Medical Forum / Diseases and Disorders / Prostate BPH / October 2004
Avodart and Uroxatral
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John Bishop - 30 Sep 2004 13:38 GMT I have been reading posts from your newsgroup for several weeks. I am 60 and have suffered from BPH for at least 20 years.
Tuesday, my urologist did a cystoscopy (I had one done about ten years ago) and declared that my prostate was probably about 35cc in size, was not growing into my bladder, no stricture observed, my bladder was fine (no lesions, growths or other abnormalities) and that we should continue to treat my condition medically. I brought up Avodart and he recommended Uroxatral, and that the two could be used in tandem.
(Had a urodynamics test about a year and half ago, and it indicated that my bladder function was good.)
I have tried Hytrin (5mg, no effect) and FloMax (had some relief but could not tolerate the side effects). Have never tried Proscar. In short, I was glad that he was not recommending surgery (he said that if my prostate were his, he definitely would not), but have mixed feelings about a continued drug regimen: cautiously optimistic, you might say
My problem is getting up five or more times a night. It is something I have lived with, tolerated for all these years but find that my limit has been reached. I am in reasonably good physical condition. Was running for about 25 to 30 minutes in the morning (to avoid the heat in Savannah) but stopped last month when I was waking up tired and running was the last thing I'd want to do. I miss it, but now that the weather is cooler, plan to start again in the late afternoon.
I enjoy two beers and a glass of wine in the evening. Is that an excessive fluid intake before bed?
Look forward to reading your responses.
Thanks.
JBB
Jim W. - 30 Sep 2004 16:02 GMT > I enjoy two beers and a glass of wine in the evening. Is that an excessive > fluid intake before bed? Obviously yes. Jim W.
Spread deMocracy - 02 Oct 2004 10:21 GMT Go see a therapist. If you meant that as a regular practice, 2 beers plus a glass of wine EVERY night, then you meet the definition of an alcoholic. Also, any alcohol or caffeine aggravates a prostate.
>I have been reading posts from your newsgroup for several weeks. I am 60 >and [quoted text clipped - 41 lines] > > JBB redbeard - 03 Oct 2004 00:37 GMT A man writes in and you have the temerity to call him an alcoholic. Who appointed you god?
What are your qualifications to make such a judgement without talking to him?
Spread deMocracy - 03 Oct 2004 03:22 GMT Not god, just going by the info he provided. If you did any reading about alcoholism you may understand.
>A man writes in and you have the temerity to call him an alcoholic. > Who appointed you god? > > What are your qualifications to make such a judgement without talking > to him? Roger - 12 Oct 2004 22:50 GMT rubbish
> Not god, just going by the info he provided. If you did any reading about > alcoholism you may understand. RUBBISH - and why hide behind a nonsense username like that?
>>A man writes in and you have the temerity to call him an alcoholic. >> Who appointed you god? >> >> What are your qualifications to make such a judgement without talking >> to him? John Bishop - 13 Oct 2004 16:24 GMT OK. For the sake of eliciting some useful information (that's why I posted originally), let's assume I am an alcoholic, currently in rehab (AA, that is, gingerly doing the twelve step) and am off the booze. Would anyone care to respond with their experience taking Avodart and Uroxatral?
Like most newsgroups, boards, etc., there resides here the usual mix of humanity: from the humane to the insane.
JBB
> rubbish > [quoted text clipped - 8 lines] > >> What are your qualifications to make such a judgement without talking > >> to him? XS11E - 13 Oct 2004 20:41 GMT > OK. For the sake of eliciting some useful information (that's why > I posted originally), let's assume I am an alcoholic, currently in > rehab (AA, that is, gingerly doing the twelve step) and am off the > booze. Would anyone care to respond with their experience taking > Avodart and Uroxatral? I know nothing about them but doing a Google search it appears they are almost the same as Proscar and Hytrin? FWIW I am taking those...
John Bishop - 13 Oct 2004 22:13 GMT Hytrin didn't work for me, and I've never tried Proscar. After only two weeks, I can say that I'm seeing some relief.
What's your experience been?
