Supplement Pills For Your Prostate-Probably Not Effective

Saw palmetto fruit extracts are widely used to treat lower urinary tract symptoms attributed to benign enlargement of the prostate gland. However, a new study shows that these extracts are no better than placebo at easing symptoms.
The findings were reported in the Journal of the American Medical Association (2011;306:1344-1351).
In the study, men were randomly assigned to receive a daily dose of saw palmetto extract, beginning 320 mg, or matching placebo. After 24 weeks, the saw palmetto dosage was increased to 640 mg per day. After another 24 week, it was increased to 960 mg per day, which is triple the standard dose. After 48 weeks there was no significant difference between placebo and saw palmetto supplements.
“Now we know that even very high doses of saw palmetto make absolutely no difference,” said study co-investigator Gerald Andriole, MD, Chief of Urologic Surgery at Washington University School of Medicine in St. Louis.

Bottom Line: Saw palmetto is probably not effective in treating or preventing prostate gland enlargement.

Up All Night? Help For The Enlarged Prostate Gland

Most men over the age of 50 have symptoms of an enlarged prostate gland. I will discuss the treatment options for this condition on 11\15\11 at St. Charles Surgical Hospital at 5:30. Please join me for a program that will help you make a decision for this common medical problem.

Can’t Pee? It May Be Your Medications

Having the urge to urinate — and not being able to do so — is painful, as many men know.  Certain medications may make the emergency form of this condition, known as acute urinary retention, more likely.

Painful urination or difficulty urinating are listed as possible side effects of the drugs studied – sold under the names Atrovent, Combivent and Spiriva.

An article published in the prestigious Archives of Internal Medicine reported that men with chronic pulmonary or lung diseases who had just started taking inhaled anticholinergic medications, a common treatment for the breathing diseases, had 42% greater odds of developing the urinary problem than men who were not on anticholinergics.

Bottom Line: There is an association between respiratory inhaler use and urinary symptoms especially urinary retention.  This is particularly important issue in men who have enlarged prostate glands as they are at an increased risk of having the complication of urinary retention.

Lasers For the Prostate Gland-Makes An Old Man Pee Like A Young Boy

Meg Farris, the health and science reporter at WWL, did a nice segment on the use of lasers for treating the enlarged prostate gland.  For more information go to:

http://bit.ly/f2wYjR

Getting Up At Night To Pee Doesn’t Have To Be

NEW YORK(Reuters Health) – A new study finds that one in five U.S. men have to get up at least twice a night to empty their bladders — which for some could signal an underlying medical problem or even contribute to poorer health.

Known as nocturia, those frequent overnight trips to the bathroom can be a sign of a health condition, ranging from a urinary tract infection to diabetes to chronic heart failure. In men, a benign enlargement of the prostate can also be a cause.

For some people, the constant sleep disruptions can themselves cause problems — contributing to depression symptoms or, particularly in older adults, falls.

On the other hand, getting up during the night to urinate can also be normal. If you drink a lot of fluids close to bedtime, for example, don’t be surprised if your bladder wakes you up at night.

Nocturia also becomes more common with age. Part of that is related to older adults’ higher rate of medical conditions. But it could also result from a decrease in bladder capacity that comes with age.

The researchers found that  men age 20 and up, 21 percent said they had gotten up at least twice per night to urinate.

Nocturia was more common among African-American men (30 percent) than those of other races and ethnicities (20 percent). Not surprisingly, it also increased with age: Just 8 percent of men ages 20 to 34 reported it, compared with 56 percent of men age 75 or older.

Other factors linked to an increased risk of nocturia included prostate enlargement, a history of prostate cancer, high blood pressure and depression.

Nocturia can also be a side effect of some medications, such as diuretics used to treat high blood pressure. This study did not have information on men’s medication use.

Avoiding caffeine and a large fluid intake at night may help as may other lifestyle tactics, like adjusting your sleep habits.

One recent study of 56 older adults with nocturia found that lifestyle changes — including fluid restriction, limiting any excess hours in bed, moderate daily exercise, and keeping warm while sleeping — helped more than half of the patients significantly cut down their overnight trips to the bathroom.

There are also medications available specifically for overactive bladder and nocturia. Those include a synthetic version of a hormone, anti-diuretic hormone,  that keeps the body from making urine at night, a drug that blocks the ability of the bladder muscles to contract, and antidepressants that make it harder to urinate by increasing tension at the bladder neck.

The bottom line for men is that bothersome nocturia is something they should bring up to their doctor.

