Prostate Health (cont.)

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.

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.

This is very common after radiation. The very benefits of radiation -- the damage to cells -- also damages the delicate cells within the nerves and the blood supply and that can lead to erection problems.

In this particular situation, with this added history, I would think that again, the new medications -- Cialis, Levitra and Viagra -- are an excellent option and almost always provide outstanding results to men in this scenario.

What are the most common prostate problems that men experience? We talked a little bit about erection and prostate cancer. What other kinds of problems do men experience?

The biggest problem is that as men get older, in the face of normal testosterone levels which is part of what men have, the prostate grows. As it grows it squeezes on the urethra and that causes some degree of blockage in the majority of men as they age. This can result in a variety of symptoms. Some men have no symptoms, some men have all the symptoms, but they can be quite bothersome and can actually in certain situations become significant, causing serious problems.

The most common symptoms are waking up at night frequently to urinate, urinating frequently during the daytime and a sense of urgency to rush into the bathroom. Sometimes with even leaking of urine, called urge incontinence. Some men have lots of dribbling afterwards, sometimes they have to stand a long time and strain to start the stream and strain to finish. For men many the stream can be significantly weaker and instead of strong and steady it can wax and wane, starting and stopping. These are some of the symptoms that men can experience as the prostate enlarges and squeezes on the urethra.

The good news is if they identify these problems early there are very effective nonsurgical treatments that can work to prevent further problems and hopefully keep men out of the hospital and out of needing any surgical intervention.

What are causes of reduced ejaculate volume, consistency and frequency?

This is a very common question and it is asked frequently on the men's health message board on WebMD.

As men age the prostate changes and in a changing hormone environment, the volume of ejaculate can fluctuate and as men get older usually the amount of semen ejaculated decreases. In addition, the ability to generate those volumes goes down on a frequent basis. So young guys can have significant volumes and can have that frequently. As men age it's very normal to have less volume in the semen and it takes longer to build up to that volume. That's again, just normal aging, changes that occur as men get older.

Many times with a big gut and the increased abdominal fat, that increases the estrogen level and that alters the normal balance of hormones and can also reduce the ejaculatory volume.

So how is it treated?

The first question is do we really need to treat that? If a man is trying to father children, the first thing to do is to obtain a series of semen analysis to see if the total picture is still adequate. If there is a problem specifically relating to volume, then the way to do that would be to reduce the ejaculatory frequency to allow the body to build up enough, and also to make sure that the man is well hydrated. Other than that, I think it's just one of those things that men just need to accept, is they are not 18 anymore and there are some changes that go along with that.

What are the signs of prostate cancer?

That's an excellent question. The biggest problem with prostate cancer is that there really are absolutely no early warning signs. As the prostate develops the cancer they tend to be very small. They grow very slowly and this is the best time to identify it and treat it. But it's also the hardest time to find it because you're not going to usually have symptoms of obstruction, you're not going to be getting up at night, you're not going to be urinating frequently. It's very rare to have blood or any warning signs, which is why organized medicine continues to encourage all men to see their doctor for a prostate exam and PSA annually.

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