Treatment Options for Men With Prostate Cancer-Side Effects You Need to Know

Prostate Cancer is the most common cancer in middle aged and older men.  It is the second most common cause following lung cancer of death from cancer in men.

This article will discuss the most common treatment options for prostate cancer and what are the side effects of these treatments.

For younger men with localized disease, surgical removal of the prostate gland either with an open 6-8-inch incision or through a robotic prostatectomy-5 small pencil-sized holes in the lower abdomen that removes the entire prostate gland.

Temporary or even permanent erectile dysfunction (impotence) occurs in many of the men who undergo surgery.  Urinary incontinence, inability to control the flow of urine, occurs in 3-30% of men who have their prostate gland surgically removed.

For older men or for men who have prostate cancer beyond the prostate gland, radiation therapy is treatment option.   The side effects include temporary fatigue, diarrhea or other bowel problems, urgency of urination, and impotence (ED).

For men with spread of prostate cancer beyond the prostate into the bones or lymph nodes, then hormonal therapy is often recommended.  Hormone therapy is used in men with advanced, high-grade prostate cancer. Hormone therapy is also used in men who cancer has recurred after being treated with radiation therapy or surgery.  This is usually determined with an elevation of the PSA level.  Prostate cancer is very sensitive to testosterone, the male hormone produced in the testicles, and removal of testosterone reduces the cancer and helps control the disease but does not cure the problem.

The side effects of hormonal therapy include reduced libido, hot flashes, softening of bones or osteoporosis which leads to bone fractures, impotence, loss of muscle mass, fatigue, weight gain, and increased risk of heart disease and diabetes.

Chemotherapy is indicated for men who do not respond to removing the testosterone produced by the testicles.  Chemotherapy leads to hair loss, nausea\vomiting, diarrhea, fatigue, muscle pain, and weight loss.

Proton therapy is a similar to external radiation that targets difficult to reach tumors and is designed to allow higher doses of radiation to be delivered to the prostate with fewer side effects.

Bottom Line:  Over the past few years there have been numerous options available for the management of localized prostate cancer and even prostate cancer that has spread beyond the prostate gland.  New Orleans has several doctors who are national and even global experts in managing prostate cancer.  For more information, contact your doctor.

The Care and Feeding of the Enlarged Prostate Gland

If you are a man, then you have a prostate gland.  If you have a prostate gland, then you are likely to be one of the 14 million American men who experience bothersome symptoms beginning around age 50.  This article will discuss the diagnosis of the enlarged prostate gland and what are some of the available treatment options that can reduce the symptoms associated with this common condition.  It is a walnut sized organ at the base of the bladder and surrounds the urethra or tube that is in the penis and transports urine from the bladder to the outside of the body.  It is common and even normal for the prostate gland to become enlarged as a man ages. Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause problems until middle age or around 50. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have symptoms of BPH.

The prostate gland encircles the urethra like a donut, so problems with urination can occur if the gland restricts urine flow through the urethra. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose.

The following changes occur over a period of time.

• The bladder wall becomes thicker and will contract without the owner’s permission causing urgency of urination.
• The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination.
• Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder.

The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Some problems associated with BPH are

• Urinating more often during the day
• Need to urinate frequently during the night
• Urinary urgency, which means the urge to urinate is so strong and sudden, you may not make it to the toilet in time and soil your clothing-very embarrassing!
• The urine stream is slow to start
• Dribbling after urination
• A sensation that the bladder isn’t emptied after urination
• Lack of force to the urine flow, which makes aiming more difficult
• The sensation of needing to go again a few minutes after urinating

Diagnoses

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine check-up. The doctor can determine the size of the prostate gland during a physical examination.

The diagnosis is made with several of the following tests:

Symptom Score

This is a brief questionnaire that provides a numerical value to the symptoms associated with urination.  The higher the score (maximum is 25), the more symptoms a man has and the more likely he will want to have treatment for relief of his symptoms.

Urinalysis

A urine sample is taken to look for signs of blood and infection.

