Jul 9, 2010

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website

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.

Luke, I am your father! Join me on the Dark Side and togetherWait a minute I have to pee! Okay, I may have butchered a classical scene from Star Wars Episode V: The Empire Strikes Back, but think about it. Luke Skywalker is in his mid-twenties. Darth Vader would then be right around 50. That is the age many of us men will begin to have problems with benign prostatic hypertrophy, or BPH.

The prostate is a walnut size gland that surrounds the urethra, the canal through which urine passes out of the body. 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 empty itself completely, leaving behind urine. Although BPH and prostate cancer share similar symptoms, having BPH does not increase your chances of developing prostate cancer.

Symptoms of BPH rarely show up before age 40. However as men age, the chance of BPH symptoms go up. About 50 percent of men in their 60s have BPH and over 80 percent for 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 havent completely emptied your bladder, and more frequent nighttime urination.

So 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? Well 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. Usually BPH treatment will start with medication.

Now just because you go to the doctor and complain about trouble peeing, dont be disappointed if they dont immediately offer you surgery or medication. If your symptoms dont 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 dont last a long time. Their effects usually only last 6 months to a year and then symptoms often return. And alpha blockers dont 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 guys symptoms.

One 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. So, 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. Recent studies like the Combination of Avodart and Tamsulosin (CombAT) study have showed that the combination of these two types of drugs works well together.

So, yes Luke Skywalker would have won that classic, My dad can beat up your dad school yard controversy. But even Darth Vader would have to worry about frequent night time trips to the bathroom. So be kind to your prostate and have that talk with your doctor.

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


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