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Medical Forum / Diseases and Disorders / Prostate BPH / April 2009Adding Avodart to Flomax
I'm 62, had bph for many years. Had been on 2 Flomax/day and Saw Palmetto for a long time. Doc added 1 Avodart/day last week. He sez it takes about a month to work. The Avodart literature sez it takes 3-6 months. What can I expect from such combination? I feel less virile. Thx, Peetie >I'm 62, had bph for many years. > [quoted text clipped - 9 lines] > Thx, > Peetie Check out http://tinyurl.com/cp49za. Avodart (and similar drugs like Proscar) reduces the amount of dihydrotestosterone. That makes you feel less virile... but might make you LOOK more virile, since you might get more hair on your head. OK, that has little to do with it. The drug is supposed to shrink the prostate, and that should improve your flow. I'm on Proscar, so that's where my experience is. The relief takes a long time to come, and is slight. IMHO, the more important benefit is that the prostate won't grow any more, or at least not as fast. So you can avoid the knife for longer. Effects most likeky vary from individual to individual. In my case, after around 5 years of taking Proscar, I'm feeling that the drug is not really helping enough any more, and I may have to have a TURP or other procedure. I believe Avodart is a stronger version of 5-alpha-reductase inhibitor, so may be more effective. Ed >Avodart (and similar drugs like Proscar) reduces the amount of >dihydrotestosterone. That makes you feel less virile... but might make >you LOOK more virile, since you might get more hair on your head. Fringe benefits! :-) >OK, that has little to do with it. The drug is supposed to shrink the >prostate, and that should improve your flow. I'm on Proscar, so that's >where my experience is. The relief takes a long time to come, and is >slight. IMHO, the more important benefit is that the prostate won't >grow any more, or at least not as fast. So you can avoid the knife for >longer. OK. >Effects most likeky vary from individual to individual. As does most everything. >In my case, >after around 5 years of taking Proscar, I'm feeling that the drug is >not really helping enough any more, and I may have to have a TURP or >other procedure. Sorry to hear. I guess the pills -and- most/all of the procedures just put off problems/miseries for a spell. >I believe Avodart is a stronger version of 5-alpha-reductase >inhibitor, so may be more effective. from http://en.wikipedia.org/wiki/Dihydrotestosterone Dutasteride is three times more potent than finasteride inhibiting the type II enzyme and 100 times more potent than finasteride inhibiting the type I form of the DHT producing enzyme. Dutasteride is not approved by the FDA for the treatment of Male Pattern Hair Loss and is approved at a dose of 0.5 mg a day for the treatment of prostate enlargement. While both the type I and type II enzymes are found in the hair follicle, there is a recent study which shows that type I is present in the human brain. The function of this enzyme in the brain is still unclear.[8] So, I may become a eunuch, but it'll grow hair on a billiard ball, and we got nary a notion what it'll do to my brain. :-) Seriously, I was fishing for personal experience, and your response was helpful. Much Thanks, Peetie >>Avodart (and similar drugs like Proscar) reduces the amount of >>dihydrotestosterone. That makes you feel less virile... but might make [quoted text clipped - 52 lines] > Much Thanks, > Peetie Have you not considered having a PVP? A day out of your life for a lifetime without medications and side effects. After ten years of Saw Palmetto and a few days of terrible side effects from Proscar and Flowmax I am now nearly four years post PVP. Derek >Have you not considered having a PVP? A day out of your life for a lifetime >without medications and side effects. 1.) I know next to nothing about PVP. 2.) I have yet to find a uro that is worthy of any serious trust. 3.) Money, Money, Money, Money, and Money. >After ten years of Saw Palmetto and a few days of terrible side effects from >Proscar and Flowmax I am now nearly four years post PVP. I'm very glad to hear it is working well for you, and appreciate your response. Recall anything about total cost of procedure 4 years ago? Clinics in the business of selling PVP use phrases like "proven safe and effective". To what extent is this accurate? Obviously there are some risks. Others in this forum with PVP experience? What is a good source of info re PVP? Thanks, Peetie >> Have you not considered having a PVP? A day out of your life for a >> lifetime without medications and side effects. [quoted text clipped - 21 lines] > Thanks, > Peetie As I live in the U.K. it was free on the NHS. It was a struggle to get it done as very few NHS hospitals here do it.I had it done on a Friday afternoon in Newcastle. Travelled back to Edinburgh by train on the Sunday. On the Monday I went to the races. Unlike before when going to the toilet every hour I suddenly ralised that I had not been for about five hours and should gp before going home. Most who have reported back here over the years have had trouble fee experience of PVP. At one time that was mainly all that was written about now things seem to have gone backwards to drug treatment. Do an advanced Google search for PVP on this group and you will come up with 98% satisfaction. I and one or two others still keep an eye on the group to see if we can offer and advice. Derek >>> Have you not considered having a PVP? A day out of your life for a >>> lifetime without medications and side effects. [quoted text clipped - 34 lines] >if we can offer and advice. >Derek Yes, PVP seems to be a very good alternative, as long as your prostate