Digital Rectal Examination (DRE)

Your doctor inserts a gloved finger into the rectum to feel the condition of the prostate that lies close to the rectal wall. If your doctor feels something suspicious such as a lump or bump, further tests will be carried out. Other tests are needed to enable a more accurate diagnosis. 

Prostate Specific Antigen (PSA) Test

A blood sample is taken by your doctor to check for prostate specific antigen (PSA), which is produced by the prostate and is increased by cellular abnormalities within the prostate.

As men get older the prostate gland grows and so the PSA is likely to rise. A high PSA may indicate some type of prostate disease. The level can be raised due to inflammation of the prostate (Prostatitis) and enlargement of the prostate gland (Benign Prostatic Hyperplasia or BPH).

Urine flow rate

This test consists of a man urinating in private over a funnel which measures the volume of urine and the time that it takes to empty the bladder.  The urine flow rate is expressed in milliliters per second.  Normal is greater than 15 ml\second.

Urodynamics

Sometimes the doctor will ask a patient to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.

Imaging studies

The ultrasound examination evaluates the size of the prostate gland which often determines the treatment option which is best for your situation.  It is a painless examination consisting of the insertion of a small pencil-size probe into the rectum and uses sound waves to determine the appropriate treatment for prostate gland enlargement.

Cystoscopy

In this exam, the doctor inserts a small tube through the opening of the urethra in the penis. This procedure is done after a solution numbs the inside of the penis so all sensation is lost. The tube, called a cystoscope, contains a lens and a light system, which help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.

Treatment options

1. Watchful waiting-If the person has BPH but is not bothered by the symptoms, the patient and the doctor may decide to simply wait and monitor the condition regularly. This option requires regular check-ups with the doctor – usually once a year – to see if the condition is getting any worse.

2. Drug therapy–Your doctor may advise drug therapy which aims at shrinking the enlarged prostate. The doctor will select the medication that best suits the condition, keeping in mind the person’s general health condition, medical history, medications taken for other conditions and quality of life considerations.

3. Minimally invasive treatments-The prostatic urethral lift or UroLift is an implant of several polyester sutures connected by two small metallic tabs that opens the prostate gland located in the urethra and improves the flow of urine thus decreasing the symptoms of the enlarged prostate gland. UroLift has been approved by the FDA to relieve the symptoms of the enlarged prostate gland. There have been nearly xx thousand of men who have had the treatment which reports favorable results up to 4 years. Most insurance companies will now pay for the UroLift procedure 

4. Surgery-Surgery is another option for the treatment of BPH. The most common type of surgery for BPH is TURP (Trans Urethral Resection of the Prostate). This procedure requires an admission to the hospital, a general anesthesia, a urinary catheter for several days, and the risk of sexual problems afterwards.

Bottom Line:  Nearly all men will experience the problems associated with the enlarged prostate gland.  The enlarged prostate gland impacts a man’s quality of life.  Help is available and nearly all men can be helped.  If you have symptoms associated with urination, speak to your doctor.

FAQs on the Enlarged Prostate

 

What is BPH?
 Benign prostatic hyperplasia is commonly known as enlarged prostate. BPH is a non-cancerous condition in which prostate cells grow, enlarging the gland and causing it to squeeze the urethra. A variety of symptoms may result, including difficult, frequent or urgent urination.

When Should I Seek BPH Treatment?
If you are experiencing BPH symptoms that are affecting your quality of life, such as losing sleep because you need to wake during the night to urinate, you are unable to urinate, you are unable to delay urination, have hesitancy, or a weak urine stream, check with your urologist to discuss if it is time to seek treatment.

BPH is not cancerous and is not life threatening, but it does create bothersome symptoms can significantly impact quality of life.

What Are the Long Term Risks of BPH?

If left untreated, BPH can progress and cause subsequent medical issues. When the bladder does not empty completely, you become at risk for developing urinary tract infections. Other serious problems can also develop over time, including bladder stones, blood in the urine (hematuria), incontinence, or urinary retention. In rare cases, bladder and/or kidney damage can develop from BPH.

What are the Treatment Options?

Based on the AUA Guidelines for the treatment of BPH, there are four recommended treatment options: Watchful Waiting, medications, in-office therapy, and surgery.

