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Doctors' Answers to "Frequently Asked Questions" - Prostate


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 04/21/2000]
Question: my psa test was 5.04 what should i do now

Answer: This would depend on your age, previous values and size of your prostate. For example, 5.04 at 50 is significantly higher than at 75. If your previous value(hopefully about a year ago) was 1.0 and this was 5.04 this would be a significant change and would usually require an ultrasound. Younger age, smaller glands, jumps in the PSA all indicate further evaluation-usually an ultrasound and biopsy. If the numbers are slowly rising, you are older etc. then you can repeat the PSA in 3-4 months and see if it is still rising.

[posted 02/6/2000]
Question: My husband just did a semen analysis, and they found white blood cells
in his urine. My doctor said he had a prostate infection. My
concern is, he doesn't have any kind of symptoms you have with
a prostate infection? Wouldn't you have some kind of symptoms?
My doctor put him on Doxycycline, he just did another analysis
yesterday 02/05/00, I am very anxious to see the outcome of this
test! If you could enlighten me on anything about this, it would
be greatly appreciated!!

Answer: Low grade infections are often asymptomatic. Very common in men, like bladder infections in women. This is not usually transmissable from men to women, depending on the organism causing the infection. Most of these are due to gram negatives from the colon(presumably), they could be due to other organisms-I assume he did a culture?

[posted 11/25/1999]
Question: Because of outrageous price increases and my very limited insurance coverage, I need to know if there is a cheaper suitable alternative to terazosin for bph and lorazepam for anxiety?
Thank you for your time:::

Answer: Saw palmetto available in any pharmacy is useful in BPH and usually cheaper. It will take about a month to be effective. As to the lorazepam, use the generic-but no other options here. Any of the benzodiazepines will work in its place but they're all about the same cost.

[posted 08/10/1999]
Question: I have a large prostrate. I also have a bladder 2 times normal size
(30 oz). I have had many UTI's, but now that I know to get the bladder
empty, I have not had a UTI.

Last UTI was last Nov(98) and at that time I did 18 days of Cipro.
For a few months after that I could easily empty the bladder (about a quart.
It felt really good. Since then I have learned a lot.

The slow and hard to empty symptoms are back. Is it worth another
extended round of Cipro or some other antibiotic. I do not
want to abuse antibiotics, but I don't want a prostrate operation either.

If an operation is in ordered, which is the best. I have heard of
new laser surgery. Can any of them be as an out patient.?
I hate being in a hospitol for any reason.

I am also type II diabetic since (1981). I take 80-100 units of insulin.
I do 4 shots a day and have a nice tight control. A1c runs 5.8 to 6.4.
I ride a bicycle a lot.

Thank You..

roger
=============

Answer: First, you must determine that there is neurologic control of your bladder. Some diabetics will lose nerve control of their bladder as a manifestation of neuropathy. Once this has been done, you should try a couple of months of saw palmetto, failing this cardura or hytrin to help this problem.

[posted 08/8/1999]
Question: I am a 75-yr. old with "chronic non-bacterial prostatitis.
I have had two TURP'S (The latest in January)
but continue to have problems. I am up 4-5 times nightly
on a good night, 8-10 on bad nights. Urination requires
straining and frequently very little urine is expelled.
I have occasional good days, but no good nights.
Currently, I take 2mg cardura daily which is not helping
much. Through the years I have run the gamut on anti-biotics
through cipro. I am active with good bp, normal indicators
on my annual blood work. My PSA is under one and urinalyses
are always "clear". I walk daily, hunt, fish, manage my
investments, etc., but the nightly pain and sleep interference
is affecting the quality of my life to the point where
I am considering seeking a radical prostatectomy, even
though I am still moderately sexually active. Is this
a viable consideration?
hank you very much.

Answer: I assume you have tried saw palmetto? Also, occasionally Kegel exercises-normally used for women's pelvic relaxation will be helpful. Occasional patients have success with high doses of zinc supplements with this problem. Lastly, there is a condition called prostadynia. Pain and discomfort in the prostate-cause unknown. Diet is the mainstay for this condition, avoid pizza sauce, ketchup, beer, highly spiced items. All worth a try. Lastly, before I would have a complete prostatectomy I would try Lupron shots every month for six months or so and see if "shrinking" the prostate will give you some relief. This is like a "medical" prostatectomy, so you can experience the "benefits" prior to the complete loss of your prostate.

