• COMPARISON OF BPH TREATMENTS

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    30 Mar 2009 /  Men's Health-Erectile Dysfunction

    Watchful Waiting Alpha Blockers

    Finasteride

    TUR

    Chances of symp-

    31-55% 59-86%

    54-78%

    75-96%

    tom improve-

    ment for at

    least one year

    Risk of immedi-

    None 3-43%

    14-19%

    5-31%

    ate complica-

    tions

    Immediate risk of

    None None

    None

    0.7-1.4%

    incontinence

    Risk of impo-

    Probably no additional risk; how-

    Can cause im-

    3-35%; how-

    tence

    ever, without any treatment,

    potence in

    ever, doctors

    one out of fifty men age 67 and

    about 5% of

    think the

    older, per year, loses ability to

    men; this is

    risk for most

    get an erection.

    reversible

    patients is

    and should

    5-10% and

    disappear

    actually may

    when the

    be no higher

    drug is

    than with

    stopped.

    watchful

    waiting.

    Need for future

    15-65% over 3 6-54%

    Unknown

    9-11% 5 to 8

    treatment

    to 5 years

    years after

    treatment

    Loss of work and

    1 day 3.5 days

    2 days

    7-21 days

    activity time

    during first

    year of treat-

    ment

    Source: The U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research.

    *294\201\8*

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  • BHP TREATMENT.TRANSURETHRAL RESECTION OF THE PROSTATE (TUR): WHAT HAPPENS

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    30 Mar 2009 /  Men's Health-Erectile Dysfunction

    The prostate’s innermost core is removed, usually after spinal anesthesia (see above), without opening up the abdomen. This operation, called a TUR procedure, is a proven, effective way to improve BPH symptoms quickly, and keep them at bay for years. In a TUR procedure, surgeons reach the prostate via the urethra by placing an instrument like a cystoscope through the penis. This instrument, called a resectoscope, shines a powerful light that allows surgeons to view the prostate as they chip away at excess tissue. (This tiny instrument even has its own “windshield wiper,” which irrigates the lens and keeps the area clear for surgeons to see.) The prostate’s core is removed in fragments, by means of electrosurgical cautery. These tissue chips amass in the bladder, and at the end of the procedure, they’re flushed out, collected and sent to a pathologist for examination. Because the resectoscope is threaded through the urethra, no skin incision is needed.

    After Surgery

    A Foley catheter is inserted into the urethra and the bladder is continuously irrigated with a salt solution for the first twenty-four hours to prevent blood clots from forming. This catheter is usually removed in two to three days. The average hospital stay is one to three days. Most men have little or no pain after a TUR. When pain does occur, it’s usually because of bladder spasms, involuntary contractions of the thickened bladder around the Foley catheter. These usually go away when the catheter is removed. You should be feeling fully recovered in about three weeks.

    *255\201\8*

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  • RECOVERY OF POTENCY AFTER RADICAL PROSTATECTOMY: VACUUM DEVICES

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    30 Mar 2009 /  Men's Health-Erectile Dysfunction

    The idea here is to create suction using an airtight tube that is placed temporarily around the penis. An attached pump withdraws air, creating a reduced atmospheric pressure—a vacuum—around the penis, causing it to become engorged with blood. The penis becomes erect. Then a constricting ring, like a rubber band around the neck of a balloon, keeps the blood trapped in the penis, so the erection can be sustained. (This imitates the clamping action of the veins in normal erection.) It usually takes about five minutes to produce the erection, and this generally lasts for about half an hour. (The erection probably shouldn’t last much longer than that; leaving the constricting band on too long can cause distention or swelling due to fluid retention in the penis.)

    This erection is not quite the same as a normal erection—it begins only above the constricting band. But it is sufficient for successful intercourse. Vacuum devices have few complications; these can include trouble with ejaculation, pain in the penis, and tiny, pinpoint-sized bruises. (Men taking aspirin or other blood-thinning medications may be more likely to experience such complications.) Some men are highly satisfied with the result of vacuum devices; others are not.

    *218\201\8*

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  • PROSTATE CANCER TREATMENT: DRUGS THAT INHIBIT PRODUCTION OF TESTOSTERONE

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    30 Mar 2009 /  Men's Health-Erectile Dysfunction

    Ketoconazole

    This drug got its start as an antifungal agent. Then doctors noticed that men taking it developed breast enlargement—clearly, more than fungal problems were being treated here! Doctors learned that ketoconazole blocks production of testosterone by the testicles as well as androgens made by the adrenal gland. It works quickly; taking 400 milligrams of ketoconazole every eight hours reduces testosterone to the castrate range within twenty-four hours. The drug’s effects are reversible, and testosterone goes back up again as soon as a man stops taking ketoconazole. It’s debatable whether the drug is as effective as other hormonal treatments for long-term use; ketoconazole causes a surge in production of LH that might, over time, overpower the drug’s tight clamp on testosterone. Therefore, ketoconazole generally is used in short-term situations where fast action is needed—in a man with acute spinal pain, for example, or in a man with DIC (disseminated intravascular coagulation, a blood-clotting disorder that develops in some men with advanced prostate cancer). In addition to the hormonal effects, some derivatives of ketoconazole have also been shown to have some effect in directiy blocking the growth of cancer cells; this potential is undergoing intense investigation. One technicality: The drug is not approved by the FDA for use in the treatment of prostate cancer. It can have adverse effects on the liver. Because it can also suppress the production of steroids normally produced by the adrenal gland, ketoconazole should be prescribed along with a corticosteroid such as prednisone (five milligrams a day), to compensate for this loss.

    Conclusion: Ketoconazole is not a drug for the long haul, but it is helpful in some situations.

    *179\201\8*

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  • WHAT HAPPENS IF MY PSA GOES UP AFTER RADIATION TREATMENT? INVESTIGATION

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    30 Mar 2009 /  Men's Health-Erectile Dysfunction

    Recently, investigators at Johns Hopkins studied 51 radical prostatectomy patients who experienced a rise in PSA after surgery. These men were followed until the location of the recurrent cancer could be identified; 30 percent of these men developed palpable local recurrence of cancer that was confirmed by biopsy; 70 percent showed signs of distant metastases with positive bone scans.

    In this study, distant metastases were present in nearly all men who had early elevations of PSA during the first year after radical prostatectomy, men whose tumors had a high Gleason score (8 or higher), and men with cancer in the seminal vesicles or lymph nodes. Therefore, radiation therapy to the prostate bed (the area where the prostate used to be) probably isn’t going to get all the cancer in these men.

    However, men in this study who had a late rise in PSA, men with low-grade disease (Gleason 7 or lower), and men with cancer-free seminal vesicles and pelvic lymph nodes were more likely to have local recurrence of cancer— cancer that has not yet metastasized. These men, then, would be more likely to benefit from radiation therapy to the prostate bed.

    Should a man have radiation therapy immediately after surgery? No. It should be delayed at least three months, to give the body a chance to heal— and particularly to give the urinary tract a chance to recover. Irradiating a tender, sewn-together urinary tract is not the best way to encourage this inflamed tissue to heal.

    *141\201\8*

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