Antidepressants Blog

Say you have some of its symptoms and they go away. Everything’s fine, right? Maybe. But you should still have your prostate checked out. Other causes for these symptoms could be serious, and include:

A urinary tract infection that does not involve the prostate;

Benign prostatic hyperplasia (BPH), or enlargement of the prostate;

Urethritis, or inflammation of the urethra, often caused by an infection. Not seeking treatment for this condition could result in a urethral stricture or a nasty infection that progresses back into the vas deferens and involves the epididymis .

In rare instances, urinary problems such as those manifested in prostatitis could indicate something even more serious, such as bladder cancer; they also could mean a stricture or blockage in the urethra, an infected kidney stone or early signs of diabetes.

There are causes of prostatitis other than the ones we’ve covered here; these are not only extremely rare, but they’re secondary to another disease, such as gonorrhea or tuberculosis. In some parts of the world (but hardly ever in the United States), prostatitis can be caused by parasites or fungal infection.

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This group of procedures can be divided into three categories based on temperature. The normal body temperature, 98.6 degrees Fahrenheit, is 37 degrees centigrade. All of the temperatures discussed below are in centigrade.

Hyperthermia, the mildest approach, uses temperatures that are less than 45 degrees—which probably isn’t hot enough to accomplish major relief of obstruction. In thermotherapy, tissue is heated to temperatures greater than 4s degrees—at which point some cellular protective mechanisms are overwhelmed, and normal cells are destroyed. To make sure only the BPH tissue is destroyed, temperatures in the region are monitored closely during this treatment. Thermal ablation techniques can produce the hottest temperatures of all—above 60 degrees—and are usually performed using high-intensity focused ultrasound, transurethral microwave therapy, interstitial radio frequency waves, and lasers.

An important fact about thermal therapy is that—except for contact laser prostatectomy—the BPH tissue in the targeted area is killed but not removed. One problem with this is that many men experience acute swelling immediately after these procedures and may need a catheter until the dead tissue is re-absorbed by the body, or is sloughed into the urethra and washed away in urine. (Another problem is the lack of tissue samples for pathologists to examine.) This marks a big difference from surgical procedures such as TUR, where the obstructive tissue is extracted, and the patient generally can urinate well immediately afterward.

As noted, temperatures in hyperthermia range from 41 degrees to 45 degrees. As heat treatment goes, these temperatures are rather lukewarm. Hyperthermia is not painful, and it can be performed as an outpatient procedure; it usually involves multiple treatments. It can be done in two ways—trans-rectally, by a probe inserted into the rectum, and transurethrally, by an instrument inserted through the penis into the urethra.

The technique has only recently undergone randomized, placebo-controlled studies, in which patients were treated without knowing whether the heat generator was activated. The largest recent study has demonstrated no significant objective improvement in urinary flow rates.

Why is this? For more than a century, doctors have known that heat can kill cancer cells. Hyperthermia as a treatment for BPH grew out of techniques used to treat malignancies, including prostate cancer. It can be given to cancer patients along with radiation because rapidly multiplying cancer cells in certain phases of division are particularly susceptible to heat.

The basic problem here is that normal cells respond differently than cancer cells; and just because a technique works on cancer cells, it doesn’t necessarily follow that it will work in normal tissue. BPH tissue—though growing—is benign, not cancerous, and it just isn’t that sensitive to these temperatures. Scientists who have looked under the microscope at BPH cells heated to 45 degrees have trouble telling them apart from BPH cells that have not been treated. Hyperthermia isn’t hot enough to kill BPH tissue. The tissue reacts, certainly, but the results are not permanent, and the injured tissue eventually recovers. So at this point, using temperatures less than 4S degrees should be considered an ineffective solution to a long-term BPH problem.

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Nobody knows what causes BPH; that’s why doctors are unable to prevent it, or even to make it go away completely once the disease process has begun. Briefly, here’s what we do know: Hormones play a major role, but their presence may only be permissive—they may simply provide the necessary soil for the disease to take root and grow. Aging is crucial to the development of BPH; as men age, the prostate becomes more sensitive to hormones. Family history is important, particularly in families where men develop BPH at a relatively young age. The balance between epithelial an A muscle cellsis also important for the development of the disease, as is the role of growth factors, but in what ways? For doctors to fill in these blanks, much more research is needed. Basically, BPH is a different disease in every man. Its many symptoms—and how a man responds to treatment—depend on an intricate interplay of factors, including the site and configuration of the enlarged lobes, the ratio of smooth muscle and glandular tissue involved, and how all these things affect the bladder.

BPH Causes Urinary Trouble.    

Obstructive Symptoms Weak flow

Hesitancy in starting urination; a need to push or strain to get urine to-flow

Intermittent urine stream (starts and stops several times) Difficulty in stopping urination “Dribbling” after urination

A sense of not being able to empty the bladder completely Not being able to urinate at all

Irritative symptoms Frequent urination, especially at night

A strong sense of urgency in urination; inability to postpone urination

Sleep disrupted by the need to urinate Urgency incontinence

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Currently, researchers are working hard to develop analogs or “cousins” of suramin—to make it more powerful, with fewer side effects. And scientists are investigating whether suramin given in combination with another drug— EMCYT, perhaps—might be more effective.

“We’re talking about the very end of a lifetime of a tumor here,” says the Johns Hopkins oncologist. “By this point, tumors become resistant to drugs in many ways; they express different pathways of resistance. If you treat with Drug A, for instance, this may be effective against a certain portion of the tumor, but probably not all of it—some part of that tumor is probably going to be resistant to that treatment. Therefore, because we’re dealing with a heterogeneous disease, it’s unlikely that any one drug is going to make a significant impact.”

Timing of treatment also may make drugs such as suramin more effective. Some doctors are letting PSA be the guide to beginning additional treatment. “In following men on hormonal therapy,” says the oncologist, “if we see that the PSA is rising—even before patients develop problems—that is probably a better time to start (with other drugs) because the disease is not as extensive as it becomes if you wait until pain, weight loss and other cancer-related symptoms begin.”

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Treatment planning begins with a series of CT images that give enough cross-section views of the prostate, seminal vesicles, and surrounding terrain (including the bladder wall, rectal wall, small bowel, bony structures and skin) to create a three-dimensional reconstruction. Dosage, and the area over which it will be distributed, can be calculated plane by plane, millimeter by millimeter. Each radiation beam—the 3-D approach allows more segments of treatment than traditional therapy—is automatically shaped by the computer so the energy focuses on the tumor alone (in the prostate as well as in tissue outside the gland where cancer has spread), rather than its entire neighborhood. A special body cast is custom-built for each patient to minimize movement during a treatment session, and also to make sure that a man’s exact position can be reproduced every time. Several quality-control mechanisms are built into this approach; after-the-fact or instantaneous means of verifying that the radiation went to the right spot for the right length of time help guarantee the most successful treatment possible.

Right now, it’s impossible to predict how well these techniques will work. There’s just not enough information yet to give meaningful results on PSA levels after treatment or to predict long-term survival rates; however, this information should be available within a few years. At eighteen months after treatment in one study, only 3 percent of the men had a local recurrence of cancer (two of these were men with stage T2C, or B2, cancer; and five had stage T3 or T4, or C, disease. The best we can say right now is that early results suggest an excellent potential for 3-D conformal therapy.

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