Beyond the standard treatments to shrink the prostate gland
DEAR DR. ROACH: I am an 83-year-old man who, like most men my age, has benign prostatic hypertrophy causing frequent urination. Tamsulosin, which was prescribed by my doctor, is of questionable help. I see hordes of ads for supplements claiming the ability to shrink the prostate. Do any of them really work? Is there anything other than surgery to ease this problem? -- A.P.
ANSWER: Hypertrophy -- from the Greek roots for "too much" and "growth" -- of the prostate gland is usually not cancer. Hence the "benign" in "benign prostatic hypertrophy," or BPH. Symptoms include urinary hesitancy, frequency, urinating at night, a sense of urgency and a weak urinary stream. It is common in men as they age.
Tamsulosin is an effective treatment for many, and it works by relaxing the muscle inside the prostate, allowing urine to flow better. There's another treatment that's commonly used with tamsulosin and similar drugs; it works on the hormone that promotes growth of the prostate. Unlike tamsulosin, which works quickly, drugs like finasteride that block the formation of dihydrotestosterone work slowly, over months. A combination of the two is very effective for most men.
Herbal therapies have been used for decades, and some of them have data to support their use, although their usefulness and safety are not as well proven as the prescription medications. Saw palmetto, beta-sitosterol, cernilton and Pygeum africanum all have been used. A recent review of previous saw palmetto trials found no benefit to symptoms, prostate size or urinary flow. Smaller studies of the other three supplements have suggested modest benefits.
Doctors sometimes make the diagnosis of BPH without a thorough evaluation. If treatment isn't effective, it's worthwhile to reconsider the diagnosis and get a referral to a urologist for additional testing and expertise. I have seen men treated for BPH when in fact their problem is an overactive bladder. I have learned to consider alternative diagnoses when treatment for BPH isn't effective.
If the diagnosis is confirmed as BPH, and traditional medicine and supplements have failed, it is worthwhile to consider surgery and related options. There are many, including traditional surgery, laser and microwave treatments, prostate lift procedures, water vapor energy ablation, and photoselective and plasma vaporization procedures. An expert is needed to review the different options, any of which may be beneficial in certain situations.
DEAR DR. ROACH: I'm an 83-year-old woman in very good health, and I take no medications. My doctor informed me I have an extra heartbeat, but I have no noticeable symptoms. Will my heart wear out sooner? -- A.P.
ANSWER: All of us get extra heartbeats from time to time. They occur when part of the heart generates an electrical impulse faster than the normal pacemaker cells of the heart (in the right atrium), and they can come from the upper or lower chambers of the heart. After a premature beat, there is usually a pause, leading to the sensation of a "skipped" beat.
Unless there are a great many of them (more than 30 an hour in one recent study), or they are causing symptoms, they are of no concern and do not cause problems.
People with very long, protracted bouts of excessively fast heartbeats can get damage to the heart, but a few extra heartbeats are not a concern.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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