NAC Prostate Injection Protocol Recommendation

Biofilms: Biofilms are commonly found in connection with prostatitis.[1,2] Biofilms enable persistent infections due to shielding of bacteria from the action of WBCs and the existence of persister cells. Persister cells remain dormant until the bacterial population is depleted and the biochemical environment becomes favorable. To understand the effectiveness of persister cells, there was a case of contaminated povidone-iodine solution wherein bits of contaminating biofilm remained viable after months of immersion.[3] No chemical intervention compatible with living tissue is likely to eradicate persister cells protected by biofilm. The biofilm itself must be disrupted, allowing WBCs to finish off the persisters. Fortunately, there is an ideal agent for this purpose, N-acetyl cysteine (“NAC”). NAC has the following desirable properties:
a) Disrupts a wide variety of biofilms at 10 mg/ml(1%) concentration.[4,5,6]
b) Reduces prostate inflammation[7]
c) Reduces nephrotoxicity of gentamicin [8] and chemotherapy [9]
d) Reduces carcinogenic DNA damage [10]
e) Is approved for intravenous use at 150 mg/kg loading dosage for relief of liver toxicity (Acetadote).[11,12]
f) It has been shown to improve the neurological status of Parkinson's patients.[13]

Peak plasma NAC concentration at the prescribed Acetadote loading dose can be expected to be about .6 mg/ml.[14] This is insufficient to disrupt prostate biofilms. Five times the prescribed dose resulted in a serious adverse event.[15] So to achieve a 10 mg/ml prostate concentration of NAC it will be necessary in include it in a prostate injection cocktail. The 200 mg/ml concentration of NAC in Acetadote means a volume of Acetadote of equal to 5% of the volume of the prostate will result in a 10mg/ml concentration of NAC in the prostate. So this is a reasonable addition to a prostate injection cocktail.

There is now a report of successful use by intra-tympanic injection of NAC at 10% concentration to protect against the ototoxicity of chemotherapy [16], 10 times concentration needed for the prostate. Because it has been shown safe to use at such high concentrations in this extremely vulnerable location this is good evidence it can be safely injected into the prostate.

1 http://prostatitis.org/redirect.php?lin ... 659.x/full
2 http://prostatitis.org/redirect.php?lin ... 4/abstract
3 Infect Control Hosp Epidemiol. 1991 May;12(5):297-302.
Investigations of intrinsic Pseudomonas cepacia contamination in commercially manufactured povidone-iodine. http://prostatitis.org/redirect.php?lin ... DDE167BBB5
4 http://prostatitis.org/redirect.php?lin ... 180-10-140
Pseudomonas aeruginosa biofilms were completely disrupted at 10 mg/ml NAC.
5 http://prostatitis.org/redirect.php?lin ... rmation-of
15 strains of Staphylococcus epidermidis… The 'slime' index relative to the control was 63%, 55%, 46%, 34%, 26% and 26% in the presence of 0.25, 0.5, 1, 2, 4, and 8 mg/mL of N-acetylcysteine,
6 http://prostatitis.org/redirect.php?lin ... 7903002322
Effect of fosfomycin alone and in combination with N-acetylcysteine on E. coli biofilms: 8 mg/ml of NAC. After treatment of pre-formed biofilms with NAC at the highest concentrations used, the remaining exopolysaccharide matrix was reduced to 25–68% of the amount found with the untreated control.
7 http://prostatitis.org/redirect.php?lin ... 016-0327-1
8 Reduces nephrotoxicy of gentamicin: https://www.jemds.com/data_pdf/1_Elizabath.pdf
9 http://prostatitis.org/redirect.php?lin ... 91790/full
10 http://prostatitis.org/redirect.php?lin ... 5148.short
11 http://prostatitis.org/redirect.php?lin ... 1-2016.pdf
12 Acetadote® (acetylcysteine) Injection label: http://prostatitis.org/redirect.php?lin ... 004lbl.pdf
13 http://journals.plos.org/plosone/articl ... ne.0157602
Weekly Acetadote IV 50 mg/kg plus 600 mg NAC p.o., b.i.d.
14 http://prostatitis.org/redirect.php?lin ... lCode=ajvr
15 http://prostatitis.org/redirect.php?lin ... 011.609821
16 http://prostatitis.org/redirect.php?lin ... 10367.html

I have given thought to this myself. If you could atone for the acidity (I believe you have already, iirc) then it should be viable as long as it's followed up by an oral, or IV course of antibiotics, or prostate injected antibiotics within a few hours afterwards. Possible anti-inflammatory medications as well as we don't exactly know what kind of reaction NAC would have directly on inflamed prostate tissue, or on the urethra shortly thereafter.

Thanks for commenting. The injectable version of NAC - Acetadote - is pH neutralized. I believe Acetadote could be combined with antibiotics in one cocktail for prostate injection.