. Feliciano's work. The fact that he is now convinced that Dr. Feliciano's method works carries a lot of weight with me.
(3) Dr. Feliciano's ideas are completely logical and his findings support them completely. That the encapsulation of infection should be the big problem in diagnosis and treatment should be no surprise to anyone. The big news is that he has found successful ways to deal with this.

Postscript: I posted the message above over 5 years ago. Since it   accurately expressed my beliefs at the time, I have no objection to  Dr. Feliciano's including it here. However, a lot has happened since then. In particular, a large amount of new data has been gathered by very intelligent and dedicated scientists, some of whom have also presented new theories of CPPS. As I understand the situation currently, it is believed that a regimen of culture-guided antibiotics with prostate massage is effective in a relatively small fraction of American CPPS patients.
 
My own experience with our local effort to duplicate Dr. A. E. Feliciano's protocol was partially positive.

(a) A hard nodule on my prostate, which had caused my urologist to order a biopsy a year earlier, disappeared. It has not returned over the several years since.
(b) My EPS became water-white and crystal clear. (I  understand that this is considered to be abnormal.)
(c) All cultures became negative.
(d) My EPS pH normalized.
(e) I had partial relief of pain symptoms (but only partial).

I believe that some patients who are given the diagnosis CPPS, NIH Category III, may belong instead in Category II, chronic bacterial prostatitis, but I doubt that this is true of a large fraction of
Category III patients. I see CPPS as set of conditions for which infecting organisms are not likely to be primary, even though some of these conditions may somehow involve bacteria and/or yeasts in secondary roles.

John Garst (19 Aug 2001)

A Patient's Testimonial: (A letter he distributed to friends that eventually reached me)

September 7, 1999

Dear Friends,

About three weeks ago, I flew to Cagayan de Oro (CDO), Philippines to consult with a Genito-urinary Specialist who had moved his practiced there a few years ago.

Old friends who moved to CDO from Manila a few years back recommended the doctor. They were on a short trip to Manila and we heard they were a bit downhearted so my wife and I decided to invite them for dinner. The idea was to cheer them up and also get my mind off the prostate biopsy that I was to have shortly.

Well, when they heard about my forthcoming biopsy they talked about Dr. Manny Sta. Cruz, a Cagayan de Oro MD who was a crusader of sorts against invasive medical procedures to which so many men suffering from prostate problems were being subjected to unnecessarily.

Despite what we heard that night I felt I had to go on with the biopsy because I wanted to know whether or not I was positive for prostate CA.

Even then however, the thought that this new track may have been one of those rare divine appointments God Himself was making for us was foremost in my mind.

Praying about it that night, my wife Evelyn and I proposed to see this Cagayan de Oro MD if, Lord willing, the biopsy results were to be negative.

The biopsy cleared me for prostate CA. Unlike the three others I'd had before however, this last biopsy triggered a severe urinary tract infection with accompanying high fever and chills like I had never before experienced.

That infection also shut down my urethra so that I had to have a catheter put in place for temporary relief. It is a thoroughly disgusting procedure that I really don't think you would want to wish on anyone even your worst enemies.

After consultations and startup treatments, Dr. Manny Sta. Cruz referred me to a colleague whose practice was based in Ermita, Manila.

I was to find out later that in April 1997, Dr. Antonio E. Feliciano, Jr. had presented his findings from his research and practice in Manila at the 92nd Annual Meeting of the American Urological Association. His work consisted in reviving and updating available body of knowledge on transrectal Prostatic drainage combining that with meticulous isolation of infectious organisms from the resulting discharge and treating them with proper antibiotics.

After exhaustive discussion, his conclusions and procedures for treating Prostatitis became popularly known as the "Manila Protocol."

Remarkably, prominent medical practitioners have been coming to Manila to observe and learn about the "Manila Protocol" even as we Filipinos go West to have to have our prostate problems treated!

Dr. Feliciano's work will soon be published in the latest medical textbooks on the subject. I have enclosed excerpts from early proofs of one such textbook for those of you who are more technically inclined.