Are In-Office Therapies Safe?

Yes, these treatments are safe. UroLift has been cleared by the FDA to treat BPH. In-Office BPH Treatments are associated with few side effects and adverse events.

Are In-Office Therapies Effective?

Based on clinical studies, in office procedures is proven to be a safe, effective and durable option for BPH with very few side effects.

Are In-Office Therapies Covered By Insurance?

Medicare and many commercial insurance plans provide coverage for the UroLift procedure. Ask your doctor’s office to assist you by providing the information your insurance plan may require.

Do In-Office Therapies Hurt?

Some men describe the UroLift as causing some discomfort, while most men report no discomfort at all.

Will I need a catheter after the treatment?

Most patients will not need a catheter after the procedure.

Can I go home right after the procedure?
 Yes. You should arrange for someone to drive you home because you may have been given some medication to help you relax during the procedure. Your urologist will give you post-treatment instructions and prescriptions and explain the recovery period to you.

Bottom Line: BPH is a common problem and effective treatments are available.  For more answers, speak to your physician.

Complications of the Large Prostate Gland

 

The most common condition affecting millions of middle age American men is benign enlargement of the prostate gland.  This is called benign prostatic hyperplasia or BPH, which is a non-cancerous enlargement of the prostate. For reasons not entirely known, the prostate increases in size around age 50.  As the prostate gland grows, the gland compresses the urethra, which is the tube that transports urine from the bladder to the outside of the body.

Over time, the growth causes the urethra to become so compressed that it becomes difficult for men to empty the bladder.   The symptoms associated with enlarged prostate gland include frequency of urination, urgency of urination, dribbling after urination and even the complete inability to urinate or allowing only a small amount of urine to exit the bladder.

Bladder stones are formed when crystals inside the bladder collect together and harden to form a stone.  They often occur when the bladder is not fully emptying, so the urine that is left behind remains in the bladder for long time and coalesce and form stones.

Symptoms of bladder stones include frequent urination throughout the day, lower abdominal pain, a burning sensation when urinating, urine that appears cloudy or contains blood, and urgency of urination.

Urinary retention is the inability to fully empty your bladder. Acute urinary retention is a medical emergency, so it does require immediate medical attention.

There are two main types of urinary retention.  If there is an obstruction such as a bladder or kidney stone, then urine cannot properly be released, resulting in urine remaining in the bladder after urination. In this case, urinary retention can be life threatening, and you will require immediate medical intervention and the insertion of a catheter to relieve the blockage.

The most common cause of acute urinary retention is the enlarged prostate which compresses the urethra or the tube from the bladder that transports urine from the bladder to the outside of the body.

Non-obstructive urinary retention is caused by the weakening of the bladder muscles or nerve problems disrupting the communication between the bladder and the brain. Causes of non-obstructive urinary retention include stroke, pelvic injury or trauma, nerve diseases, impaired muscle or nerve function, and spinal cord injury that affects the nerves to the bladder.

Chronic urinary retention mainly affects men as a result of prostate enlargement. Although the condition is not life threatening, it can lead to permanent kidney damage. In chronic urinary retention, a man is unable to fully void their bladder, so urine stays within the bladder, increasing the risk of urinary tract infections.

Symptoms of chronic urinary retention include urinary frequency, urgency and hesitancy, nighttime urination, symptoms similar to a urinary tract infection, and lethargy and emotional irritability.

Urinary tract infections are often associated with urinary retention. Symptoms include cloudy or foul-smelling urine, blood in urine, difficulty urinating, pain while urinating, nausea, vomiting, shaking and chills, and fever.

Hematuria, or blood in urine, is frequently a benign condition, but there may be a risk of a more serious condition, too. For men with documented blood in the urine which is confirmed by a urine examination, you will will need some additional testing such as urine culture, a radiologic examination of the kidneys, and a cystoscopy or a look in the bladder with a lighted tube.

As the bladder retains urine, it continues to stretch. Excess stretching weakens the bladder muscles, making it impossible for the bladder to contract.  If this is left untreated, then permanent damage to the bladder muscle will occur and even if the obstruction is relieved the bladder muscle cannot contract and the man may be left with a permanent urinary catheter or may have to catherize himself several times a day.

