Dr. Donohue: Treating Enlarged Prostates
Dear Drs. Donohue and Roach: I have to trot to the bathroom many times during the day and many more times at night. Is this due to my prostate gland? I’m 74 and wasn’t bothered by bathroom visits a year ago. Does this mean surgery for me? How do I know if this is prostate cancer? — R.R.
Answer: Odds are you have benign prostatic hyperplasia, the official name for a large prostate gland. In their 40s, a quarter of males have a gland that’s larger than normal. In their 70s, 80 percent of men have an enlarged gland. Not all these men have symptoms like repeated trips to the bathroom, a hard time starting the urinary stream and a decrease in the force of the stream. The prostate gland lies directly below the urinary bladder, and the bladder’s drainage tube, the urethra, runs through the gland. A large gland presses on the bladder and obstructs the urethra. That’s why many men with a large gland have to run to the bathroom so often — they cannot completely empty their bladder.
You don’t have to jump to surgery right off the bat. Medicines often solve the problem. One class of medicines stops the forceful bladder contractions that signal an urgent need to void. Uroxatral, Flomax and Rapaflo are examples of this drug family. Their effect is seen within a week. Another family of drugs shrinks the gland. Avodart and Proscar are two such medicines. Their effect isn’t seen for up to six months. Combining both classes of drug is another method of treatment.
If medicine therapy fails, a variety of surgical procedures can remedy the problem.
You don’t know if an enlarged gland has cancer cells in it. The PSA blood test, flawed as it is, provides some evidence for cancer. Biopsy of the gland is the ultimate cancer test. A urologist will solve this problem for you.
Dear Drs. Donohue and Roach: Since my blood sugar has been going up, I have become a label reader. Recently I was stunned to read how much sugar is in milk. Is that natural, or is it added to milk? Should I continue to drink milk? — P.D.
Answer: Milk contains milk sugar, lactose, a natural ingredient, not an added one. An 8-ounce glass of milk has approximately 12 grams of lactose, 48 calories — not a huge calorie load.
You can continue to drink milk. It’s a rich source of calcium for your bones, with 300 mg in 8 ounces. It also has a healthy supply of many vitamins, including vitamins B-1, B-2, A, C and D. Eight ounces of milk has 150 calories. The same amount of skim milk has 86.
Dear Drs. Donohue and Roach: My boyfriend says he has a bleeding ulcer. When it hurts him, he says he needs to eat something. He won’t go see a doctor. He tells me he already did, and there’s nothing they can do for him. Is there something a doctor can do, or will my friend just have to bleed to death? — S.H.
Answer: Your boyfriend saw the wrong doctor. Medicines can cure an ulcer, bleeding or not, almost 100 percent of the time. If medicines don’t get the job done, surgery will put an end to an ulcer.
If your friend’s ulcer is bleeding, that’s an emergency and calls for immediate action.
How has your friend arrived at the diagnosis of a bleeding ulcer? If he truly does have one, he can’t dilly-dally about it. It has to be treated.
Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors P.O. Box 536475, Orlando, FL 32853-6475 or email ToYourGoodHealth@med.cornell.edu with medical questions.