JBB
> > OK. For the sake of eliciting some useful information (that's why > > I posted originally), let's assume I am an alcoholic, currently in [quoted text clipped - 4 lines] > I know nothing about them but doing a Google search it appears they are > almost the same as Proscar and Hytrin? FWIW I am taking those... XS11E - 17 Oct 2004 22:05 GMT > Hytrin didn't work for me, and I've never tried Proscar. After > only two weeks, I can say that I'm seeing some relief. > > What's your experience been? Hytrin = wonderful! It keeps me able to urinate at night. I can't take much (5mg/day, 10mg works better but I had fainting spells and hurt myself badly once) as it drops my BP too much (I'm taking it primarily as a BP medicine).
Proscar = Good news, it shrank my prostate. Bad news, it didn't shrink it much. Good news, it keeps it from growing more. Bad news, it's already WAY too big.... :-(
Spread deMocracy - 17 Oct 2004 15:38 GMT John, my apologies for my previous comment. You do have a solid point: my comment was an over-reaction, insensitive and quite out of line. Since I appear to be THE inhumane a.shole who caused your postings to have stalled, let me offer some comments in hopes stimulating others to dump their wisdom and experiences in hopes of helping to get an answer to your question...
If your frequent visits to the washroom at night is something fairly recent then my comments below may apply--in my non-medical opinion. I must admit at the outset that I could not interpret the implications around the size of your prostate based on the description of 35cc in your post. Much of what I know of prostate size is based on an estimate of WEIGHT: 20 to 30 grams are considered in the normal range. But let me continue. There are 4 reasons for urinary urgency, that I am most aware of: 1-enlarged prostate, 2-obstructive prostate, 3-infection of prostate, or 4- irritation of the prostate. Let me take these in reverse order:
4- Irritation: Things that MIGHT--in my nonmedical opinion-- irritate prostate: coffee, hypertension, stress, and high blood glucose. You can easily rule out blood glucose with a fasting blood test and hypertension with a quick peek at your blood pressure. If you take blood pressure readings while on the meds in "A" below, then your blood pressure might read "normal" so, you have to factor around those meds since they might lower blood pressure throughout the body and not just in the (lower part of the body), the urinary tract.
3- Infection: Called PROSTATITIS, symptoms are frequent urination, possible urinary tract irritation, possible burning on urination, BUT NOT NECESSARILY. Hard to treat, takes a long time. Course of treatment is by anti-biotics for both you and your intimate partner. Your uro would have carefully ruled this out by asking you about the urinary burning and by an uncomfortable prostate massage to extract prostate fluid to study it under a microscope while you waited. If white blood cell count is up then he would have prescribed about a 3 month course of anti-biotics for you and about 6 weeks for your partner...in my non-medical opinion. Since your uro has not put you on anti-biotics, (not indicated in your post), we can then move on to possibility number 2.
2- Obstructive prostate. Obstuction the uro looks for is the enlargement of the median lobe or prostate growing into the bladder. You indicate in your post that he found no obstructions. You are fortunate. So, the last possibility would be a possible enlarged prostate, item #1.
1- Enlarged prostates are typically 70 grams or larger and that represents about double the normal size. But some people do experience BPH symptoms even if the Prostate has grown a wee bit larger than what they normally had in the past. If so, then doctors MIGHT consider one of three things: a)- relax the urinary tract with Alpha Blockers: Flomax, Hytrin, Cardura, or Xatrol; b)-shrink the prostate with Proscar or Avodart; or c)-Surgery: TURP, TUMT, or PVP--though they ought to want to consider surgery as a very, very last resort.
A)- If a doctor thinks a prostate is enlarged, BUT IS NOT GROWING VERY RAPIDLY then the doctor might offer Alpha Blockers--reduces lower body blood pressure and allows urinary tract to relax. [By the way, referring to the side effects you mentioned in your post: I also found that Flomax interfered with my sports. What's more frustrating is my doctor didn't relate to "getting my internal energy up to where it was". Merely suggested we switch to Xatrol. Xatrol got rid of retro-ejactulation, but still, internal energy is no where near as intense. ] Some guys can stay on Alpha blockers for quite some time, if their DHT is not that high and therefore if their prostates are not growing too quickly.