Bottom Line: Every man over age 50 should see his doctor every year to check his prostate and to obtain a PSA blood test which is a screening test for prostate cancer.  Nearly every man can be treated with either medications or minimally invasive procedures that can often be done in the doctor’s office.

PSA Testing-What Every Man Needs to Know

Prostate specific antigen is a simple blood test that can be a metric for prostate health.  It is a good screening test for prostate cancer.  This blog will discuss the PSA test and what you need to know to make a decision to obtain this common test.

Let’s start by reassuring men that having an elevated PSA level does not necessarily mean you have prostate cancer.

PSA is also likely to be increased with benign enlargement of the prostate gland as well as prostate infections or prostatitis.

It is important to emphasize that the PSA test is not a specific prostate cancer test, but it is a vital first step in screening for the potential presence of cancer.

The other factors that can cause PSA levels to rise:

• Age: PSA levels can increase gradually as you age
• Prostatitis: Inflammation of the prostate gland, due to infection or some unknown cause
• Benign prostatic hyperplasia (BPH): This condition refers to an enlarged prostate.  More prostate means more cells making prostate specific antigen, increasing the potential for an elevated PSA.
• Urinary tract infection: can irritate and inflame prostate cells and cause PSA to go up
• Medications: Some medications like Proscar, Avodart, or Propecia can falsely lower your PSA.  This too is important to remember.  If you are on any of these medications, talk to your doctor.  The general rule of thumb is to double your PSA for an accurate score.
• Sex/ejaculation:  This can cause a mild elevation in the PSA, but should return to normal after a few days. That is why I usually recommend that men refrain from sexual intimacy for 48 hours prior to PSA testing
• Prostate trauma: Anything that causes direct trauma to the prostate such as riding a bike, having a catheter inserted into the blader, a prostate biopsy, or a cystoscopy which is a look using a lighted tube through the urethra (tube in the penis that transports semen and urine) can increase the PSA temporarily.

A PSA level of less than 4.0 ng/mL is normal, while changes of more than 2.0 ng/mL over the course of a year could be an indicator of the presence of prostate cancer.

I point out that there is a familial or inherited basis of prostate cancer and also an increased risk of prostate cancer in African-American men.  In these men who are are at a greater risk of prostate cancer, I suggest annual testing with a digital rectal examination and a PSA test after age 40.  For all others, I suggest testing begin at age 50.

For men who have an elevated PSA test, then a discussion with the doctor about repeating the test in a few weeks or proceeding to an ultrasound examination and a prostate biopsy is in order.

Bottom Line: PSA testing is a non-specific test used to screen for prostate cancer.  Not all elevations of the PSA test indicate cancer.  Further testing and close monitoring as well as a prostate biopsy is in order.  For more information, speak to your doctor.

Prostate Biopsy Negative? What’s Next?

There are over 1 million men who have a prostate biopsy each year.  Many of the biopsies are negative.  What can a man do who has an elevated PSA level and a negative biopsy to be certain that he doesn’t have prostate cancer and avoid having a second biopsy?

Lots of controversy surrounds the standard PSA (prostate-specific antigen) screening test for prostate cancer, which is unreliable and not specific for the disease. This uncertainty has prompted many men to ask, “Is there a better test for PSA?” Fortunately, there are options which, while they don’t replace the current PSA test, can provide significantly more reliable, actionable information.

The PSA test involves a blood draw and measuring the level of the blood protein, prostate specific antigen. Currently, men whose PSA test levels are between 4 ng/mL and 10 ng/mL typically are told they should consider getting a prostate biopsy. However, an elevated PSA can be caused by many different benign conditions such as benign enlargement of the prostate gland, a prostate infection or simply lifestyle habits, which means a biopsy would be an unnecessary invasive procedure.

Why we need more accurate testing?

