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Prostate Prognosis: Options in Treatment

The symptoms are a nuisance. Commonly, there is frequent urination and a sense of urgency to urinate.

Most likely, the diagnosis is enlargement of the prostate, the walnut-sized gland that produces fluid to transport sperm. By age 60, half of men have such enlargement, although not all have symptoms. By age 80, 80% are affected, but some not seriously enough to seek medical attention.

Those who do seek medical attention often worry that they have prostate cancer, says Dr. Charles E. Shapiro, a staff urologist at Kaiser Permanente Medical Center, Los Angeles and USC assistant clinical professor of urology. He reassures them that benign enlargement--called benign prostatic hypertrophy (BPH)--is more likely the problem, even though prostate cancer affects one of every 11 men in the United States, according to the American Cancer Society. BPH occurs as the gland enlarges and squeezes the urethra, or urine-carrying tube.

(The best way to detect both benign enlargement and cancer, experts say, is an annual rectal examination after age 40. Because the gland lies directly in front of the rectum, it can be felt this way.)

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If the diagnosis is BPH, the outlook is good, Shapiro says. There are treatment options--both surgical and nonsurgical--and on the horizon are even more options. If surgery is needed, every effort is made to preserve potency. Still, about 10% to 15% of men have postoperative sexual difficulties, according to the American Foundation for Urologic Diseases. Among the options:

* A surgery called transurethral resection of the prostate (TURP). The gland’s innermost core is removed, relieving pressure on the urethra. The procedure is done through the urethra with no incision in the skin. Recently, some researchers found that this surgery somehow increases a patient’s risk of death from cardiovascular disease, but Shapiro and other experts say the highly controversial finding is probably a fluke. Studies are continuing. If the gland is very large, TURP may not be possible; the surgery may have to be done through an incision in the lower abdomen.

* Another surgical option is transurethral incision of the prostate (TUIP). An instrument is passed through the urethra to make incisions in the prostate instead of removing tissue from the gland. The downside, Shapiro says, is that no tissue sample is sent to the pathology lab to check for malignancy, as it is after the TURP procedure. TUIP is most useful for patients with small prostate glands “and the long-term results of this relatively new procedure are still under study,” Shapiro adds.

* Balloon dilation is another fairly new option. A catheter with a deflated ballon attached is inserted through the urethra and inflated. The balloon enlarges the passage for urine flow. The technique often provides only temporary relief, Shapiro warns.

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* Drug treatment can relieve some prostate problems. One type of medication works by relaxing the muscle tissue in the prostate, thus relieving part of the blockage. The drugs are approved by the Food and Drug Administration for high blood pressure treatment, not specifically for prostate enlargement, but many urologists prescribe them for prostate problems.

* Another drug, finasteride (Proscar), works by shrinking the prostate. It is not yet FDA-approved. Also under study is microwave treatment, in which heat is used to shrink the prostate.

For more information on prostate and other urologic problems, contact the American Foundation for Urologic Disease, (800) 242-2383 weekdays from 8:30 a.m. to 4:30 p.m. EST. Consumer requests for patient education materials will be accepted.


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