Are there any treatments for BPH that would also be effective for prostatitis?
The distinction between BPH, which is a big prostate, and prostatitis, which is a form of
inflammation — it's sort of a mushy distinction. We all know that what a big prostate is and we
all in our heads think we know what an inflamed prostate is, but both of these things can cause
similar symptoms—getting up at night slow urination irritation when you urinate—and
how much of it is from the BPH and how much of his from the prostatitis is oftentimes
not that clear. There are certain types of prostatitis, overt infectious inflammation,
men have a fever — it's no doubt that it's prostatitis. Yes, the answer is that there
are actually a number of medicines that control these symptoms and can help the symptoms whether
it's due to the enlarged prostate or due to the inflammation, and I would say that the distinction
between these two different entities generally isn't that important. It's more an issue of
through trial and error trying different pharmaceuticals to see which is going to be
effective in controlling the symptoms and whether the symptoms are coming from inflammation or from
a big prostate is less important than the fact that you're actually controlling the symptoms.
So, do you have a preference between LDR and HDR brachytherapy?
So LDR would be what we call low-dose rate implanted radioactive seeds. HDR would be
high-dose rate in planted seeds. The difference, the LDR seeds are
placed in the prostate in a 45-minute outpatient procedure and they remain there emit radiation
for a few weeks to a month and then they die out and they stay there forever. The high-dose rate
temporary seeds are placed in a hospitalization, they only stay in the body for during that
hospitalization, then everything is removed. LDR? HDR? I'd say that for men that have any type of
cancer that's growing outside the prostate, you want to use HDR. The LDR seeds are put in
the prostate and so if the cancer is outside the prostate it's difficult to implant the seeds to
make sure that all the cancer is controlled. The men that have more manageable situations
where the cancers thought to be confined might be might prefer to use LDR because it's a more
simple outpatient procedure. When possible, LDR is preferable for convenience, and then for the
more serious troublesome cases HDR is preferred for its ability to cover outside the prostate.
So currently, do you prefer Depo Provera or an estrogen patch for treating
hot flashes caused by hormone therapy?
Both are very effective. There are other agents like antidepressant agents
or anti-seizure agents like Gabapentin that can have some efficacy against hot flashes,
but Depo Provera and estrogen have the best results. I. tend to stay away from Depo Provera
because it can be converted into testosterone. So, we tend to go more toward the estrogen
direction in men that are struggling with hot flashes. I mean, a lot of men the hot flashes
aren't that big a deal and so unless they're truly troublesome—disturbing sleep and whatnot—we don't
recommend treatment for hot flashes, but if someone is really suffering,
an estrogen patch is probably the most effective and the most reliable way to get rid of hot
flashes. We don't recommend estrogen pills because those can cause an increased risk of blood clots,
but estrogen patches appear to be safe in that regard and they're very effective.
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