Middle-Aged Men Confront Prostate Problems

Prostate health is taking its place among all those things you're not
sure you want to hear about while snacking in front of the TV.

Not since "erectile" and "dysfunction" became household words
have there been so many media messages about middle-aged men and their
plumbing problems.

But here's the thing about the prostate gland: Every guy has
one. And as men get older, this body part they were only vaguely aware
of can cause problems such as frequent or difficult urination.

Thus they might wonder whether they have "a going problem" or
"a growing problem," as described in a commercial for a medication
treating an enlarged prostate.

Ads for medications such as Flomax and Avodart depict men who
now can enjoy ballgames, go fishing and get a good night's sleep
without the worry of urination difficulties that an enlarged prostate
can entail.

"I think the overall effect of the ads has been positive,
because I think education is the key to health care," said Dr. Kevin
O'Kelly, of Low Country Urology in Florence, S.C.

The ads also urge patients to make sure their symptoms are not
related to prostate cancer. That helps raise awareness about the cancer
most frequently diagnosed in men, said O'Kelly, who recently began
doing robotic assisted prostate surgery at Carolinas Hospital
System."It's getting the attention of a lot of females, too," he said.
"A lot of wives and sweethearts are saying, 'You need to make sure you
don't have prostate cancer.'"

Here's some information about prostate problems (and
solutions).

Growth is common

The prostate is a round gland that's underneath the bladder
and usually is about walnut-sized. It manufactures the fluid in semen.
It surrounds the urethra, through which urine and semen pass.

A painful, swollen prostate might mean a man has prostatitis,
an inflammation usually treated with antibiotics and other drugs.

But simple prostate enlargement -- benign prostatic
hyperplasia -- is "as common a part of aging as gray hair," according
to the National Institutes of Health, which says the condition sent 4.5
million men to their doctors in 2000.

That number is bound to increase as baby-boom men hit their
senior years, said Joe Turner, a urology nurse practitioner at the
Medical University of South Carolina.

An enlarged prostate might not cause symptoms and isn't
necessarily a crisis. But it can be, if the gland grows to the point
where it blocks the flow of urine. It can lead to serious bladder and
kidney ailments.

More commonly, urination may become difficult, more frequent
or more urgent. As with the guy in the commercials with the "going
problem," that can interfere with a man's normal activities and social
life.

Surgery to remove some tissue from the prostate -- which can
reach the size of an orange or larger -- has been the time-honored
treatment.

In a procedure called transurethral resection of the prostate
(TURP for short), the surgery is done through an instrument inserted
through the penis.

"About one in four men would have some sort of procedure for
this, before the (prostate) medicines came out," said Dr. John Wofford
of Columbia Urological Associates.

Now, Wofford said, most urologists probably perform only about
20 to 25 TURP procedures a year. Usually, men whose enlarged prostates
are causing problems will try medication first:

• Avodart (dutasteride) works by lowering the level of the
  hormone dihydrotestosterone, which in turn can shrink the prostate
  gradually. An earlier drug, Proscar (finasteride), is similar.
• Flomax (tamsulosin) is one of several drugs that work by
  relaxing muscles in the prostate and the neck of the bladder, helping
  urine flow more easily. It doesn't change the size of the prostate, but
  may relieve symptoms such as difficult urination in only a few days,
  Wofford said.

Side effects are possible with both types of medication, but
"very few men have complaints," Wofford said.

Turner said that for older patients especially, medications
can help men avoid surgery.

"If you are 75 and this could stop you from having surgery for
seven years, in all likelihood that's the rest of your life," Turner
said.

Prostate cancer

A man who seeks treatment
for problems caused by an enlarged prostate
may have tests including an examination of the prostate (which a doctor
can feel by checking through the rectum), tests of urine flow and
volume, and possibly ultrasound imaging.

A major ailment that must be ruled out is prostate cancer.
Though
it usually grows very slowly, it is the No. 2 cancer killer of men
(behind lung cancer).

Prostate cancer death rates are declining, but are twice as
high in black men compared to white ...

Early prostate cancer usually does not cause symptoms, but
when
the disease is advanced, it may cause symptoms similar to those of an
enlarged prostate. Prostate cancer screening is recommended at age 50
for white men and at 45 for black men.

Virtually everything about prostate cancer is complicated,
however.

Experts disagree on the usefulness of the PSA screening test
for
a protein found in the blood. A recent study did back the notion that a
rapidly rising PSA could signal more aggressive cancer.

There's also debate on whether older men should be screened,
on
whether surgery is advisable in some cases since it may cause impotence
and incontinence, and on when a strategy of "watchful waiting" makes
sense.

Men need to read up on the options and discuss them with their
doctors.

"You have to figure out what works best ... for the person and
his stage of life," Turner said.

Surgical techniques and other treatments -- such as targeted
radiation now offered at Lexington Medical Center in Columbia, S.C. --
are focusing more on removing the cancer while preserving a man's
ability to have sex and urinate normally.

The robotic assisted prostate surgery O'Kelly is doing lets
him
operate through five small incisions rather than one larger one. So
far, he said, subsequent rates of impotence and incontinence are
similar to those of regular surgery, but patients benefit from shorter
hospital stays and lower rates of infection.

The first man to have robotic prostate surgery in South
Carolina was O'Kelly's patient Michael Best, who came to Florence,
S.C., all the way from Chicago. Best, who sang for 22 seasons with the
New York Metropolitan Opera, has a home in Florence but was teaching in
Chicago when his prostate cancer was discovered.

Best recalled that a cousin who had prostate surgery "was
practically immobile for two months. I was up and walking the next day
and they sent me home."

When his prostate was removed, so was his cancer, said Best,
67.

"We caught it, fortunately, at the earliest stage," he said.

"Fortunately" is right: Men whose prostate cancer is found
early
have a five-year survival rate of about 100 percent, compared with 33.5
percent when the cancer has spread significantly.

Now, along with all those TV commercials, Best's male friends
can count on him to remind them about paying attention to early
detection and prostate health.

"I was surprised to learn how common prostate cancer is," he
said. "I'm preaching this to my friends."

Prostate health

Information on some problems that can affect the prostate:

• Prostate enlargement is common as men age, especially
  after 50. In
  some cases it can cause problems with urination (trouble starting to
  urinate, or frequent or urgent urination).
• Medications such as Avodart may shrink the prostate by
  lowering levels of a male hormone. Side effects may include impotence
  and breast tenderness.
• Medications such as Flomax may help urinary symptoms by
  relaxing prostate and bladder muscles. Side effects may include
  dizziness and retrograde ejaculation (semen flows back into the
  bladder).
• Prostatitis involves painful inflammation and swelling of
  the prostate, which may be treated with antibiotics and other
  medications.
• Prostate cancer is the most common cancer in men and the
  No. 2 cancer killer in men. More than 65 percent of cases are diagnosed
  in men 65 and older, with black men at increased risk.
• Annual prostate screening -- including a digital rectal
  exam and PSA blood test -- is recommended for white men starting at age
  50, black men at 45.
• There is evidence that obesity increases a man's risk for
  prostate cancer.

   

For more information: www.nih.gov, cancer.org" target="window">www.cancer.org,
www.ustoo.org.

Sources: National Institutes of Health, American Cancer Society, Merck
Manual of Medical Information

Source: The State
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