Approximately 1.3 million prostate biopsies are performed annually, and less than one third of them reveal cancer. While that sounds like good news on one hand, on the other hand it means that two thirds of those biopsies may not have been necessary and/or these men have negative biopsy results but other clinical risk factors for prostate cancer such as a family member who has prostate cancer or being an African-American man who have a slightly greater risk for prostate cancer than a Caucasian man.

If you have been in this situation, you probably know how frustrating and confusing it can be. What should you do? Have a repeat biopsy or choose to have more tests? The uncertainty of having a hidden prostate cancer can lead men to get repeat biopsies, which can be associated with an increased risk of infection, hospitalization, emotional trauma, and significant costs.

Fortunately, some progress is being made in the realm of better testing for prostate cancer and in determining whether a prostate biopsy is necessary. In this blog I will discuss the PCA3 test that may be helpful and prevent additional biopsies and additional psychological anxiety.

PCA3 Test

PCA3 is an acronym for Prostate CAncer gene 3. Prostate cells have PCA3 genes that are responsible for making this prostate cancer-specific protein. Prostate cancer cells produce higher levels of PCA3 than do healthy cells, and when the level of PCA3 protein is high, it leaks into the urine, where it can be measured. Unlike the PSA test, PCA3 is not affected by benign prostatic hyperplasia (enlarged prostate) or other noncancerous prostate conditions such as prostatitis.

To take the PCA3 test, you must first have a digital rectal examination (DRE), which stimulates the PCA3 to enter the urine. Then you must immediately provide a urine sample. Typically, it takes 1 to 2 weeks to obtain the results of the PCA3 test. For diagnostic purposes, the higher the PCA3 score, the more likely a man has prostate cancer. When the PCA3 score is used to help with treatment, the higher the score, the more aggressive the prostate cancer is likely to be.

The Food and Drug Administration approved the PCA3 test in 2012. Physicians can use the PCA3 score, in addition to DRE and PSA test, to help them make treatment decisions. For example, knowing a man’s PCA3 score can be helpful when:

• Men have a family history of prostate cancer
• Men have a positive biopsy, because their PCA3 score can provide additional information about how aggressive the cancer may be and therefore, be helpful in determining which treatment approach is best
• Men have an elevated PSA or a suspicious DRE and are considering a prostate biopsy
• Men have a negative result on their biopsy but the doctor is still uncertain about the presence of cancer
• Men have a positive result on their biopsy and they and their doctor want to better understand how aggressive the cancer is
• Men who have early, nonaggressive prostate cancer and have chosen active surveillance want to monitor any possible cancer progression

How effective is the PCA3 score in detecting prostate cancer? This question was addressed in a study involving 859 men who were scheduled to undergo a prostate biopsy. The authors found that use of the PCA3 test improved over-detection of low-grade prostate cancer and under-detection of high-grade cancer. Cost of the PCA3 test is about $450. The test is paid by most insurance companies including Medicare.

Bottom Line:  Prostate cancer is the most common cancer in men and the second most common cause of death in men.  The PSA test is a good screening test for men between the ages of 50 and 70.  However, there are false positive results with consequences of unnecessary prostate biopsies or may result in unnecessary repeat prostate biopsies.  The PCA3 test is helpful in identifying prostate cancer or helpful in reassuring a man that he doesn’t have prostate cancer and can avoid a repeat biopsy.  For more information, speak to your urologist.

Put Pumpkin On Your Holiday Table-Your Prostate Will Thank You

From The Daryl and Luellen Berger Halloween Display

It’s holiday season and time to carve a pumpkin for Halloween and have pumpkin pie for Christmas.  If the only thing you have ever done with pumpkin is carve it and fill it with a candle, you are not alone. Many people tend to think of pumpkins as little more than just a holiday decoration or a pie filling, but you may want to rethink this plump orange plant.  It has wonderful medicinal value that you might want to know before carving that pumpkin and discarding the seeds the pulp from this veritable medicine chest of good nutrition.

Pumpkin is an extremely nutrient dense food, meaning it is chock-full of vitamins and minerals but low on calories. There are many creative ways pumpkin can be incorporated into your diet, including desserts, soups, salads, preserves and even as a substitute for butter. Next time pumpkin season comes around, don’t carve it, cook it up and eat it!

