What do you count as success, and do patients relapse after treatment?
What we count as success and where our high success rate comes from, why “relapse” after antibiotics is untreated disease, what happens in the years after the protocol, and what our own ultrasound records show after breaks of one to four years.
We receive a version of this question frequently, usually from a man who has read our pages carefully and wants to know exactly what he would be signing up for. A recent e-mail put it well: “What do you actually count as success? What percentage of your patients are symptom-free and culture-negative at 6–12 months?” It deserves a full answer rather than a slogan: what success means at this clinic and where our high success rate comes from, why the usual “relapse” statistics for prostatitis measure the wrong thing, what happens in the years after the protocol, and what our own ultrasound records show when a patient comes back after a long break.
What we count as success, and where our success rate comes from
A patient is not finished when he feels better. He is finished when the disease has been reversed in the tissue, and that is measured, not assumed. Our aim is not improvement but complete clearance: every problem we can see in the things we measure has to be gone, and stay gone. In practice that means the cultures of prostatic fluid and semen are negative and stay negative on repeat testing; the white blood cell count in the prostatic fluid has fallen to 10 per field or below; the transrectal ultrasound shows a settled gland, smaller, softer and without the excess blood flow; and the urine flow and the symptoms have returned to normal as a consequence. The full endpoint is described on How the Georgiadis Protocol works.
This is where our high success rate comes from. We do not stop at “better”; we keep treating until nothing measurable is left, so the patients who stay until the end of the treatment leave with the disease reversed, not suppressed. Roughly 8 out of 10 patients stay until the end, even if they have to space the treatment out. The ones who do not have a very recognisable profile, which we describe in Do you have any unsuccessful cases and why?: almost without exception they are the men who stopped in the middle, usually during the first stage. The audited volume data, the microbiology and three documented cases are on the Georgiadis Protocol page.
Why the “relapse” statistics of other treatments measure the wrong thing
The question about relapse comes from a real experience. Most of the men who write to us have been through the standard pathway: a course of oral antibiotics, often several, which helped for a while and then stopped helping. The literature describes the same thing, roughly “80% respond, then relapse over the following one to ten months”, and it is usually interpreted as the disease coming back.
In our opinion those patients were never cured in the first place. A few weeks of an oral antibiotic can lower the bacterial load enough for the symptoms to ease, but nothing in that treatment repairs the damage of chronic prostatitis: the blocked ducts and calcifications that trap organisms where oral drugs cannot reach them in adequate concentration, the resistant strains the earlier courses selected, the congested, inflamed tissue and its abnormal blood flow. When the drug stops, the infection that was only suppressed reasserts itself. That is not relapse; it is the natural course of an untreated disease with a pause in it.
Two other histories are so common that they are worth naming. In the first, no organism was ever found, the patient was given the label “non-bacterial” or CP/CPPS, and the disease simply continued under a different name, because the sampling was never adequate. In the second, an organism was found, the man took the antibiotic, a subsequent test came back “negative”, and he believed the matter was closed, yet the symptoms carried on. In both cases nothing had actually been resolved. This is precisely why we refuse to define success by symptoms or by a single culture. If the definition is loose, the “relapses” are guaranteed.
What happens after treatment: the honest answer about 6–12 months and beyond
We are a private clinic, not a research programme, so we do not run a formal trial-style follow-up visit at six and twelve months. Many of our patients travel to Athens from other countries; when they reach the endpoint they go home, and a man who is well does not book a flight to have his prostate checked again. We instead check in with our patients by e-mail from time to time, and after months of treatment together the relationship is close enough that they would not hesitate to message us, through any of the many channels they have, if anything came up. Every patient leaves with one instruction: if any symptom returns, or anything new appears, get tested locally and contact us immediately.
In 2020–2026, from the patients who finished the protocol, two have come back with symptoms, four and five years after their treatment. Both were examined in full, and both told the same story. First, the prostate on ultrasound was largely as it had been at the end of their treatment years earlier: the reduction in size had held, the gland had not returned to its former state. Second, the organisms we cultured were completely new, not the ones we had treated. These were new infections in a gland that had been repaired, not the old disease resurfacing, and both men were cleared with short bursts of treatment, in a fraction of the original time.
