Prostate Health

WebMD Live Events Transcript

From benign enlargement to cancer, prostate problems will affect the majority of men at some point in their lives. WebMD's Sheldon Marks, MD, dscussed the latest diagnostic tools and treatment options on July 7, 2005.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Dr. Marks. Thank you for joining us today.

MARKS:
It's my pleasure to be here. Thank you for having me.

MODERATOR:
Are prostate problems inevitable?

MARKS:
For the vast majority of men, probably yes. If we live long enough, men will sooner or later have some problems. For most men it will not be serious, but you just never know. The biggest problem is that some of those symptoms are very nonspecific and can actually be a warning sign of more serious problems.

MEMBER QUESTION:
Is there anything that men can do to stave off prostate problems? What would you recommend to maintain prostate health?

MARKS:
The first thing and the best thing, if men could do it, would be to select different parents. Since we can't do that, then we have to look at some lesser options.

I think an intelligent diet, avoiding high-fat beef and high-fat dairy has been shown to be beneficial, a diet high in antioxidant fruits and vegetables which are basically colorful fruits and vegetables, the less cooked the better -- these have been shown to be very helpful. There are some supplements such as pygeum africanum and saw palmetto that have been shown to have some benefits. And staying in close contact with your regular physician to be sure if a problem develops you identify it and treat it early rather than waiting until it develops into a more serious problem later on.

MODERATOR:
How often should men be getting their prostate checked?

MARKS:
The official recommendation is that most men, starting at age 50, should have an annual prostate exam -- a digital rectal exam that takes just a few seconds. That should be done in combination with the PSA (prostate-specific antigen) blood test.

If the man is in a high-risk category -- if he's African-American or has a family history of prostate cancer, then those tests should probably begin starting at age 40 and continue on an annual basis.

MEMBER QUESTION:
During the past few weeks I have not been able to get a firm erection. I saw my doctor on Tuesday and asked if the meds he had me on might be the problem. The meds he has me on are for leg pain -- clonazepam and amitryptiline. He told me to stop taking the amitryptiline for a while and see what happens. What do you think of this?

MARKS:
Any time I have any patient of any age who presents with erection problems, what I try to explain to them is that the erection problem is not the concern. It is usually the symptom of something far mere serious that's going on. It may be hormonal or it might be blood vessel damage of the kind that causes heart attacks. Quite often it is from medications but we have to be careful that we don't assume it's the medication and miss this opportunity to find something else.

So yes, it's reasonable to start changing the medicines around to find out if one is causing the problem. Often they do, but it's also important to be aware that there could be something else and to just get a baseline workup that usually includes evaluating the liver, the kidney function as well as thyroid function, probably a testosterone and estrogen level, and in addition to that, probably some form of evaluation of the blood vessels in the body, especially the coronary arteries that provide the blood and nutrition to the heart muscle.

I do think that it's reasonable to go ahead and alter the medications one at a time with the doctor's advice and guidance to see if perhaps one medicine is responsible and that way if you can find the culprit then they can oftentimes come up with other medications to treat the problems and yet allow you to have normal erections.

Sometimes though, the problems need to be treated with those medicines and that's where the use of Viagra, Levitra or Cialis becomes very helpful.

MEMBER:
I am 66 and have gone through radiation treatment for prostate cancer. It took care of the problem and my PSA is back to normal. I know I can get a full erection because I wake up very early in the mornings with one. But I don't need it then. I need it at night so my wife and I can have sex.