is not too large. Ed >>>> Have you not considered having a PVP? A day out of your life for a >>>> lifetime without medications and side effects. [quoted text clipped - 41 lines] > > Ed Mine was 74 grams but my urologist beleived that it is no problem with bigger glands. He had used PVP on a 112 gram prostate for a man in his 90's. He said that it is ideal for the older patients as it is such a gentle procedure. Derek > As I live in the U.K. it was free on the NHS. It was a struggle to get it > done as very few NHS hospitals here do it.I had it done on a Friday [quoted text clipped - 9 lines] > see if we can offer and advice. > Derek Derek, I too live in the UK. Can you tell me the name of the consultant who did your PVP in Newcastle? Steve >> As I live in the U.K. it was free on the NHS. It was a struggle to get it >> done as very few NHS hospitals here do it.I had it done on a Friday [quoted text clipped - 16 lines] > > Steve Hi Steve, I had asked the reluctant, doubting, fuddy duddy consultant at Edinburgh's Western General to refer me to The Freeman at Newcastle in September 2004. I had previously phoned the Freeman and spoken to the Consultant Urologist Phil Powell's secretary (0191-233-6261) John Davies the Staff Urologist later phoned me back. The up to date link to the Freeman: http://www.newcastle-hospitals.org.uk/services/urology_treatment-and-medication_ laser-prostatectomy-using-greenlight-ktp-laser.aspx He told me that the waiting time for an initial consultation was three months and another three month wait for the procedure if I was accepted as a patient. At that time as they had just started doing PVP and they were being choosy in their patients and wanted ones willing to give them a lot of feedback after the operation. I went down to see John in January 2005 for a thorough examination and discussion of my symptoms. John impressed me with his enthusiasm for PVP and he was surprised by my knowledge of the procedure ... well I had been reading this NG since PVP started and I had some correspondence with an American Urologist and I had E-Mail correspondence with Mike Degun the UK Laserscope representative. Laserscope now owned by AMS (American Medical Systems) They accepted me as a patient but it took a while for my Area Health Authority to agree to my having the procedure outwith their area and arrange the cost transfer.I had the procedure at the end of June 2005. By that time the Freeman had done 38 PVP. John Davies did mine and I was his sixth patient. Send me an E-Mail and I can answer any other questions that you have and give you full details of my experience, take the NOX out of my address to reply. Where in the UK are you? I am now in Sussex and at least two NHS hospitals in the County do it. What Maurice did not say in his post was that he had to go back again if I remember correctly to have scar tissue removed. Two other U.K. posters had to be redone within three or four years but they are the exceptions. Derek >>> As I live in the U.K. it was free on the NHS. It was a struggle to get >>> it [quoted text clipped - 60 lines] > to be redone within three or four years but they are the exceptions. > Derek Thanks, Derek. That's most helpful. Steve > What Maurice did not say in his post was that he had to go back again if I > remember correctly to have scar tissue removed. The reason why the 1st PVP was followed by a 2nd was because during the first he found tiny pre-tumours in the bladder, which he removed first, before doing a 'quick' PVP. Because of the fast recovery from the 1st PVP I had no hesitation or qualms about returning to finish the job, again with fast recovery.  Signature/\/\aurice (Replace "nomail.afraid" by "bcs" to reply by email) >> What Maurice did not say in his post was that he had to go back again if >> I [quoted text clipped - 5 lines] > Because of the fast recovery from the 1st PVP I had no hesitation or > qualms about returning to finish the job, again with fast recovery. Did your insurance cover you again? Derek > Did your insurance cover you again? Yes. (Two PVP's is still cheaper than one TURP, as in hospital 1 night only (if at all).) Signature/\/\aurice (Replace "nomail.afraid" by "bcs" to reply by email) >As I live in the U.K. it was free on the NHS. It was a struggle to get it >done as very few NHS hospitals here do it.I had it done on a Friday [quoted text clipped - 8 lines] >satisfaction. I and one or two others still keep an eye on the group to see >if we can offer and advice. Thanks. That info is helpful. Peetie > Others in this forum with PVP experience? Yes, had mine 4 years ago (in Haywards Heath, UK). Overnight stay, catheter removed in morning, then caught train home. Played snooker all morning next day - normal life. Since then only get up once during night (unless heavy supper...). Was about £3,000 all in. Go for it! Signature/\/\aurice (Replace "nomail.afraid" by "bcs" to reply by email) >> Others in this forum with PVP experience? > [quoted text clipped - 4 lines] > >Was about £3,000 all in. Go for it! Maybe $7500 4 years ago. At 8% compound inflation, could be about $10,200 here (if I was lucky). I would be interested in knowing if I would "qualify" if that is practical. They go by prostate weight in grams? How can I weigh my prostate? :-) Thanks, Peetie >They go by prostate weight in grams? How can I weigh my prostate? :-) The best way to determine the size of the prostate is by ultrasound... typically done when the prostate is biopsied. The ultrasound image allows them to estimate the volume. Human tissue has a density of close to 1, so one mL (milliliter, same as cc) of prostate tissue is close to one gram. The accuracy of this method is not that great, but is better than DRE (finger). Ed >>They go by prostate