That is the whole list. Out of everyone who has finished the protocol in those six years, and with every one of them able to reach us in a moment, two have needed us again, and neither of them for the disease we had treated.
What this means for the way we treat
It is the reason the protocol is built the way it is. Microbiology is repeated throughout treatment, not just at the start: prostatic fluid obtained after firm pressure, semen, cultures kept for days rather than hours, PCR for the organisms that do not grow. Each round frequently reveals a second or third organism that was hidden behind the first, and treatment is adjusted to what is actually there. We do not stop when the man feels well, or when one culture is clean. We stop when every culture is negative and stays negative, when the white blood cells are down and when the ultrasound confirms it. Whatever is left behind at the end of treatment is exactly what will be called a “relapse” a few months later, so the last stage of the protocol is about making sure that nothing is left behind.
What our records show when patients come back after a long break
Patients who finish rarely come back, so the men we can actually follow over the years are a different group: those who stopped in the middle of treatment for a year or more and then returned for a new ultrasound. They are not cured patients. All but one stopped before their cultures were clear, and during the break they had either nothing at all or the occasional course of antibiotics. That makes them a tough test: if our improvement were only temporary, these are the men in whom it would disappear. From 2020 to 2026 there are 26 of them, away for 1.8 years on average and up to 4.2.
In plain words: at the end of their treatment block, these men’s prostates were on average 39% smaller than at the start. When they came back, after almost two years on average with no treatment from us, they were still 32% smaller. About four fifths of the improvement was still there. Twenty-five of the twenty-six were still clearly smaller than before treatment; in eleven of them nothing had changed at all during the break, and in four the prostate had even gone on shrinking. The one man who had cleared his cultures before stopping is the navy dot: exactly the same size two and a half years later. That is what a finished prostate looks like, and it is what we saw in the two finished patients who came back with new infections.
This is our own patient record, not a clinical trial, and we chose the hardest group on purpose: men who stopped with the infection still there and did nothing for years. Even they kept most of their result. What they lost is the price of stopping: our records show that patients who leave long gaps in their treatment end up with about half the progress of those who keep going. The improvement holds; it just does not continue on its own.
In short
- Success means complete clearance of everything we can measure: negative cultures that stay negative, white blood cells at or below 10 per field, a settled gland on ultrasound, normal flow and no symptoms. Our high success rate comes from not stopping before that point; roughly 8 in 10 patients stay to the end.
- “Relapse” after antibiotics is the untreated disease resuming. Nothing in a short oral course repairs the gland, so nothing was cured.
- After the protocol patients are asked to report anything new, and we check in with them. In 2020–2026, two finished patients came back, four and five years later; both had a stable prostate and entirely new organisms, and both were cleared with short bursts of treatment.
- Our records show that even men who stopped mid-treatment for almost two years kept about four fifths of their improvement, and the one who had cleared his cultures kept all of it.
Considering treatment?
The patient handout explains what a course involves week by week, and the Georgiadis Protocol page has the full audit and three documented cases. Write to us with your own history and results.
Frequently asked
How do you know your patients stay well after treatment?
We do not run a formal twelve-month visit; we check in with our patients by e-mail from time to time, and after months of treatment together they have every means, and every reason, to message us if something comes up. Every patient is also told to get tested locally and contact us immediately if anything new appears. From all of these, only two have reached out so far, years after finishing, and both returned for short bursts of treatment to clear new infections.
Can I get prostatitis again after I have been cured?
Yes, as with any infection. The two finished patients who came back in 2020–2026 both had new organisms in a prostate that had stayed as it was at the end of treatment. A new infection in a repaired gland is a short job, not a repeat of the original disease.
Why do you keep testing when I already feel well?
Because feeling well is not the endpoint. Organisms that are still present at low numbers, or a second organism hidden behind the first, are exactly what produces a “relapse” a few months later. Treatment stops when the cultures, the white blood cells and the ultrasound all say it can.
Does the improvement in prostate size last?
Yes. Even men who stopped mid-treatment for almost two years on average came back with a prostate still about a third smaller than before treatment, and the patient who had cleared his cultures before stopping came back unchanged after two and a half years. The result is best protected by finishing the protocol rather than leaving long gaps.
