Man seeks prostate treatment options
Dear Dr. Roach: A recent CAT scan to measure my aortic aneurysm (4.1 cm) showed that my prostate is 5.1 cm. That’s somewhat larger than normal. I’m 68 years old and do have some mild symptoms — only at night. Due to the pandemic, I don’t want to go to my doctor right now, and he is not seeing patients unless they are ill. Is there a standard medicine for this? Years ago, I would have tried an OTC medicine, but I have read that they do not really help (except placebo effect). What do you recommend for this, other than consulting with my primary care physician? If I call him and ask him to prescribe a standard medicine for my case, I’m sure he will.
R.O.
Answer: Most men will develop an enlarged prostate as they get older, but the severity of symptoms varies widely. Men with mild symptoms may still choose to try treatment. The standard medical therapy is called an alpha blocker. One commonly used one is tamsulosin (Flomax), but there are many. Tamsulosin is less likely than most others to cause dizziness on standing, which is a common side effect of alpha blockers. This class of medicine is generally safe, but it still requires a physician’s prescription, as there are potential interactions with some other medicines and with some heart problems.
Although many men will try herbal therapies, the evidence for their use is mixed. Probably the most commonly used supplement for BPH is saw palmetto, but a 2012 evaluation of the published studies showed that it was no better than placebo, as you said. Two other agents, beta-sitosterol and Pygeum africanum, showed relief that was better than placebo, but longterm safety has not been well studied. As always, I caution that some over-thecounter supplements do not contain what is listed on the label.
The international prostate symptom score is a useful tool to grade the severity of symptoms and monitor response to therapy.
Finally, a PSA test should have been done to help stratify risk for prostate cancer. Hopefully it was done for you and the result was low.