Healthpharmablog. About Health & Medicine

Doctors generally base any diagnosis at least in part on the patient’s medical history and physical examination. But these aren’t always helpful in diagnosing prostatitis. Many men with the chronic and nonbacterial forms of this disease often have a history of problems centered around the prostate—numerous occasions of pain or spasms in the region, for example, Also, because the urethra, bladder, and prostate are so closely associated, it can be difficult to pinpoint the source of a problem in that region; the symptoms often overlap.

Clearly, the easiest form of prostatitis to diagnose is the acute bacterial form (the fever and chills are a big tip-off). But for the other kinds, and for prostatodynia, other tests are needed. Because of the prostate’s location—below the bladder, and just in front of the rectum—it can’t been seen or examined from the outside. So the first step in examining it is usually the digital rectal examination, in which a doctor’s gloved, lubricated finger is inserted into the rectum to feel for lumps or enlargement, or anything else unusual. This examination may be uncomfortable, but it doesn’t hurt and it’s generally brief, lasting less than a minute.

One important test for prostatitis is prostate massage. This is also done during a digital rectal exam, as a doctor vigorously massages or presses on the prostate to express, or force, fluid out of the prostate and into the urethra. This fluid then is collected on a glass slide and examined under a microscope in the doctor’s office. The purpose of the test is to look for such signs of infection or inflammation as abnormally high levels of white blood cells. This can be done while you wait and, like the digital rectal examination, it’s usually more uncomfortable than painful. (One exception: In acute bacterial prostatitis, the rectal examination will have found a remarkably tender prostate that is also swollen, warm and firm. In this case, a doctor should not continue with prostatic massage; it would be too painful, and could lead to the release of bacteria into the bloodstream, causing sepsis. Because a urinary tract infection often accompanies acute bacterial prostatitis, the harmful bacteria can be targeted by a simple urine test.)

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Look at the Study. If you can, ask your doctor for a copy of the study, or at least get the reference to the medical journal in which it was published. Before you accept any results, make sure the new drug or technique has been evaluated in a randomized, controlled study that lasted at least one year. If it’s a medical (as opposed to surgical) or minimally invasive form of treatment, the

The treatments in this section all have something in common: Waves. They all channel a form of energy—heat, radio frequency, ultrasound, microwaves, and light—to kill cells. Energy waves are generated, focused, aimed, and fired at the overgrowth of BPH tissue surrounding the urethra. Some waves work like a shotgun, blasting holes in the prostate. Others are as sensitive as a scalpel, delicately nibbling away at BPH tissue until the urethra is free.

As yet, none of these treatments can be classified as standard therapy. They’re trial should include a placebo-treated group of patients for comparison. If it’s a more invasive form of treatment, the results should always be compared to the accepted gold standard—in this case, the TUR. Is there a noticeable improvement in benefits?

Next, make sure that both subjective and objective results were measured. (Remember, encouraged by being involved in a study, a man might feel that his flow rate has improved more than it actually has.) All participants in the study should at least have completed symptom scores and had uroflow measurements taken. Ideally, the study should be stratified according to age, risk factors and severity of obstruction. Endoscopic treatment techniques preferably should be compared only to TUR and, if feasible, these studies too should include a placebo-procedure group.

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What’s Happening to Urine Flow?

Think of arteries “hardening” as years and years of cholesterol build-up take their toll; eventually, blood has a hard time maintaining its normal pressure and flow as it makes its way through them. BPH doesn’t involve a plaque-like accumulation—the build-up here involves an increase in cells, spongy glands and muscles—but what’s happening to the flow of urine is roughly the same, and that can be linked to the gland’s increased size and weight.

The Estrogen Connection

Another hormone that’s being implicated as a factor in BPH is estrogen. Male hormones, such as testosterone, can be converted to estrogen by an enzyme called aromatase. By itself, estrogen doesn’t make the prostate grow significantly. Researchers have learned, however, that estrogen stimulates the body’s receptors for androgen, or testosterone. Among other things, this enhances the action of DHT in the body; it also stimulates stromal cells, and inhibits cell death. This can lead to BPH.

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What should you do? First, let’s make sure that you’re receiving the maximum benefit from hormone therapy—that it’s doing the job it’s supposed to do, and that it’s not making things worse.

If you’ve been castrated, make sure that all the tissue was taken out. This is easier than it sounds; all you need is a blood test to measure your testosterone level. Similarly, if you’re taking estrogen or an LHRH agonist, make sure you’re getting the recommended dosage and taking your pills regularly— taking a pill at six one morning and at midnight the next night, for example, might mean the level of hormones is fluctuating. Again, a blood test can confirm whether your testosterone level is at the crucial castrate range. In either case, if there’s too much testosterone in the blood, dosage regularity is probably the problem, and it can be fixed.

If your testosterone is in the castrate range and you’re not on flutamide, you could try taking it to see whether this makes your PSA levels fall. Some men are helped by this. If, however, you already are taking flutamide in addition to castration, estrogen or an LHRH agonist, try stopping the flutamide.

In a few men, prostate cancer comes back as a kind of tumor called a small-cell carcinoma. This may be the case if there is a large recurrence of cancer in the pelvis or liver—especially if your PSA level is low. A biopsy should find this out. It’s an important fact to know because small-cell prostate cancers have a make-up similar to other small-cell cancers (of the lung, for example), and they respond to the same kinds of chemotherapy drugs used to treat these other small-cell tumors.

If all of these options for hormone therapy have been tried, and the cancer is not a small-cell carcinoma, the next step may be to try and control the cancer and its symptoms with other kinds of drugs—chemotherapy. However, this option is recommended only for men who are strong enough to withstand chemotherapy’s side effects. The other option is to treat specific symptoms as the cancer progresses.

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This approach has great potential to sharpen the cancer-fighting ability of external-beam radiation while reducing the damage to nearby tissue. In fact, some doctors believe three-dimensional conformal therapy will eclipse other radiation treatments for prostate cancer before the end of the century.

Little more than a decade ago, the idea here—zeroing in on the prostate more accurately and completely, but leaving surrounding tissue little the worse for wear—would have seemed like a nice daydream to most radiation oncologists. But over the last several years, great technological strides have made 3-D conformal therapy seem, suddenly, not only achievable but highly promising.

This therapy developed because scientists looked at what was not happening with radiation treatment: Conventional approaches, studies found, weren’t precise enough. For one thing, they weren’t accurately estimating the volume of their target; and because of this, they often didn’t supply enough radiation to kill the whole tumor. What was happening in some men, researchers have learned, was like what happens when a speaker with an inadequate microphone tries to make himself understood to an audience of a hundred thousand people in a vast amphitheater—some, maybe even most of the crowd can hear him, but that still leaves hundreds or even thousands who aren’t getting his message. In traditional radiation treatment for prostate cancer, this inadequate coverage meant that many men who suffered local relapses of prostate cancer did so because they were underdosed.

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