As background we all do well to consider the following:

    1. Statistics from both autopsies and live studies of men afflicted with prostate disease, Prostate Cancer and its less deadly but equally debilitating twin, Benign Prostatic Hyperplasia (BPH) reveals very interesting facts. They conclusively show that practically all men will be inflicted with prostatitis defined as chronic infection and inflammation of the Prostate gland later in life. Dr. Feliciano's practice shows cases as early as the 3rd decade with incidence increasing starting midway through the 4th decade and escalating dramatically through the 5th and later decades.
    2. Although pervasive, Prostatitis remained largely ignored by medical practitioners, whose focus has through this point, been Prostate CA and BPH. Overshadowed by its more famous cousins, Prostatitis has, for all intents and purposes, been relegated to the realm of the trivial. No doubt this neglect is also due to the malady's observed unresponsiveness to treatment.
    3. Symptoms for all three (prostatitis, Prostate CA, and BPH) are common. Among these are difficulty in voiding urine, often accompanied by dribbling and reduced semen flow. At times, these are also expressed as burning sensations in the urethral passage, and sometimes by short, stabbing and even chronic pain in the genital areas and lower back. Other symptoms are frequent voiding, often resulting in inability to sleep through the night, or through other similarly extended periods. Extreme symptoms are incontinence and increasing even total sexual impotence.
    4. Usual medical therapy has to this point tended toward alleviation of symptoms through alpha blocker and testosterone suppression. When these no longer work, invasive surgical procedures like scraping the peripheral areas of the prostate, cryosurgery and even removal of the prostate gland have been the standard protocols.
    5. Because of its chronic and traumatic effects, prostatitis is suspected to lead into either or both BPH and Prostate CA over time. There is however insufficient data to categorically conclude that at this time.

In the midst of this remarkably confused milieu, Dr. Feliciano in Ermita and Dr. Sta. Cruz, in far away Cagayan de Oro, offer precious hope to countless men like me who grapple with prostate problems as best we can.

The essence of the Manila Protocol is as follows:

    1. Early attempts to cure Prostatitis got nowhere because after chronic untreated infection, the Prostate Gland shuts itself up, probably to limit further infection. Unfortunately, this damage control also has the effect of making the disease impervious to antibiotics introduced orally or even intravenously. For some reason, attempts to directly inject antibiotic transrectally into the prostate also met with minimal success.
    2. In an attempt to address this, as early as 1986, Dr. Feliciano began to revive and update the previously abandoned practice of transrectally massaging the prostate, reasoning that doing so would open up clogged prostate to receive antibiotics. He treated some 4000 patients through the years carefully noting white blood cell counts from the resulting discharge, isolating infectious organisms found and tweaking antibiotic treatments to eliminate the infections.
    3. In late 1995, Dr. Feliciano collaborated with Dr. Bradley Hennenfent from the Prostatitis Foundation (Chicago) and did a retrospective detailed chart analysis of some 35 cases treated with ages ranging from 28 to 70. The conclusions drawn, combined with laboratory data and clinical procedures from Dr. Feliciano's practice became the gist of his 1997 paper.

      Predictably, his presentation resulted in mixed reviews. No doubt there are those who weren't quite ready to accept so radical a paradigm shift so that their reaction understandably colored by a "Search and see that no prophet arises out of Galilee" (John 7:52) bias. Perhaps the business of medicine wasn't quite ready to have some of its obviously profitable underpinnings threatened particularly by something that comes from the 3rd world.

      In the end however, Dr. Feliciano's work was discussed extensively, tried and accepted, validated and coined as the "Manila Protocol."

    1. Combined with instruction and religious implementation of proper hygiene, Dr. Feliciano's protocol continue to report successful proofs of cure with no significant recurrence through a long as 24 plus post-care months.
    2. The attempt to treat Prostatitis should be the first step for one who suffers from symptoms of Prostate Disease. Early results of these treatments will quickly show whether or not one has to consider the more radical traditional protocols.

