Prostate Problems

Sep 9, 2020

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Adam begat Seth and Seth begat Enos and Enos begat Cainan and Cainan begat Mahalaleel and Mahaleel begat Jaret and so on. The male lineage described by the King James Bible doesn't just apply to people and their ancestors. I believe events have a lineage as well. Major crisis begets minor crisis. Minor crisis begets frustration with bureaucracy. Frustration with bureaucracy begets resolution. Resolution begets funny story about starting post-secondary education. On a completely unrelated matter, did I mention my daughter is at school in a different province and lost her wallet?

Whether at home or away, kids these days seem to watch a lot of videos and TV on their phones. I can't watch TV on my phone. I find it just too hard on my eyes. Maybe my vision is going as I age. Trouble peeing is another common complaint as men age. Let's do a quick anatomy review. The urethra is the canal through which urine passes. It starts at the bladder and goes out of the body. The prostate is a walnut sized gland that surrounds the urethra in males. Benign prostatic hypertrophy (BPH) is a condition where a male's prostate becomes enlarged to the point that it starts to push against the urethra, much like clamping a garden hose. This causes the bladder wall to thicken and become irritable. The bladder starts to contract even when it contains only a small amount of urine. Eventually the bladder weakens and becomes incapable of emptying itself completely, leaving urine behind.

Symptoms of BPH rarely show up before age 40. As men age, the chance of BPH symptoms go up. About 50 percent of men in their 60s have BPH and over 80 percent of men in their 80s have symptoms. Common symptoms of BPH include needing to urinate often, feeling like you really need to go now, straining to start urinating, a stream that starts and stops several times, feeling like you haven't completely emptied your bladder, straining to pee, decreased force of the stream and more frequent nighttime urination. Other less common BPH symptoms can include: kidney problems, bladder infections, blood in the urine and stones in the bladder.

What should you do if you have trouble urinating? Visit the doctor. They can determine if your symptoms are related to BPH and discuss your treatment options. What treatment options are available for BPH? There is surgery and medication. The gold standard for surgery is called TURP or trans-urethral resection of the prostate. It is usually reserved for more severe cases of BPH. BPH treatment will usually start with medication. And don't panic about a BPH diagnosis. Despite what you may have heard, although BPH and prostate cancer share similar symptoms, having BPH does not increase your chances of developing prostate cancer.

Just because you go to the doctor and complain about trouble peeing, don't be disappointed if they don't immediately offer you surgery or medication. If your symptoms don't bother you that much or if your prostate is still considered small, watching and waiting is a very reasonable strategy. Treatment of BPH is only recommended when it poses a health risk for the patient or when it becomes very bothersome.

There are two main types of medications used to treat BPH. They are alpha blockers and 5-alpha-reductase inhibitors. Alpha blockers include alfuzosin, doxazosin and tamsulosin. Alpha blockers relax the smooth muscle in the prostate and the bladder neck. They work quite quickly, and gentlemen say they can pee more easily in two weeks to a month. As good as alpha blockers are, their benefits don't last a long time. Their effects usually only last 6 months to a year and then symptoms often return. And alpha blockers don't shrink the prostate. 5-alpha-reductase inhibitors like dutasteride and finasteride stop the conversion of testosterone to dihydrotestosterone (DHT). DHT causes the prostate to grow. 5-alpha-reductase inhibitors help BPH symptoms and also reduce the size of the prostate. Unfortunately, these medications work slowly. It takes 6 months to a year for a 5-alpha-reductase inhibitor to help a guy's symptoms.

An unexpected concern about finasteride , a 5-alpha-reductase inhibitor came up in early 2019. There were reports to Health Canada that men on finasteride think about suicide more often than men who aren't on finasteride. The theory is finasteride may block the production of allopregnanolone and that is a hormone which is important in depression. Now that I've scared you into throwing out your finasteride, DON'T DO IT! This is a weak link at best. And there still isn't any proof that finasteride causes suicidal ideation. This is a correlation at best. Finasteride is still a safe and effective treatment for BPH. But if for any reason you start thinking of suicide, regardless of what medication you are on, seek medical help. You aren't crazy, weak or weird. And mental health professionals really can help you.

An obvious solution to the problem of quick acting but no staying power alpha blockers and slow acting but good in the long haul 5-alpha-reductase inhibitors is to use them together. Doctors often put guys on both an alpha blocker and a 5-alpha-reductase inhibitor. That way the alpha blocker can get the guy to urinate more easily within two weeks while the 5-alpha-reductase inhibitor is slowly starting to shrink the gland. Studies like the Combination of Avodart and Tamsulosin (CombAT) Study have showed that the combination of these two types of drugs works.

Another type of drug that is being used for BPH is the class called phosphodiesterase-5 inhibitors. This is interesting because we usually use PDE5 inhibitors for treating erectile dysfunction. However, PDE5 inhibition has been show to relax the smooth muscle of the lower urinary tract. So low dose, daily medications like tadalafil or Cialis can be used to treat erectile dysfunction and BPH when they occur together.

I am starting a new parenting stage. I am learning how to comfort, console and problem solve over the phone. When your child is in a different province, you can feel quite powerless when they run into problems. I'm happy my wife still happened to be with my daughter when the wallet was lost, but I guess next crisis will have to be handled remotely. Kids and teachers are figuring out how to do remote learning, so I guess I'll have to figure out how to do remote parenting. If I'm honest, some of the people I called to cancel and re-issue debit cards, credit cards, drivers license, health cards etc. were very helpful. And some were just as bureaucratic as you'd imagine. Major crisis, minor crisis, frustrating bureaucracy, resolution, funny story. And Jaret begat Enoch and Enoch begat Methuselah. Since Methuselah lived 969 years, I bet he had some issues trying to pee.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

 


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