Dear Dr. Roach: I am 88 years old and in good health except for a small stroke I had a year ago with no lingering deficiencies. I have had an enlarged prostate for most of my adult life, but a biopsy showed no cancer. I have had problems with urgency. I tried a medication, doxazosin, with poor results, if any. My last visit, they recommended nothing more than medication. Is removing the prostate not advisable because of my age? What鈥檚 the reason they don鈥檛 remove it completely? C.W.S.
Symptoms of an enlarged prostate in men without cancer are common, and the condition is called benign prostatic hypertrophy. BPH can be treated with either medication or surgery.
For most men, medication works well. Saw palmetto is used by many men, but well-done trials have shown it to be no better than a placebo. Medications like doxazosin, including tamsulosin (Flomax), often are the first ones tried and usually work pretty well, but finasteride (Proscar) and dutasteride (Avodart) are effective, as well. A combination is probably most effective. However, even that doesn鈥檛 work for some men. The most common prostate surgery nowadays is a TURP (transurethral resection of the prostate). This is far less invasive and has fewer risks than the old open method, and generally has good results. However, as with any surgery, there is never a guarantee of success, and I have seen several men get worse after TURP, even though most get better.
Age in and of itself does not necessarily preclude surgery. However, a history of stroke does make surgery a bit more risky. I don鈥檛 recommend surgery lightly, and since you haven鈥檛 reported giving finasteride or dutasteride a chance, either alone or in combination, I would recommend a good trial of those before surgery.
Dear Dr. Roach: North Americans are infatuated with grilling, barbecuing and charring meat 鈥� all forms of high-temperature cooking. Isn鈥檛 charred food carcinogenic, leading to stomach and colon cancers? S.B.
Yes, charred meat is carcinogenic, at least according to the preponderance of the data. In fact, increased red meat of any kind probably increases overall cancer risk, but high-temperature cooking creates several kinds of toxic chemicals and increases colon cancer risk specifically. There is some evidence that leaner cuts of red meat aren鈥檛 as dangerous, and also that marinating, especially in wine, reduces the production of the dangerous chemicals.