If you've spent some reading about and thinking the Creator's ways through, then no doubt like me you've come to marvel at how God's perfect design for the human body works.

Anatomically, the Prostate Gland guards one of the critical portals into a man's body. By design, God intended it to trap and eliminate infections before they find their way inside the vulnerable recesses inside. This works marvelously well provided we do not abuse this design. And how do we do that?

The most obvious way is unbridled sexual promiscuity. The bible clearly says so…

Flee immorality. Every other sin that man commits is outside the body, but the immoral man sins against his own body. 1 Corinthians 6:18

History is replete with examples of horrific plagues that are directly traceable to sexually transmitted infections. Syphilis, Herpes, Gonorrhea and now AIDS all find their genesis in sexual promiscuity. Again and again in the bible we are warned against sexual immorality. It is as if the Creator was saying I've given you all the protection you need…abuse if you wish, but know something: you do so at your own peril!

Exposing our selves recklessly to multiple sexual partners multiplies the risks from sexually transmitted diseases tremendously. Ironically, in our day and age, even those determined to cut those risks down to size by carefully restricting their dalliances to one partner at a time are at grave risk.

A recently published article told of one such woman. She limited herself to sex to one boyfriend but she was terribly shocked when her doctor told her she was infected. A venereal tracer later revealed that her boyfriend had consorted with only one other woman, but that woman had had relations with five other men who had in turn been with 19 women some of them prostitutes. The woman who had carefully confined her relationship to only one person had had contact through him to at least 92 others!

An even more dangerous way to court trouble is perverse and unnatural sex like sodomy. Any doctor will tell you that the very nature of the act exposes one to infections like no other sexual act can. Obviously, fecal matter carries far more infectious, virulent bacteria and other harmful microorganisms.

History tells us that God has consistently frustrated man's every puny attempt to go around his simple injunctions against sexual perversion and wanton immorality. Generation after generation of sexually immoral and perverse action has resulted in sexually transmitted plagues. And just when it seems that science has finally began to find a solution for the current plague, another more virulent problem breaks out to frustrate those who would thumb their noses at the Creator.

So, if you're one of those who have been lured into this so-called sexual revolution, be warned of the trouble you are courting. Is the fleeting pleasure worth the risk?

But what about the rest of us, the greater majority I think, who for the most part lead unremarkably monogamous lives?

Neither my wife nor I were sexually active before we got married. And in all of our 32 years of marriage we have remained completely faithful to one another. How then did I manage to catch Prostatitis?

Drs. Feliciano and Sta. Cruz proposed a very simple explanation. The infections have their origins in simple straightforward hygiene. They proposed that we labor under silly misconceptions that do not help like washing our hands after relieving ourselves and not before. They say urine is sterile and will not give us infections but our hands are not and can give us the very infections we sought to avoid by washing later, not before.

They also say that the anatomy of a woman makes her prone to infections so that gynecologists are not alarmed by recurring Cervicitis in women. But while one might argue that these are minor irritants and relatively innocuous for most women, we ought to take note because recurring Cervicitis is typically caused by the same microorganisms that cause Chronic Prostatitis in men.

To put in another way, wife catches an infection and gives it to her husband during sex. Often, the wife merely shrugs off the infection. Again the Creator has equipped her marvelously to deal with it. Her genitals have been so constructed that they can get no further than the cervix. Her insides are chemically lined so that she repels them routinely provided they do not come in overwhelming numbers.

Husband on the other hand, catches the infection from the wife but the prostate traps and deals with the infection before it can go anywhere.

When we are young, we all take these infections in stride. They cause mere hiccups that we chuck off easily. But over time and as our bodies begin to atrophy, the cumulative toll becomes heavier and soon the infections multiple to the point where their numbers begin to overwhelm our natural antibodies. The result is untold misery…

Well, thankfully for Drs. Feliciano and Sta. Cruz, who appear to have made a breakthrough that offers hope in millions of men like me whom, suffer from the pervasive malady of degenerative prostate disease…

And the knowledge stemming from their research and practice offers hope for our wives as well.