Enlarged Prostate Treatment [posted 1/14/99]
Question: My father, who was born in 1936, started having the problem with his prostate (his prostate is enlarged). After the examination, doctors recommended him to take Flomax 4 mg, and it helped. But now he is out of them and the replacement that he was offered is Cardura. Would you please describe the differences and similarities between these two?

Answer: Flomax is generally better tolerated by most of my patients, although some prefer cardura. They are completely different classes of drugs. If the flomax is working, why not stay with it? Cardura will lower his blood pressure that Flomax will not. Maybe that is his doctor's goal.

Prostate Cancer & Barrett's Syndrome Concerns [posted 11/24/98]
Question: Can cancer of the prostate affect barretts syndrome, or conversely can cancer from barretts syndrome transfer cancer to the prostate?? 

Answer: No 

Is Prostitis Related to Sexual Activity [posted 11/11/98]
Question: Can prostitis be aggravated or passed through sexual contact? It seems as though every time I change partners protection or not I get symptoms and am diagnosed as having prostitis. I then get prescribed a regimine of antibiotics. I think that this is to much of a coincidence. I am uncircumsized so is this causing problems?

Answer: Prostate problems have no correlation with sexual activity. If anything, increased activity decreases infections by increasing flow through the prostate.

Saw Palmetto: The Better Herbal Remedy ? [posted 10/13/98]
Question: In concerning to my last doctors visit, I was told that my prostate gland had started to enlarge a little. Since I'm already taking quite a bit of medications for my other health problems, I have been concerned about the new herb I've heard about selenium, do you think I should consult my doctor first before taking it.

Answer: Yeah, but a better herbal treatment is Saw Palmetto, very effective.

Saw Palmetto Herbal Remedy for Prostate
Question: I have heard much about the benefits of Saw Palmetto extract for prostate health. But also heard from nay-sayers.My urologist says I have quite a large prostate. Cardura (2mg/da) keeps me "going". But could Saw Palmetto help reduce the size and get it back to normal? Is it a preventative for prostate cancer? Could it be used along with the Cardura? Could I or should I try to stop taking Cardura and use Saw Palmetto exclusively? I also heard it might regrow hair! I could use that too. Is there anything to that?

Answer: Saw Palmetto doesn't usually reduce the size ;but, often allows better urine flow after being taken for several months. I have seen no contraindications to taking the two together;but, this is a question I've posed to the makers of Cardura myself. To date, I have no information back from them. I would probably try it if it were me.

Prostate Infection Treatment
Question: My brother has a prostate infection. He has been told that there is a new drug by the name of Prostata that will eliminate surgery, but I cannot find any information on this drug at all. Could you please tell me more about this drug?

Answer: I haven't heard of this drug. Drugs that sometimes work are zinc tablets and/or saw palmetto (Assuming traditional antibiotics aren't helpful).

Prostate Infection
Question: I am a 23 Irish male who suffers from prostitis. I do not know what form it is as I was never really checked out properly. I am now on a waiting list but have been prescribed Ipral 200 mg for three weeks then 100 mg for nine weeks. My condition has not improved and I am very worried as I am a bit young for this. Will it go away? I have had symptoms for a long time but many doctors said it was stress. I would appreciate it if you could give me some advice as in Ireland it is very difficult to dictate what tests one should have done.

Answer: Prostitis is unusual in a young man, but does occur. The first step in refractory infections is to identify the organism. This will take massage of your prostate and culture of the exudate. This is essential for elimination of the organism. If nothing cultures, go on a good broad spectrum antibiotic for at least 4-6 weeks. There are those who think that zinc orally (found in any pharmacy) will help. This is unclear, but it won't hurt. There are advocates of saw palmetto as well, which is also untested, but fairly risk free. Regular prostatic discharge is thought to help. This means regular masturbation or sex (you are not infectious sexually). Good luck.