If your doctor felt your prostate was TOO LARGE then several options might be considered: B)- The Alpha Blockers to relax the urinary tract to let you have a wiz while one of the 5-Alpha-Reductase Inhibitors (DHT inhibitor) is considered. FDA approved DHT inhibitors include: PROSCAR or AVODART. Avodart is the more recently approved med., but both are approved. DHT inhibitors work VERY SLOWLY--many months, if they work at all, so some doctors combine the Alpha Blocker with the DHT inhibitor to buy the patient time while the DHT slowly kicks in. [I have never seen any publications indicating how long one has to take the DHT inhibitors. I am assuming it has to be lifetime since they only treat the symptoms and not the cause of high DHT. If DHT is high, and one wants to get to the cause of high DHT one may have to do a complete blood work up--see my posting for blood workup details. Getting at the cause of high DHT may need a trip to the endocrinologist and about 6 vials of blood for the blood workup.] Studies talk about the efficacy of this combined med therapy versus any one med alone. It makes sense. But no longer term results cited if the meds are discontinued.
C)- If the above is not working, or if there is acute symptoms, then surgery MIGHT be indicated. Like DHT inhibitors, surgery buys you time. If your DHT is within normal range then, in my non-medical opinion, surgery may provide long-lasting relief. I can't locate any evidence of the long-term efficacy of surgery when DHTs are above normal ranges. If DHT is too high, then likely the prostate will keep on growing and surgery may only provide a few years of relief? If DHT is above normal high ranges, then maybe an endocrinologist MIGHT be able to pin down the culprit.
Again, my apologies and I hope this posting gets others to offer you helpful suggestions. Best of luck to you.
"John Bishop" wrote: I am 60 and have suffered from BPH for at least 20 years. Tuesday, my urologist did a cystoscopy ...prostate was probably about 35cc in size, was not growing into my bladder, no stricture observed, my bladder was fine.. tried Hytrin (5mg, no effect) and FloMax ...never tried Proscar. ... I was glad that he was not recommending surgery ...mixed feelings about a continued drug regimen...My problem is getting up five or more times a night. I am in reasonably good physical condition. ...waking up tired and running was the last thing I'd > want to do.
John McNerney - 24 Oct 2004 03:36 GMT >I enjoy two beers and a glass of wine in the evening. Is that an excessive >fluid intake before bed? [quoted text clipped - 4 lines] > >JBB I am a certified drug and alcoholism counselor. Consistency does not define alcoholism; it is about behavior. In my working definiition, if a person continuously behaves in a specific manner that (s)he knows is harmful, that is addictive behavior. Vis, alcohol, drugs, gambling, sex, whatever. Enough said about that.
I take both Hytrin 10mg and Avodart 0.5mg daily. I started the Hytrin about 6 years ago at onset of symptoms, I'm 53. It provided wonderful relief, and had little or no side effects, until about 18 months ago, when it stopped being quite so effective. My Doc put me on Avodart. I was expecting some effect within 6 to 12 months, but like you, in just two weeks I did notice some effect.
My annual follow up showed a reduced prostate, from about 75g to about 50g. Not great - but good enough that I sleep all night... IF I do not take coffee or caffeinated beverages after about 4pm or 5pm.
My response to John is this: Knowing that this alcohol *might* be causing some of your discomfort - and not knowing any other alcohol related behaviors - why don't you try an experiment. Don't drink any alcohol for two weeks, see if in fact it might be at least partially responsible. If so, then to continue your nightly constitutional would meet my working definition, see 1st paragraph.
Recently, my Doc has suggested we stop the Hytrin. Brother, I got a formula that is working, I don't want to mess with it. But maybe I will try reducing the dosage at my next annual follow up. Avodart is working for me - although I have developed a slight case of man boobs, which I am working on at the spa. They are not pronounced enough to cause me great concern... Yet. And it seems their development has slowed or stopped after the initial growth spurt of about 3 to 6 months after starting the Avodart. So I'm hopeful. -John-
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