DEAR DR. ROACH: I am 88 years old and in good health except for a small stroke I had a year ago with no lingering deficiencies. I have had an enlarged prostate for most of my adult life, but a biopsy showed no cancer. I have had problems with urgency. I tried a medication, doxazosin, with poor results, if any. My last visit, they recommended nothing more than medication. Is removing the prostate not advisable because of my age? What’s the reason they don’t remove it completely? — C.W.S.
ANSWER: Symptoms of an enlarged prostate in men without cancer are common, and the condition is called benign prostatic hypertrophy. BPH can be treated with either medication or surgery. For most men, medication works well. Saw palmetto is used by many men, but well-done trials have shown it to be no better than placebo. Medications like doxazosin, including tamsulosin (Flomax), often are the first ones tried and usually work pretty well, but finasteride (Proscar) and dutasteride (Avodart) are effective as well. A combination is probably most effective of all. However, even that doesn’t work for some men.
The most common prostate surgery nowadays is a TURP (transurethral resection of the prostate). This is far less invasive and has fewer risks than the old open method, and generally has good results. However, as with any surgery, there is never a guarantee of success, and I have seen several men get worse after TURP, even though most get better.
Age in and of itself does not necessarily preclude surgery. However, a history of stroke does make surgery a bit more risky. I don’t recommend surgery lightly, and since you haven’t reported giving finasteride or dutasteride a chance, either alone or in combination, I would recommend a good trial of those before contemplating surgery.
DEAR DR. ROACH: Unbeknownst to us, our son had an accident — while walking, a car hit him and knocked him unconscious. He does not have insurance. He was checked out, and the attending physician said there didn’t appear to be any harm done, but that in following days, symptoms could appear. Months later, he is experiencing dizziness, nausea and tiredness. Will these symptoms go away, or will he continue to have them? — A.A.
ANSWER: A concussion is a change in mental status that occurs after a head injury. The most common symptoms in concussion are confusion and memory loss. There does not need to be loss of consciousness at the time of the event to develop a concussion, and concussions should be promptly evaluated.
It sounds as though your son has postconcussion syndrome. Thirty percent to 80 percent of people with concussion will have some symptoms of postconcussion syndrome. These include headache, dizziness, difficulty concentrating and sometimes psychiatric changes. Fortunately, these usually get better within a few weeks or a few months.
Treatment of the symptoms needs to be highly individualized. Not having insurance makes that very difficult. Hopefully, he will be able to get insurance soon and see a neurologist, the type of doctor skilled in treating this condition.
DEAR DR. ROACH: Americans are infatuated with grilling, barbecuing and charring meat — all forms of high-temperature cooking. Isn’t charred food carcinogenic, leading to stomach and colon cancers? — S.B.
ANSWER: Yes, charred meat is carcinogenic, at least according to the preponderance of the data. In fact, increased red meat of any kind probably increases overall cancer risk, but high-temperature cooking creates several kinds of toxic chemicals and increases colon cancer risk specifically. There is some evidence that leaner cuts of red meat aren’t as dangerous, and also that marinating, especially in wine, reduces the production of the dangerous chemicals.
I recommend limiting consumption of high-temperature-cooked red meats.