DEAR DR. DONOHUE:
For men with BPH, would you recommend the Prolieve System for treatment? It involves reducing the prostate with heat. Must it be done periodically to maintain symptom improvement? Any information will be appreciated. — Anon.
BPH — benign (not cancer) prostate hypertrophy (overgrowth) — is a common condition of older men. The urethra — the bladder’s drainage tube — runs through the prostate. A large gland acts like a vise, squeezing the urethra and making it impossible for the bladder to completely empty. Large glands make men get up many times during the night to visit the bathroom. They make it difficult to start the urinary stream, and they can reduce the stream to a dribble.
Minimally invasive procedures, many done right in the doctor’s office, pare the gland so that a free urine flow is re-established. The Prolieve System (a trademark name) delivers microwaves to the gland to shave the excess growth. In this and in similar techniques, instruments are inserted into the urethra by way of the penis and passed upward to the level of the prostate gland, where the microwaves are then activated. Yes, I can recommend it. Quite often, the procedure need be done only once. However, it is possible that a repeat will be necessary to trim the gland again should it regrow to the size where it compresses the urethra.
Other procedures include the Green Light laser, in which a laser beam reduces prostate size in a similar manner. TUNA — transurethral needle ablation — is another minimally invasive procedure, done in a like way. It employs radio waves to reduce prostate size. All of these methods work. The most important element in making a choice is the doctor’s skill in the technique.
Medicines are another possible route for handling an overgrown gland. Drugs can relax tight muscles in the prostate and in the outflow tract of the bladder to permit better urine flow. Flomax and Uroxatral are two examples. And medicines like Proscar and Avodart shrink the gland, but they can take months to work.
The booklet on this gland and its problems discusses these issues in greater depth. To obtain a copy, write: Dr. Donohue — No. 1001W, Box 536475, Orlando, FL 32853- 6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE:
I always heard that one must fast before being tested for cholesterol. My doctor always told me to do so. At my last visit, he had his nurse draw my blood for a cholesterol check. I told him I had not fasted, but he said it didn’t matter. Have things changed? — D.S.
You don’t have to fast for an accurate cholesterol reading. However, you do have to fast, preferably for 12 to 14 hours, for an accurate triglyceride reading. Triglycerides often are checked along with cholesterol.
A new trend is developing for triglycerides. Many now feel that a more accurate picture of triglycerides is obtained by not fasting before blood is drawn. Whether this technique wins universal approval is something we’ll have to wait to see.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.