SOURCE: bit.ly/fGZKNN Journal of Urology, online January 19, 2011

Flossing Your Teeth and Prostate Disease-There Just Might Be A Connection

Who would have thunk that flossing would be prostate gland protecting?  It has been well-documented that inflammation in the mouth, i.e., gum disease is linked to heart disease, diabetes, rheumatoid arthritis, and now even Alzheimer’s disease.  Now good research from Case Western Univeristy in Cleveland, Ohio has made a connection between gum disease and prostate health. The researchers from the dental school and the department of urology and the Institute of Pathology at the hospital found those with the most severe form of the prostatitis also showed signs for periodontitis, or severe gum disease.  It is theorized that reducing inflammation in the mouth-by daily flossing may also reduce prostate gland inflammation.  As my wonderful Jewish mother would say, “It may not help but it vouden’t hoit!”  So if you are looking for one more reason to start flossing, you now have one.

Excerpted from Journal of Periodontology, the official journal of the American Academy of Periodontology

Men’s Health Talk

Please join me for a talk on men’s health at St. Charles Surgical Hospital (1717 St. Charles Avenue) on 8-26-10 at 6:30 P.M. Talk is free and refreshments will be served.

“Just Say No” to Sex…Before Your Next PSA Test

For men over age 50 who are going to have a PSA test for prostate cancer, ejaculation within the past two days may artificially raise PSA levels. Men should be aware of the time of their last ejaculation and tell their doctors the last time they had an ejaculation in case results are high. Finally, while the digital rectal exam or other aspects of a prostate exam shouldn’t interfere with PSA levels, I suggest that blood be drawn before the rectal exam as a precaution.

PSA, PCA3 and Pee

At the present time the only way to screen for prosate cancer is the digital rectal exam and a blood test, PSA or prostate specific antigen.  Now a urine test is available to detect prostate cancer.  The PCA3 measures a gene produced by prostate cancer cells in the urine.  A positive PCA3 is helpful for men who have an elevated PSA test, which can be elevated due to benign causes such as benign enlargement of the prostate gland or prostate infections, decide that they may need a prostate biopsy.  Or the PCA3 test can be useful if the test is positive and the prostate biopsy is negative which may indicate that the cancer was missed during the biopsy.  It is hopeful that the PCA3 test will be helpful to differentiate slow growing cancer from a cancer that is more aggressive and more malignant and help the patient make a better decision regarding treatment.

Bottom Line: New and better tests are being discovered that will help diagnose prostate cancer.  PCA3 urine test is one of those new tests soon to be available from your urologist.

PSA Testsing-WWYDD or What Would Your Doctor Do?

There is probably nothing that has become more controversial than the PSA screening for prostate cancer in men.  There is one group that suggests annual screening for all men after age 50 and sooner after age 40 for African-American men and men with a relative, i.e., a father, a brother or an uncle with prostate cancer.  Then another group that recommends no PSA testing be done as the testing does not significantly reduce death from prostate cancer and screening tends to over-diagnose prostate cancer and with over-diagnosis more men receive treatment including radiation and surgery that results in complications such as erectile dysfunction and urinary incontinence.  So what is a man to do?  For this article I will not definitively answer the question but will shed light on the issue and then let you decide what you should do or what advice you should give the important men in your family.

What are the facts?  Approximately 35,000 men die each year from prostate cancer, which is the second most common cause of cancer death in men.  There are 250,000 newly diagnosed cases of prostate cancer diagnosed each year.  The PSA test is the screening method of choice for dearly detection of prostate cancer.  The determination of PSA values, when followed annually is the single most convenient, cost-effective and workable way of selecting men who need close monitoring, close follow up, or need to consider further treatment with radiation, surgery or hormone therapy.

What is PSA?  PSA is a blood test that measures a protein manufactured in the prostate gland, which is secreted into the blood stream.  We do know that PSA is age-dependent or increases naturally as men get older.  In normal men less than 50 years of age the value should be less than 2.5ng\ml and in men over age 70 a normal PSA values is less than 6.5ng\ml.

The real value of the PSA test in early detection is based on establishing a baseline PSA value and performing the test once a year in order to observe changes from the baseline value.  Increases of PSA of .75ng\ml in a year should be investigated.  The take home message is that a trend is more important than a single measurement.  An elevation of the PSA may not automatically represent prostate cancer.  Elevated levels occur with advancing years, large prostates, prostate infections, a digital rectal prostate exam, and even sexual intimacy with ejaculatin 24-48 hours before the blood test.

For those who have an elevated PSA test, there is a more refined test called the free\total ration of PSA.  The ratio of free\total PSA is less than 25% in men with prostate cancer and if the free\total is greater than 25% is much less likely to have prostate cancer and probably doesn’t need a further workup such as a prostate biopsy.

So what to do?  If you are at risk for prostate cancer with a relative who has prostate cancer or an African American man, I suggest a PSA and a digital rectal exam beginning at age 40.  All others should consider a PSA test once a year.  If the PSA increases more than 0.75ng\ml\year, then you should consider an evaluation by a urologist and a prostate biopsy if you have more than ten years of life expectancy and would be a candidate for treatment.

Bottom Line:  So what would Dr Baum do?  He gets a PSA every year and the last time it was 0.7ng\ml!