Shoskes DA et al. (2005) Anti-nanobacterial therapy for men with chronic prostatitis/chronic pelvic pain syndrome and prostatic stones: preliminary experience. J Urol 173: 474–477

Chronic prostatitis/chronic pelvic pain syndrome (CPPS) is a common problem and is often refractory to treatment. Prostatic calcifications have been implicated in the etiology of this condition, although this idea is contentious. Because the core of prostatic calculi contain apatite—a mineral formed by nanobacteria—researchers from the Cleveland Clinic in Florida asked whether the elimination of nanobacterial calcification might resolve the symptoms of CPPS.

Shoskes et al. tested their hypothesis in 16 men with recalcitrant CPPS of more than 9 months duration. All had failed antibiotic and anti-inflammatory drug therapy and had prostatic calculi on transrectal ultrasound. Patients were treated daily with comET (Nanobac Life Sciences, Tampa, FL), which has three components: 500 mg tetracycline to eradicate the nanobacteria; a nutritional supplement thought to allow the antibiotic to penetrate the stone; and an ethylenediamine tetraacetic acid suppository to break down the stone.

After 3 months' treatment, symptoms had improved significantly: the mean total score using the NIH Chronic Prostatitis Symptom Index had fallen to 13.7 ± 2.0, compared with 25.7 ± 1.6 before treatment (P <0.0001). An 'extremely significant' 50% improvement in symptoms was seen in eight (53%) of the evaluable patients. The minimal side effects included fatigue and rectal discomfort.

The authors note that the observed improvements in symptoms could be attributed to any or all of comET's three components, and that the placebo effect could not be ruled out. They call for prospective, placebo-controlled trials to further investigate whether this treatment is useful in treating the symptoms of CPPS.