DEAR DR. ROACH: What’s your opinion on cooled thermotherapy for benign enlargement of the prostate? I recently was put on Flomax and finasteride, and was given the option of having this procedure to eliminate taking these two drugs.
My urologist has had great success, while my internist says the success rate is only 60 percent. My internist did say it’s great if it works. — S.V.
ANSWER: Benign enlargement of the prostate is very common in older men, and medications like tamsolusin (Flomax) and finasteride (Proscar) often are used, and are pretty effective in most men. The most effective treatment remains surgery, called transurethral resection of the prostate, TURP, which reduces symptoms by at least half in 98 percent of men. Unfortunately, TURP causes side effects in at least 20 percent of men, so there are several procedures designed to try to get the benefit of surgery without the drawbacks.
Cooled thermotherapy is a procedure using a microwave device to reduce prostate tissue. It isn’t as effective as TURP: Only 72 percent of men reduce their symptoms by half or more; however, it has reduced side effects, such as need for blood transfusion. Unfortunately, there were more symptoms of uncomfortable urination, urgency and need for a catheter after surgery.
I think both of your doctors are right: Some men have good experiences, but not everyone will get relief. Some serious side effects are better with thermotherapy, and others are worse. You need to decide how much taking the medications bothers you and if you can live with the symptoms the way they are.
READERS: The new booklet on the prostate gland discusses cancer, enlargement, infections and erectile dysfunction in detail. Readers can obtain a copy by writing: Dr. Roach — No. 1001W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 with the recipient’s printed name and address. Please allow up to four weeks for delivery.
DEAR DR. ROACH: I just read your column regarding the shingles vaccine. I am an insurance agent who is often asked about coverage for the shingles vaccine. The Affordable Care Act does include this under preventive care for individuals 60 and over. Preventive care is covered at 100 percent for health plans that are not grandfathered. (Grandfathered health plans are plans that have been continued virtually unchanged since 2010. They are not required to comply with all aspects of ACA, so these plans might not provide this service.)
You also may be interested in knowing that, in our area, the Department of Health clinic does offer the shingles vaccine for a fee of $5 for individuals over the age of 50 who do not have it covered under a health plan. I am not aware if this is unique to our area, or if it is a widespread provision.
ANSWER: Thank you for writing in. Others wrote to me that their Department of Health paid for most or all of the cost. Some said they could get the vaccine covered at a pharmacy but not at physician’s offices.
Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803. ©2016 North America Synd.