Mens Health Blog. Medical Blog

For acute bacterial prostatitis, doctors approach first things first—they get the fever down and stabilize the patient; some men may need to be hospitalized for a few days. Other treatment may include bed rest; drinking plenty of fluids (to keep the body well hydrated—this helps the body’s defense mechanisms); analgesic drugs such as aspirin to relieve pain; temporarily abstaining from sex; stool softeners (because the prostate is directiy in front of the rectum, straining to have a bowel movement could make the already tender prostate hurt even worse); and, in some cases, the temporary insertion of a catheter (a flexible, lubricated tube inserted in the urethra via the dp of the penis) to drain the bladder, if a man is unable to urinate, or if he’s retaining urine.

The good news: The intense inflammation of the tissue gives many drugs ready access to the normally not-so-accessible prostatic fluid. That’s why this condition responds so dramatically to antibiotics. The bad news: Many men are undermedicated; they are not prescribed an adequate dose of antibiotics.

Many doctors prescribe antibiotics such as ciprofloxacin (one of a new class of antibiotics called fluoroquinalones) for a week to ten days. This is not long enough. Ten days of treatment may ease all signs of infection, and a man may feel “back to normal” within that time. But infections in the prostate are insidious. This is due in part to something called the blood-prostate barrier; it serves the same function as a bouncer at a bar—it’s designed to protect the prostate from harmful substances. Yet despite its good intentions, it often keeps out the very drugs needed to stop infections in the prostate. This barrier breaks down during bacterial prostatitis—acute as well as chronic. And while these defenses are weakened, says a University of Maryland urologist who is an expert in prostatitis: “This is the time to hit hard, to knock it out the first time.”

The University of Maryland urologist tells his patients that having nonbacterial prostatitis is like having arthritis or bursitis: “It’s a chronic condition; we can treat the symptoms, even if we can’t figure out what causes it.” Muscle relaxants, such drugs as alpha blockers (originally marketed as antihypertensive drugs, also used to treat BPH—see Chapter 10), have been helpful in alleviating the muscle tension in the prostate, and making urination easier. Some doctors recommend anti-inflammatory drugs and the use of hot sitz baths, where the patient sits in (or sometimes over a fine spray of) soothing, warm water. Also, many men have found that diet has an effect on nonbacterial prostatitis, and that some foods—particularly, spicy dishes, red wine and caffeine—seem to aggravate their symptoms.

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Comments (0) Mar 30 2009

This form of treatment uses microwaves to produce temperatures hotter than 50 degrees and “zap” the tissue in the prostate’s innermost core, thereby creating space around the urethra. These temperatures are hot enough to do some good; they are able to destroy the smooth muscle and glandular cells in BPH tissue. What grows back over the next few months is a different mixture of cells that include collagen.

TUMT works by miniature remote control: A tiny antenna that targets BPH tissue surrounds a catheter that goes through the penis and into the urethra. The microwave generator is situated nearby, in the rectum. (The device is called the Prostatron.) The degree of power is controlled by different software programs that can produce a range of temperatures.

At Temperatures below 60 Degrees C. The technique produces significant improvements in urinary symptom scores and in urinary flow rates, but litde change in pressure-flow urodynamic studies—which suggests that the ultimate improvement in obstruction may not be great. The procedure can be performed under local anesthesia.

At Really Hot Temperatures—from 60 to 75 Degrees (this may be needed in cases of severe obstruction)—the treatment can create gaping cavities where tissue used to be. This can cause irritative symptoms that last until the tissue in the prostatic urethra dies and then is sloughed and reabsorbed by the body, or washed away by urine. (When all the dead tissue is gone, the prostatic urethra should be much less constricted.) The treatment causes inflammation and may require stronger pain-killing medication. Swelling and urinary retention (usually temporary) are also common after the procedure and can be eased with a catheter. Preliminary results are encouraging. However, how long these results will last—and whether or when a repeat procedure will be necessary—is not yet known.

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Comments (0) Mar 30 2009

BPH affects the urethra first, then the bladder. As BPH begins to impede urine flow, men may experience symptoms that can be broken down into two categories: Obstructive and irritative. The first category is just what it sounds like—symptoms resulting from a mechanical obstruction, from the prostate squeezing the urethra. These include the following: A weakened urinary flow or stream; hesitancy in starting urination and difficulty in stopping; intermit-tency, when the urinary stream starts and stops repeatedly; “dribbling” after urination; a sense of not being able to empty the bladder completely; and occasionally, urinary retention—when the bladder stays completely or partly full.

Early on in BPH, men experience few symptoms because the powerful bladder muscle compensates for the narrowed urethra by making more vigorous contractions and forcing urine through the prostate. But over time, this extra effort takes its toll on the bladder. The mechanical obstruction means the force is diminished for each length of muscle fiber—the bladder becomes less efficient, thus the decreased flow rate and obstructive symptoms.

But as this is happening, the muscle hypertrophies—it gets larger—and there’s a marked increase in the smooth muscle tone. Here’s where the second category of symptoms comes in. The bladder wall becomes thick and doesn’t stretch like it used to; the bladder itself doesn’t hold as much, becomes unstable and overly reactive, and causes a need to urinate more often—unfortunately, sometimes spontaneously. These irritative symptoms can include urge incontinence (when a man knows he has to urinate, but can’t make it to the bathroom in time); and nocturia, which is frequent urination during the night. The major cause of nocturia from BPH is a thickened bladder that doesn’t hold as much as it once did. Another cause is leftover urine from a never-emptied bladder, which gready reduces the bladder’s functional capacity. (Imagine a glass that’s capable of holding a pint of fluid, but which is always half-full. This means the glass must be emptied every half-pint—twice as often as before!)