Prostate Infection
Question: A few months ago I had problems with my prostatitis. I took some medicine and it was OK. Now I have the same problem again. It is becoming painful again. What should I do? What are the risks?

Answer: Prostate infections are notoriously hard to cure. Often antibiotics are needed for 3-5 weeks. Also, the organism must be isolated to ensure proper antibiotic coverage. This will need a prostatic massage and subsequent culture of the penile discharge. Occasionally, surgery will be needed if long term antibiotics are not curative.

Prostate
Question: My Dad has been treated for an enlarged prostate for the past few years. He has taken Hytrin on a regular basis. Recently, he had a biopsy to see if there were any malignancies. The tests were negative, but since the procedure his prostate problem has gotten much worse. He has a lot of trouble urinating, and it is very painful. He is still taking Hytrin, and his doctor gave him some antibiotics. Is this a normal reaction to a biopsy? If so, shouldn't it be clearing up? What should he do?

Answer: Hytrin is drug given to decrease the symptoms of Benign Prostatic Hypertrophy. This is a condition where the prostate continues to grow and slowly blocks the ability to urinate. A biopsy of the prostate is done to detect cancer of the prostate. Occasionally, the inflammation produced by the biopsy needle will cause additional swelling or a flare of an underlying infection. Increasing the dosage of Hytrin is occasionally of help. The antibiotics are what I would prescribe.

Prostate
Question: I have noticed when I urinate I do not urinate with much force even though if I have to go bad. Could my prostate be causing this restricted feeling? It can be very painful when I am forced to not go to the bathroom when I need to and when I finally do get to go, it comes out in a slow trickle even though my bladder is overflowing.

Answer: The prostate is the most common problem in mens’ urinary tract. As the prostate ages, it continues to grow. It is anatomically positioned between the bladder and the penis with the urethra (tube which the urine exits the body) going through the center of the gland. Consequently, as the gland enlarges it tends to block off the ability to urinate. This is seen with decreased force or urination and more frequent urination. There are several treatments ranging from drugs to affect the control muscles of the bladder to surgical treatment of the obstruction. Occasionally, this will he simply a low grade infection in the prostate and not permanent enlargement. In any case, you will need to consult your physician.

Prostate
Question: I am receiving a PSA test each year and an examination from a doctor for my prostate. My PSA is okay, but I have been experiencing some enlargement of my Prostate. My urinary tract is being somewhat restricted. I have heard that Saw Palmetto is used extensively in Europe to alleviate this condition. Could you tell me if this is a good treatment, and if so what is the recommended dosage?

Answer: Several of my patients have reported improvement with this medication. I have seen no controlled studies and do not know the dose or side effects. Another treatment might be low dose Hytrin. This is a blood pressure pill that helps prostate blockage about 75 % of the time and is available through your physician.

Prostate
Question: I am taking both Proscar and Cardura. My prostate has shrunk, but there was no improvement in symptoms until I started taking Cardura. I am considering eliminating Proscar. Will the relaxed prostate surface accelerate expansion?

Answer: Proscar got a great deal of play when it came out since it looked effective and should work if you believe the theory behind the drug. Most physicians have concluded that it has minnal effectiveness and most patients have decreased or stopped taking the drug. I would stop taking it.

Prostate Cancer
Question: Doctor, why is it that you have to wait from six months to a year before you're able to have sex after a radical prostatectomy. I feel great and have the desire but nothing happens. I also had the nerve-sparing surgery and it went fine.

Answer: Six months. One year is longer than most urologists recommend. Usually 3 is the average. Although the nerve sparing surgery preserves a higher frequency of potency, it is not 100%. Usually patients will have at least nocturnal erections if the function is adequate. Also, there is often delayed healing. When there is pressure there are minor amounts of swelling and damage, in spite of the "nerve sparing". This takes a while to heal, sometimes a year.

Prostate - Fluid Retention
Question: Could Tylenol PM cause fluid retention in a 77 year old male having the usual nocturia 3-4 times until recently, now 0-1?