Consuming one cup of cooked, canned pumpkin would provide well over 100% of your daily needs for vitamin A, 20% of the daily value for vitamin C, 10% or more for vitamin E, riboflavin, potassium, copper and manganese at least 5% for thiamin, B-6, folate, pantothenic acid, niacin, iron, magnesium, and phosphorus.

Of course, using fresh pumpkin and preparing it yourself will give you the most health benefits, so steer clear of canned pumpkin pie mix, as canned pumpkin has added sugars, syrups, etc. For the best nutritional value pumpkin should have only one ingredient: pumpkin.

Consuming fruits and vegetables of all kinds has long been associated with a reduced risk of many lifestyle-related health conditions. Many studies have suggested that increasing consumption of plant foods like pumpkin decreases the risk of obesity and overall mortality, diabetes, heart disease and promotes a healthy complexion and hair, increased energy, overall lower weight.

Pumpkin is one of the best-known sources of beta-carotene, a powerful antioxidant known to give orange vegetables and fruits their vibrant color and which is converted to vitamin A in the body. Consuming foods rich in beta-carotene may reduce the risk of developing certain types of cancer, offer protection against asthma and heart disease, and delay aging and body degeneration.

Blood pressure: Eating pumpkin is good for the heart! The fiber, potassium and vitamin C content in pumpkin all support heart health. Consuming adequate potassium is almost as important as decreasing sodium intake for treatment of hypertension (high-blood pressure). Other foods that are high in potassium include cantaloupe, pineapple, tomatoes, oranges, spinach and bananas.

Increased potassium intakes are also associated with a reduced risk of stroke, protection against loss of muscle mass, preservation of bone mineral density and reduction in the formation of kidney stones.

Cancer: One particular type of cancer where research has shown a positive benefits of a diet rich in beta-carotene is prostate cancer, according to a study conducted by the Harvard School of Public Health’s Department of Nutrition.⁵ Beta-carotene has also been shown to have an inverse association with the development of colon cancer in the Japanese population.

Eye Health: The antioxidants vitamin C, vitamin E and beta-carotene (all of which pumpkin has) have been shown to support eye health and prevent degenerative damage.

A higher intake of all fruits (3 or more servings per day) has also been shown to decrease the risk of and progression of age-related macular degeneration.

Fertility: For women of child-bearing age, consuming more iron from plant sources such as spinach, beans, pumpkin, tomatoes, and beets appear to promote fertility, according Harvard Medical School’s Harvard Health Publications. The vitamin A in pumpkin (consumed as beta-carotene then converted to vitamin A in the body) is also essential during pregnancy and lactation for hormone synthesis.

Immunity: Plant foods like pumpkins that are high in both vitamin C and beta-carotene offer an immunity boost from their powerful combination of nutrients.

A nice sedative:  Why does everyone take a nap after a heavy Thanksgiving meal?  It is the tryptophan in the pumpkin which raises melatonin and induces sleep.

Bottom Line:  Pumpkin is good for you and good for your prostate, too.  Enjoy the holiday.

New Treatment For The Enlarged Prostate Gland-The UroLift

NEW ORLEANS – It’s a condition that men may not want to talk about, but it affects their sleep, their intimate relationships, and work.

But now there’s a new, simple fix for a common prostate condition.

Doug Depp is one of the millions of baby boomer men with a common health problem, Benign Prostatic Hyperplasia, called BPH.
“I was getting up 4, 5 times a night easy and feeling the discomforts of it. I couldn’t empty my bladder. I lost a lot of confidence in being able to go places, be comfortable,” said Depp, 68.

After the age of 50, the prostate gland, for some reason, grows. When it does, it squeezes down the size of the tube that urine flows through. It affects a man’s quality of life. But now there is a new procedure called UroLift System. It involves no cutting or heating away tissue in an O.R.

“I think this is a game changer, and the reason being is that often times men who have an enlarged prostate, are treated with medications. These medications affect their sex life,” explained Dr. Neil Baum, a urologist at Touro.