When the prostate’s pressure on the urethra gets to be too great for the bladder’s compensatory muscle power, a man loses the ability to empty his bladder completely during urination. Sometimes this leads to symptoms that go beyond merely annoying and require treatment—such as repeated urinary tract infections (UTIs) caused by stagnant urine; or damage to the bladder and kidneys from the backup of urine. Sometimes, in acute urinary retention, a man suddenly becomes unable to urinate at all.

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Comments (0) Mar 30 2009

“Pain is very closely associated with quality of life,” says a Johns Hopkins oncologist. “People in pain have a reduced appetite; they lose weight. They’re often depressed. Sometimes they’re bedridden, the pain is so bad. If we control the pain aggressively, we often see patients getting stronger and eating better. Aggressive pain management is clearly to the patient’s benefit.”

It’s not only beneficial, it’s your right as a patient not to suffer. Far too many men with advanced prostate cancer endure excruciating pain in the course of their disease. Several studies have shown that an average of 72 percent of men with advanced prostate cancer are in pain. In one recent study of 201 men with prostate cancer, 47 percent reported feeling pain that ranged from “moderate to very bad”—despite the use of painkillers. This tells us several things. One is that, as diseases go, prostate cancer is more painful than most. Its particular patterns of spreading—metastases to bone, and particularly to the spine— make it second only to cervical cancer in terms of severe pain. But this study also shows us something else: These 201 men were on analgesics—painkillers —yet they still hurt. Some of them even felt miserable pain. Does this mean that painkillers don’t work? No. It means the doctors treating these men weren’t giving them enough medication to make them comfortable.

There is no excuse for that. And often, both sides—doctors as well as patients—are at fault. A recent article by University of Colorado scientists cited some reasons why prostate cancer patients often are under-medicated.

Here are some of the reasons why doctors may not give enough pain medication: One is that many doctors just don’t learn enough about pain medication in medical school and in their subsequent professional training; they learn how to save or prolong lives, but not always how to make their patients comfortable. (This is improving as medical schools and continuing education courses are doing a better job teaching doctors how to manage patients’ pain.)

But perhaps a bigger problem—and this also has to do with the way health care professionals are educated—is the very real fear that patients will get addicted. This is hogwash. The sole purpose of these drugs is to alleviate pain, and frankly, few patients need these medications more desperately than people with cancer—especially men with metastatic prostate cancer whose pain is extreme.

And yet every day all over this country, this study showed, some doctors prescribe painkillers at inadequate dosages; some nurses withhold doses of painkillers; and some pharmacists refuse to provide drugs.

In addition, some doctors worry about controlling the side effects of analgesics (see below). They worry about inadvertently precipitating a patient’s death—or worse, being an unwitting part in a patient’s suicide attempt—if he overdoses.

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Comments (0) Mar 30 2009

Craig, a retired internist, was 78 years old when his prostate cancer was diagnosed. He had recentiy undergone a TUR procedure to alleviate symptoms of BPH; no cancer was found at that time, when a pathologist examined the chips of tissue taken from his prostate. But within a year, Craig’s urologist found a nodule during a routine digital rectal exam, which turned out to be cancer localized to the prostate, with a Gleason score of 6.

Because of his age, Craig agreed with his doctors that external-beam radiation therapy was his best option. (Also, because of his age, he received treatment only in the prostate and seminal vesicles.) Craig began receiving doses of radiation every day. After a few days of treatment he began experiencing severe bowel problems, including debilitating diarrhea. These symptoms got better after Craig’s radiation oncologist changed his treatments to four times a week, which gave his lower gastrointestinal tract a chance to recover. The new treatment schedule helped considerably, he recalls, and “things subsided fairly well.”

That was twelve years ago. The radiation treatment worked, and he has been cancer-free ever since. “I went to see my urologist last year, and he joked with me, ‘I don’t know why you’re coming back, because your ten-year warranty is up!’” Since his treatment, Craig has traveled extensively with his family.

They’ve been, among other places, to London, Copenhagen, Prague, and Vienna; they’ve taken ocean cruises and flown to South America.

This is particularly remarkable because a few years after his treatment Craig began to be plagued with episodes of severe diarrhea, infection, and bowel problems that his doctors have been largely at a loss to explain. “I’ve had cultures, searches for parasites, everything you can think of, and they can’t find any explanation.” (One set of problems, including blood in his bowel movements, was attributed to some large polyps in his intestinal tract; these were removed several years ago, however, and the episodes of diarrhea have continued.)

The conclusion reached by a number of doctors, including a urologist, a radiation oncologist, an internist, and a gastroenterologist, is that Craig has what’s called an “irritable bowel” (a spastic, overly reactive colon prone to diarrhea) and that it is “secondary to”—a delayed effect of—his radiation treatment.

This is not uncommon; many men have delayed effects of radiation treatment, but these usually begin within a few months of treatment. In Craig’s case, his bowel problems may have been made worse by some of the antibiotics he’s been given over the years to combat infection. Craig’s self-diagnosis? “I think very probably the radiation made the colon irritable, and then the prolonged treatment with the mycins (antibiotics) might have been a contributing factor.” ”

Despite the episodes of bowel problems over the years, Craig does not seem to have slowed down too much over the last decade. In between their globetrotting expeditions, he and his wife are restoring an old family home on Maryland’s Eastern Shore. For Craig, radiation treatments have meant a gift of time and—bowel problems aside—good health. He has made the most of both.

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Comments (0) Mar 30 2009