DEAR DR. DONOHUE: I am 82 and have been on medication for two-plus years for an enlarged prostate. It’s still enlarged. I have no problem voiding. I drink six to eight glasses of water daily and have one or two wake-up calls a night. My urologist is letting me decide if I want more treatment. What are the risks — bleeding, infection, clots and scarring? What would your thinking be, taking my age into consideration? — J.L.

ANSWER: You have a good doctor who lets you make decisions regarding treatment. If your twice-a-night trip to the bathroom doesn’t bother you, you don’t need any treatment. You also don’t need six to eight glasses of water a day. Drink when you’re thirsty. Don’t drink any fluids within two hours of bedtime. That might give you a whole night of sleep.

Two different classes of medicines exist for an enlarged gland. One is called alpha blockers, and the two most often prescribed are Flomax (tamsulosin) and Uroxatral (alfuzosin). They relax the bladder outlet so the bladder empties completely. These medicines start to work within a week or so. The other class of medicines shrinks the gland by blocking the action of the male hormone testosterone. Proscar (finasteride) and Avodart (dutasteride) are the two most popular ones. They take months before results are seen. I mention the two classes of medicines because they can be combined to produce a therapeutic double whammy.

The ultimate treatment for a large gland is the TURP, transurethral resection of the prostate. The procedure pares away the gland through a scope and instruments passed through the penis to reach the gland without any skin incision. Bleeding can be a problem, as can the other complications you mentioned. Less-comprehensive procedures, mostly done right in the doctor’s office, deserve consideration. They include TUMT, transurethral microwave therapy (heat reduction of the gland); TUNA, transurethral needle ablation; and laser reduction of the gland. They don’t have the complications that TURP has and they don’t require a demanding convalescence.

As things are going well for you, don’t upset the cart. Keep on doing what you’re doing.

Prostate-gland problems are discussed in the booklet on the gland. Readers can obtain a copy by writing: Dr. Donohue — No. 1001, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have an enlarged prostate. Many years ago, my urologist put me on Proscar and later decided I needed a TURP procedure. After the surgery, he took me off Proscar.

Now, during a routine exam with my local doctor, he became aware of my prostate enlargement and prescribed Proscar again. He wondered why I was taken off it. What is your opinion? I am 72. — T.

ANSWER: Are you urinating without trouble and can you sleep through the night without getting up and going to the bathroom? If so, I don’t understand why Proscar is being prescribed again. The surgery should have ended the problem.

How about asking your doctor why? Maybe I can learn something.

DEAR DR. DONOHUE: I read that using the microwave oven changes food and water and is not good for the body. We cannot digest the food well after it has been changed. Have you heard of this? — V.M

ANSWER: I have heard many things about microwave ovens and their bad effects on food. None of the things I have heard is true. Neither is what you heard.

Microwaves cause water in food to vibrate, and that creates heat.

Microwaving heats food so rapidly that nutrients are preserved better than they are in other ways of food preparation. I don’t intend to give up my microwave.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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