Answer: Tylenol will have no effect on the prostate, but the PM part will. The PM part is an antihistamine to promote sleepiness. However, it has the effect of interfering with the outlet muscle of the bladder (bladder sphincter). Any antihistamine will have this effect and it should clear within 1-2 days of stopping the medication.

BPH - Saw Palmetto
Question: Do you have any recent reliable information on use of Saw Palmetto/pygeum in treatment of BPH? It seems to be better than Hytrin.

Answer: Several of my patients have tried this and swear by it. I can't find any research done comparing the effectiveness of this with any prescription medication. However, I also can't find any particular toxicity. My current feeling is to try it, and if it works, keep with it. It's not like medicine has particularly good alternatives.

Prostate Infection
Question:I have had prostate infections in the past and believe I may have a current infection. I am experiencing the feeling that I have to urinate very frequently. No pain or discharge. Has been going on for several days now. Should I wait and see if this goes away or see a doctor soon?

Answer: Prostate infections in men are very common and somewhat difficult to clear up. The bacteria which causes the infection usually comes from the colon and is a "gram negative". The prostate is very cavernous with many places for bacteria to "hide". This usually takes antihiotics-sometimes for a protracted course. Some people have recommended oral zinc replacement for recurrent infections. Controlled studies have not shown this to be very helpful; but, I do have some patients who think it helps recurrent infections.

Cardura Substitute
Question:I am 31 years old and taking Cardura for BPH and prostatis. I recently found out that my insurance company will no longer cover this medication. Is there another doxazosin mesylate that I can take? I have been on Hytrin, but it does not work to the degree that Cardura does.

Answer: These are really it. Cardura is about due to go generic. I have had some patients who have had improvement with saw palmetto or zinc replacement in minimizing prostatis. This is anecdotal and not proven.

Prostate Irritation
Question:I have been experiencing very mild prostate irritation/pain for several weeks. What are the symptoms of prostate cancer? My mother died of breast cancer and my father of adenocarcinoma of unknown origin. Should I be concerned about my currant symptoms?

Answer: This is probably a prostate infection although could be a condition called prostadynia. Prostate cancer (in the prostate) is painless-it is painful after it spreads to bones etc. If it were painful in the prostate, deaths from prostate cancer would be rare. You need to have your prostate checked for infection. If none is present you could be having prostadynia a painful condition of the prostate which is triggered by certain foods beer, tomato sauce etc.

Floxin
Question:My doctor prescribed 60 days of floxin for a prostate infection. I was advised to take the medication on an empty stomach. However, it seems to upset my stomach when taken in this fashion. What are the effects of taking the medication with a meal? Can you recommend another alternative?

Answer:There are several antibiotics available for prostate infections. I'd personally take at least a little food until the antibiotics are used up and tell him/her the next time to try a different medication. There is a similar drug called Levoquin which is only the active ingredient in Floxin and seems to have less GI toxicity.

Cardura
Question: I am taking 2 mg of cardura the last 2 months. I was feeling so bad that I went to the urology doctor. I am so afraid about it because I am 48 yo and I have never have this kind of prostate problems before and I don’t know if I have to be taking this medicine the rest of my life. I feel some relief ol pI am not totally well. The doctor says that it is nothing wrong with my condition because the rectal test and the cancer blood test is OK, and may be it is not BHP either. Could you tell me something of your experience with cases like this.

Answer: If you are having difficulty urinating, it can be from several problems. These can range from prostatic enlargement(treated by Cardura) to a mild infection to different drugs(like antihistamines) causing the problem. Usually, I treat my patients for 2 weeks or so with antibiotics to see if there is a mild infection(hard to diagnose). If this doesn't work Cardura, Hytrin, or occasionally Saw Palmetto are used to treat the obstruction. Occasionally, previous gonorrhea infections etc. could cause a problem.

Enlarged Prostate
Question: What Treatment is recommended for a suspected enlarged prostate?

Answer: Depends a little on the patients age. Use of Hytrin or Cardura is sometimes helpful by changing the tone of the outlet muscle. There is a drug called Proscar;but, I don't think it is very helpful. Some patients tell me that saw palmetto(available in health stores) is helpful. If none of these works, surgery is the last option.


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