Question: Can urinary or sexual habits affect the incidence or severity of an enlarged prostate or any other prostate problems?
Answer: Those personal habits have nothing to do with the development of any prostate problems. However, modifying certain habits may help reduce the severity of symptoms. For example, urinating more frequently to keep the bladder from overfilling, allowing enough time to empty the bladder completely, and cutting back on fluids for several hours before bedtime can help reduce symptoms from an enlarged prostate. And since congestion in the prostate gland can aggravate the discomfort from chronic prostatitis (inflammation often due to bacterial infection), many urologists recommend frequent ejaculations to minimize that discomfort.
VASECTOMY AND PROSTATE CANCER
Question: I am considering getting a vasectomy. But according to a release form for the procedure, “Some studies have suggested an increased risk of prostate cancer in men who have undergone vasectomy.” Should I avoid the operation?
Answer: No. There’s no plausible reason why vasectomy, which involves cutting and tying the tubes that carry sperm, would increase prostate-cancer risk. Men who undergo vasectomy tend to be healthconscious people who see their doctors frequently. So the higher cancer rate found in some studies probably just reflects better diagnosis of prostate cancer in those men, rather than any cancer-causing potential of the procedure itself. A recent review by the National Institutes of Health concluded that the overall evidence suggests no association between vasectomy and the cancer. The 20-minute procedure, typically done in a doctor’s office under local anesthesia, remains one of the most effective means of birth control, with an average reliability of 99 percent.
PSA TEST FOR PROSTATE CANCER
Question: I recently read about a blood test for prostate cancer catted PSA. How does this test work, and is it effective?
Answer: Prostate-specific antigen, or PSA, is a protein made in the prostate gland and released into the bloodstream. The PSA blood test can indeed detect early prostate cancer. But it’s often hard to tell whether an elevated reading signals cancer or merely benign enlargement of the prostate gland. Now researchers have found that repeating the PSA test each year can help physicians make that distinction.
Researchers at Johns Hopkins University found that PSA levels remain quite stable (below the “normal” limit of 4.0 micrograms per liter) in healthy men from year to year. In men with a noncancerous enlarged prostate, those levels rise only slightly each yean But cancer causes PSA scores to rise much faster.
The researchers concluded that even if the PSA level remains in the “normal” range, a jump of more than 0.75 microgram in one year is strong evidence of prostate cancer. Since a rapidly rising PSA level could signal a quick-growing tumor, an annual test might also help physicians determine whether immediate treatment is necessary.
We recommend that men age 50 and older (and African-American men age 40 and older) have the PSA test as well as a digital rectal exam every year.
HIGH PSA AND PROSTATE CANCER
Question: My doctor ordered a PSA blood test for prostate cancer during a routine physical exam last fall The results showed a score of 28, so he ordered a biopsy; it revealed no sign of cancer. I’ve since had another PSA test, which came out just as high. What, if anything, should I do about it?
Answer: Talk to your doctor about having another biopsy— soon. A PSA (prostate-specific antigen) score above 10 indicates a strong probability of prostate cancer. The repeat biopsy should be guided by rectal ultrasound, which can help identify any suspicious areas in the prostate.
Question: I have been diagnosed as having prostate stones. I’m worried that they might increase my chances of getting cancer Will I pass these stones as kidney stones are sometimes passed?
Answer: There’s nothing to fear about so-called prostate stones. They’re actually just tiny calcium deposits that form where the gland was inflamed at one time. Those “stones” can’t be passed, and they don’t lead to cancer.
PROSTATECTOMY AND INFERTILITY
Question: You recently said that after surgery for an enlarged prostate, virtually all men become infertile due to “retrograde ejaculation * in which semen travels up into the bladder Aren’t there ways to isolate semen from the urine for artificial insemination?
Answer: Yes. But the reliability of those techniques varies from person to person, depending on the viability of the sperm. Men who want to father a child after prostate surgery may also want to consider storing sperm at a sperm bank before the operation. However, that’s not a sure bet either, since the freezing and thawing make sperm less vigorous.
IMPOTENCE AND BLOOD-PRESSURE DRUGS
Question: The medication I take for high blood pressure is making me impotent. Is there a drug that can control my blood pressure without affecting my sexual life?
Answer: All of the widely used types of blood-pressure drugs have been associated in varying degrees with impotence. However, two classes of antihypertensive drugs may be less likely to cause impotence. One is a group known as ACE inhibitors, such as captopril (Capoten), enalapril (Vasotec), and lisino-pril (Prinivil, Fosinopril). The other group, called calcium-channel blockers, includes such drugs as diltiazem (Cardizem), nicardipine (Cardene), nifedipine (Procardia), and verapamil (Calan, Isoptin). If your current medication can be safely changed to one of those without compromising blood-pressure control, switching may solve your problem. If not, your physician might consider prescribing the impotence drug sildenafil, better known by its brand name, Viagra.
ADVICE GETS A “C”
Question: Three years ago I underwent prostate surgery. Since then, on the advice of my urologist, I have been taking 500 milligrams of vitamin C twice a day to help prevent infection. Can you comment on this?
Answer: The dose of vitamin C you’re taking may make your urine somewhat acidic, but you can’t count on it to inhibit bacterial growth. Nevertheless, you probably don’t need to worry about infection. That risk presumably ended three years ago, when the prostate surgery relieved your urinary obstruction.
Question: What can you tell me about Peyronie’s disease?
Answer: Peyronie’s disease is a common disorder in which the penis becomes curved and distorted, especially when erect. The cause is unknown.
Local injections of steroids or calcium-channel blockers are sometimes successful. In carefully selected patients, surgery can sometimes be effective. It shouldn’t be ruled out simply because of age. An experienced surgeon is necessary because of the possibility that surgery may create more scar tissue. When Peyronie’s disease is combined with erectile dysfunction, the standard treatment is a penile implant. The recovery time for either procedure is about two weeks. Ask your doctor to refer you to a urologist experienced in treating this disease, or check the directory of the American Board of Medical Specialties, available at many libraries, for a list of board-certified specialists in your area.
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