After undergoing thrice weekly Prostatic massage over 3 weeks of treatment, I am now able to void urine without any of the problems I labored under for some 10 or more years now. The latest discharge taken from my prostate gland during tests of cure shows a normal white blood cell count indicating the elimination of all previously found infections of Chlamydia, cocco-baccilli and Staph. Aureus. They all turned up negative showing that all the offending organisms have been eradicated.

A transrectal ultrasound taken at the Manila Doctor's Hospital 2 weeks after my last treatment by Dr. Feliciano read, "normal sized prostate and normal urinary bladder."

Just this week, I got the results back from a post-cure PSA (Prostate Specific Antigen) test where it shows a PSA count of 4.75 ng/ml (I went as high as 11 ng/ml at one time). The high threshold for my age is 4.0 ng/ml so my doctor says we have to another one in 6 months. But he is confident that as the trauma of having had a chronic infection all these years finally and completely wears off, the result then will be below the high normal threshold.

I can only thank and praise God for orchestrating events and people encounters to have made all this possible. May you find Him and experience His goodness as I have.

Gratefully in His Service,

Dennis K. Legaspi

 June 17, 2000

Hey... I have been back from the Philippines for just over a month... I spent April there with Dr A.E. Feliciano. I am having pretty good results. I have been tormented with "prostatitis" for about 9 years. After seeing 6 or 7 doctors most of them of which were Urologist... all but one of them could not even

identify what my problem was. One of the last ones that I went to in Chicago indicated that I needed a psychiatrist. It was five years into my journey of trying to find a Doctor that could help that I finally found a Doctor in Portland that suggested my problems might be coming from the prostate. That is when I found this site and found the link to Dr. Feliciano. I was a bit reluctant to go to a third world country for health care. But I could tell by reading the litature that the Feliciano's knew more about the symptoms of this disease than any of the Doctors that I visited. (Which wasn't hard...since none of them knew anything).

Anyway...I would be happy to talk about my experiences......things are very positive right now. ... nine years was a loooooooong time. Say what you want about the Felicianos... but I will find good help wherever I can find it. 

David Paul

 Subject: Re: PROSTATITIS Digest - 17 Jun 2000 to 18 Jun 2000 (#2000-279)
June 19, 2000

Thanks for your letter. I do understand your position... My point I suppose..is... no Dr in the US or Australia...the two countries western countries that I sought help in...offered any help at all...they were completely oblivious to my complaints. Even though I tried to explain to them in detail what my symtoms were. Most of them only would discuss sexual dysfunction which was only a small consideration when you are feeling that lousy. One Urologist anwswer to EVER problem was penile injections...you could have told him you had a headache and he would have prescribed penile injections. The others completely ignored my problems might be coming from the prostate (refered pain).   And the last one proscribed antibiotics without the massage which he admitted would become incurrable... which seems to me would be a self fulfilling prophecy if only enough antibiotics penetrated the prostate to make a bacterial infection resistant.

What I don't understand is why AEF method is so controversial? Apparently they did more prostate massages earlier this century in the US... and abandoned it with the advent of antibiotics... but now they say that antibiotics don't penitrate the prostate. I must be missing something here? If prostatitis is often caused by a bacterial infection...( and the Dr that prescribed antibiotics without doing any cultures or massage must have thought it was). And there is a ability to drain the prostate and look for pathogens...why don't they do it?  One could spend a fortune in the US going from Urologist to Urologist... and having them indicate they have never heard of your type of problem... and suggest that you see a shrink. If AEF's method involved a full moon and candles with incantations...I could see it as being a bit more controversial... but what is so contorversial about draining the prostate and looking for pathogens... and having a lab right next door to your office to get quick results from cultures?

 
David Paul

    WARNING: Frequent rotation of antimicrobials is dangerous.
It promotes resistant strains and stubborn bacteria.
  
  
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