Medical Treatments VS. Surgery to Relieve Urination Distress From "Benign" Prostatic HyperplasiaClick to download document
Why is benign in quotes? Because there is absolutely nothing benign about the discomforts dealt by an enlarging prostate.
The following exercise explores what's good -- maybe not so good -- about today's treatments for BPH.
As you respond to each of the following questions, compare your choices with our suggested responses following each question.
If you have any doubts about responding to any exercise, just skip it, read our suggested response and go on.
1. The gradual and on-going growth of the prostate is generally due to -- (Check one.)
___(a) aging prostate tissues
___(b) changing male hormone, testosterone, into a different,
similar substance called dihydro-testosterone.
___(c) aging and changing testosterone into dihydro-testosterone
combine to cause the prostate to enlarge.
Since both hormones are involved, the answer is c.
2. Your bladder is a muscle built to hold, then expel, urine. As your prostate grows larger, the growth may obstruct the free flow of urine from the bladder. The obstruction may force the bladder muscles to worker harder to force out urine. This action makes -- (Check any correct statements.)
___ (a) its walls thicker and stronger
___ (b) it squeezes harder to empty itself
___ (c) it becomes super-sensitive to smaller and smaller amounts of urine
___ (d) its thickened walls become less able to stretch as when those walls were thinner and softer.
All 4 choices are correct.
3. The prostate can enlarge -- (Check statements that are correct.)
___ (1) as early as ages 30 and /or 40
___ (2) most commonly in ages late 40's, 50's, then any later age
___ (3) so commonly it can affect 9 of 10 men older than age 70.
All 3 choices are correct.
4. If excess prostate growth causes urination distress, an easy way to correct it would be to reduce excessive growth by -- (Check any statement that is correct.)
___ (1) taking Proscar to block the enzyme that converts testoster-one into dihydro-testosterone, which will reduce prostate size about 25% and simultaneously cuts PSA production about 50%
___ (2) taking Avodart which blocks the action of 2 types of enzymes that convert testosterone into dihydro-testosterone, which will reduce prostate size about 25%, and simultaneously cut PSA production about 50%.
Since Avodart blocks both types of
testosterone from forming didhydro-
testosterone, in theory it should excel Proscar. But no uncontested answer is available.
5. Reducing the size of the prostate may fail to correct urination problems because -- (Check one)
¬¬¬___ (1) some types of prostate growth do not cause problems
___ (2) some types of prostate growth squeeze muscles surrounding
the urination tube (urethra) and this growth obstructs urine
flow although, but such growth does not involve prostate
Both are correct, though poorly understood.
6. In yet one more strange happenings in male sexuality, testos-terone is the key to prostate growth, but as men age this hormone's production falls as the prostate enlarges. This tells you that -- (Mark T for true, F for False.)
___It will harm your male health if you restore your levels of tes-tosterone using supplementary testosterone.
7. It isn't the testosterone as it comes from the testes that encourages prostate growth. The growth is caused by dihydro-tes- tosterone, a form of testosterone changed into a prostate growth-stimulating hormone called -- (Check your choice.)
We hope you checked 2.
8. Why do we bring up that complex name? It's important because 2 drugs have been developed that block dihydro-testosterone's action, and you should know their name. (Check your selection of these drugs' correct name.)
___(1) 5 beta-reductase inhibitors
___(2) 5 alpha-reductase inhibitors
Correct selection is 2
9. Frequent awakening from sleep is called nocturia (knock-TUR-ee-ah), and it is one of the worst results of obstructive prostate growth. Nocturia has several causes -- and irritations -- such as: (Choose 3.)
___ (1) Increased intake of fluids after the sun goes down
___ (2) Restless sleep so the man wakes up and now awake senses a
need to urinate.
___ (3) Overeating late in the day, or a late-evening snack.
___ (4) Retaining fluids taken in earlier in the day, which leads to
increased production of urine during sleep.
Choices 1,2, and 4 are correct
10. To relieve problems like nocturia, dribbling, a weak-off-and-on stream, and or post/void dribbling, the most used treatments include: (Check all that apply.)
___(1) Alpha blockers
___ (2) 5-alpha reductase inhibitors
___ (3) An alpha-blocker combined with a reductase inhibitor
___ (4) Dietary supplements like saw palmetto and beta sitosterol
All four are in current use.
11. If medications and phytotherapy (plant-sourced substances) fail to provide urination relief and restore acceptable urination control, the next level of treatment is -- (Check what applies.)
___ (1) Ablate (destroy) inhibiting prostate tissues with cold
___ (2) Ablate (destroy) inhibiting prostate tissue with heat
Correct choice is 2.
12. In transurethral needle ablation (TUNA) a physician heats needles inside the prostate to burn away heat at about -- (Check what applies.)
___ (1) 180 to 200 degrees F
___ (2) 212 to 230 degrees F
___ (3) 230 to 245 degrees F
Suggested selection is 2. Variations in heat occur
and are confusing but high heat is clearly needed.
13. In transurethral microwave ablation (TUMT) a somewhat controversial treatment, a variety of methods are used to cook prostate tissue using an antenna mounted on a catheter inserted into the prostate. Temperatures reached are about -- (Check what applies.)
___ (1) 175 to 185 degrees F
___ (2) 109 to 111 degrees F
___ (3) 185 to 220 degrees F
Sorry, no one answer is correct. One prominent
urologist uses only 108-111 degrees F. More
common is 185 to 220 degrees F.
14. Another prostate-ablation technique uses lasers, which have no less than 3 competing versions. (Pick 3 from the following 4.)
___ (1) Interstitial Laser Coagulation (ILC) to enlarge the urine channel and improve voiding.
___ (2) High Intensity Focused Ultrasound (HIFU) A transducer inserted via the rectum heats prostate tissue and ablates it.
___ (3) Holmium Laser Ablation Process (HOLAP)
___ (4) PhotoVaporization Process (PVP). This vaporizes prostate tissue in a green cloud, leading to calling it the "Greenlight Laser." Process is claimed to avoid damage to prostate's exterior walls.
1 and 4 are preferred, although HIFU (2) has recorded success in Europe. HOLAP rate a possibility.
15. When medications and destroying prostate tissues with heat are unsuccessful, surgery remains. Check your knowledge of the pros and cons of TURP, still called the gold standard treatment.
(1) Incidence of ED (erectile dysfunction) __2% __5% __10%
(2) Percent of retreatment required __ 5% __1% __ 4%. __8%
(3) Percent of retrograde ejaculation __10% __20% __ 40%. __65% __70%
ED as low as 2%, as high as 10%. Retreat-
ment as low as 2%. Pick any number you like for retrograde ejaculation, up to 70%.
A closing to this introductory assay of prostatic hyperplasia comes from J. Stephen Jones at Cleveland Clinic, and it offers you an enormous challenge. He declares that 9 out of 10 of his patients with urination distress caused by prostrate hyperplasia can be treated successfully "with a simple prescription." If you have this problem, compare that promise from Dr. Jones with any treatment you may be offered, and be sure you know all there is to know.
If you want to know more about this subject, request our UPDATE newsletter entitled:
Medical and Surgical Treatments to Relieve
Symptoms of Benign Prostatic Hyperplasia.
For subjects of other newsletters, see page four of any UPDATE.
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Comments invited and will be sincerely appreciated! We need to know what you, and men like you, think of our brief introductory approach to prostate growth and urination distress, also our goals. Right now, while it's fresh on your mind, tell us what you think via e-mail or any other written way.Click to download document