weight in grams? How can I weigh my prostate? :-) > [quoted text clipped - 6 lines] >The accuracy of this method is not that great, but is better than DRE >(finger). Thanks. It's curious that they quote it in grams. But you've explained why it is equivalent to cc (which I readily understand). >>> Others in this forum with PVP experience? >> [quoted text clipped - 15 lines] > Thanks, > Peetie Have you never had an ultrasound scan and has your Urologist never done a DRE? Derek. >Have you never had an ultrasound scan and has your Urologist never done a >DRE? Had an ultra on my left varicocele around '01. PCP does a DRE every year. I have stripped med insurance. It'd likely cost me $500 to get ultra on prostate. Some guys sorta "cling" to their uro. I've never had a truly trustworthy uro, so I don't "cling". >>Have you never had an ultrasound scan and has your Urologist never done a >>DRE? [quoted text clipped - 7 lines] > Some guys sorta "cling" to their uro. I've never had a truly trustworthy > uro, so I don't "cling". Some sorta cling to their prostates as well:-) I refused what the Uro called an urgently needed TURP in 1995 determined to wait for Laser versions that were in the development. It was quite a long wait as America had Laserscope several years before the U.K. I often thought of combining a PVP with one of my vacations over there. Derek. >>>Have you never had an ultrasound scan and has your Urologist never done a >>>DRE? [quoted text clipped - 13 lines] >wait as America had Laserscope several years before the U.K. I often thought >of combining a PVP with one of my vacations over there. It's maybe better you kept it in the UK. There are, of course, some good docs/facilities in the US, but it's a bitch to find 'em. For the most part, the med industry over here works on the "assembly line / revenue generation" principle, and that's dangerous for patients. Many here have found out the hard way. >>>>Have you never had an ultrasound scan and has your Urologist never done >>>>a [quoted text clipped - 24 lines] > "assembly line / revenue generation" principle, and that's dangerous for > patients. Many here have found out the hard way. Initially reports of PVP on this NG were excellent. In the past year reports have been mixed probably for the reasons you state.How much do Laserscope get involved it training the Uro's who do it and how much feedback do they ever get from patients. For a long time here Mike Degun the Laserscope rep attended a lot of the procedures. He was coming to see my one after a being at a urology conference in Glasgow but at the last moment had to fly to Glasgow instead of driving. As he has had said to me earlier the Newcastle Uro's were a sh.t Hot team:-) Derek. >>>Avodart (and similar drugs like Proscar) reduces the amount of >>>dihydrotestosterone. That makes you feel less virile... but might make [quoted text clipped - 57 lines] >Proscar and Flowmax I am now nearly four years post PVP. >Derek The OP will have his own reasons... me, I'm looking at a TURP probably later this year (PVP not available in my area). The benefit of no more drugs has to be weighed against the possibility of a lifetime of incontinence and other possible side effects. One of the side effects is death (2% of cases, I believe). Ed > I'm looking at a TURP probably > later this year (PVP not available in my area). Why not look outside area, then!? Anything to avoid old TURP... Signature/\/\aurice (Replace "nomail.afraid" by "bcs" to reply by email) >> I'm looking at a TURP probably >> later this year (PVP not available in my area). > > Why not look outside area, then!? Anything to avoid old TURP... I have looked outside the area... A couple of years ago I was examined by a well known uro in Toronto who does PVP... he said my prostate was too big for PVP. (It was about 150 g.) I also contacted a clinic in Vancouver. They said the max size they did was 50 g. Other than that, I could look in the U.S., but that becomes a logistic nightmare, and also gets very expensive. (Local treatment would be fully covered by our health system here in Canada.) A couple of years ago a NG participant called Michael reported he went in for a PVP (in the U.S.) but they turned him away AFTER (!) being giving anesthetic because they deemed his prostate to be too big. He returned a couple weeks later and had an open prostatectomy done. So there does seem to be a size limit with PVP for most uros. PVP seems to be much easier on patients compared to TURP, but it seems it is not as long lasting. There is a greater chance another PVP (or TURP!) will be needed in a couple/few years, compared to TURP. More pain, more gain with TURP. Anyway, maybe it's time for me to review the situation to see if anything has changed. Ed If you lived in North Carolina I could recommend an excellent Uro, although I went through 5 uros before finding him. I had a pvp several years ago and I am still very happy with it. My full recovery period was longer than most though I was up and around within in few days. It took 12 weeks for inflammation to subside and get a full flow. I am very glad I did it. One important point not mentioned often and I feel should be paramount is: Is the bph causing your bladder muscles to work harder and thicken? If so, the bladder may be permanently weakened so that eventually self catheterization is needed. Then a pvp or turp will do little except allow the catheter to pass more easily. I wonder why many uros don't mention this. A urodynamics test can measure bladder function. I had bph for 6 years before having a pvp. There was some damage to my bladder from overwork but fortunately it still had enough elasticity to empty. Best of luck...Dave |
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