The UroLift has a pin on one side and a clip on the other. In less than an hour in the office or outpatient surgery, Dr. Baum inserts a few of the devices through the urethra. They permanently hold both sides of the enlarged prostate away from putting pressure on the urethra. Men can either be under mild IV sedation or a local anesthesia.

“This procedure, the UroLift, preserves sexual performance. The men have no problem with ejaculation. It doesn’t affect their erections and the beauty is when they have the procedure, they go out without a catheter most of the time, and they are able to urinate with improved stream immediately,” Dr. Baum explained.

Depp says there was not a lot of discomfort and a few days later he was 100 percent normal again.

“I used to always think of a place to go, you know, McDonald’s or some place you know, on the way, and you have to pick and choose but now it’s a lot more freedom not to worry about it,” laughs Depp.

The UroLift is FDA approved and most insurance companies pay for the procedure.

Elevated PSA Linked to Shiftwork

Men who work night shifts or rotating shifts are more likely to have elevated PSA levels than men who do not.
In an analysis of data from the National Health and Nutrition Examination Survey (2005-2010), Erin E. Flynn-Evans, PhD, of Brigham and Women’s Hospital in Boston, and colleagues found shiftworkers had a 2.6 times increased risk of an elevated PSA (4.0 ng/mL or higher) compared with non-shiftworkers after adjusting for confounders.
The researchers, who published their findings online ahead of print in the Journal of the National Cancer Institute, concluded that sleep or circadian disruption is associated with elevated PSA, indicating that shiftworking men likely have an increased risk of developing prostate cancer.
A previous prospective cohort study of Japanese rotating-shift workers demonstrated that, compared with day workers, rotating-shift workers had a significant threefold increased risk of prostate cancer after adjusting for age, family history of prostate cancer, and other potential confounders, according to a report in the American Journal of Epidemiology (2006;164;549-555).

Take Home Message: If you are caring for a middle age man who does shift work, it is a good idea to encourage him to get a PSA and a digital rectal exam annually.

Over the Counter Cold Medicnes May Wreck Havoc With Your Prostate Gland.

Nearly 14 million American men have symptoms related to an enlarged prostate gland. Nearly 50% of men over age 50 will have symptoms. OTC cold medications such as diphenhydramine (Benadryl), brompheniramine (Dimetapp), and loratadine (Claritin), pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE) may worsen your prostate symptoms.

The prostate gland is a walnut sized organ at the base of bladder and surrounds the urethra or the tube in the penis that transports urine from the bladder to the outside of the body. For reasons not entirely known, the prostate gland enlarges after age 50 and compresses the urethra making urination difficult and rarely impossible. Often men who have enlargement of the prostate gland have the cold or the flu and will take cold medications containing antihistamines and decongestants, which can worsen prostate symptoms.

It’s very important that men with enlarged prostate avoid cold medicines with pseudoephedrine or phenylephrine. Those are ingredients in decongestants and they constrict the prostatic and cause more compression on the urethra thus aggravating men’s urinary symptoms. Antihistamines aren’t quite as bad, because they work more on the bladder muscle, but they can decrease bladder contractility thus making it difficult for men to empty their bladder of urine.

Enlargement of the prostate is more common in older men, because as men age their prostate continues to grow. Nearly 80 percent of men age 50 and older will be diagnosed with some degree of the disease. Sometimes men need to get up every hour at night. I recommend against waiting too long to visit a doctor for this problem as urinary retention can occur and can cause kidney damage and other serious issues.

If a man is already having a little difficulty and his stream is already slow, and then you (make it worse) it by adding one of these OTC cold medicines, it’s the recipe for causing retention.

Cold remedies that are inhaled, such as a nasal corticosteroid, will not have the same side effects as an oral agent. Mentholated ointments are a safer alternative to decongestants.
If men notice problems with urination after taking certain medicines, they may need to weigh the risks and benefits of the OTC medications.

Bottom Line: I urge men to carefully read over-the-counter drug labels. You have to be aware of what a medication’s potential side-effects are. Unfortunately, the package insert for most medications is quite lengthy. Men need to have a relationship with a primary care doctor or a urologist, doctor who specializes in treatments of the enlarged prostate gland.