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'A Laser Zapped My Prostate'
by ROGER DOBSON, Daily Mail
A new green-light laser treatment for benign prostate disease takes only 20 minutes and reduces the risk of side-effects, including impotence and incontinence.
The laser is attracted to red blood cells, which means that when it is pointed at the prostate it attacks only the gland itself and not the surrounding, lighter-coloured area, which may contain nerves and other delicate tissue.
The treatment requires no overnight hospital stay and cuts recovery time, with some men returning to work the day after the operation rather than up to six weeks later as with some treatments.
Benign prostate disease is a big health problem. As men get older, the prostate gland - which lies just beneath the bladder - may begin to grow, and the enlargement can eventually cause problems because as it gets bigger, the gland may pinch off the urethra.
The problem occurs most often in men over the age of 55, and up to one in three men in their 70s have a benign prostate problem.
As a man ages, the prostate can increase in size many times without becoming cancerous. Benign prostatic disease or hyperplasia (BPH) is not the same as prostate cancer, and doesn't progress to cancer, although BPH and prostate cancer can exist together.
Symptoms differ among individuals, but the enlargement of the prostate gland stretches and distorts the urethra and obstructs urine flow.
Common symptoms include a weak urinary stream, difficulty starting the urine flow even when the bladder feels full, a feeling the bladder is not completely empty, and a need to urinate often. Increased need to urinate during the night is usually a very early symptom.
The most common surgical technique available to cure this problem is transurethral resection of the prostate (TURP), where part of the prostate gland surrounding and constricting the urethra is removed.
It is estimated that around 65,000 of these operations are carried out each year. The downside of TURP is that patients need to stay in hospital for three or four nights, overall recovery time can be several weeks, and there may be side-effects.
The possible side-effects of TURP - which are avoided with the new laser treatment - include heavy bleeding, incontinence, impotence and infection.
The new green-light laser is fast, accurate and has fewer complications.
'It can be performed in as little as 20 minutes,' says Gordon Muir, urology consultant at King's College Hospital in London, one of two centres in Britain offering the new treatment, with others expected to provide it soon. 'Recovery time and side-effects are greatly reduced.'
The surgical laser system is used to deliver green laser light pulses through a specially designed fibre optic delivery device that is inserted through the urethra.
The green light is important because it is absorbed at a greater rate by anything red, and the prostate is full of red blood cells.
The light pulses are directed at the prostate's obstructive tissue and quickly and gently vaporise and remove it completely and bloodlessly, without harming surrounding tissue.
Green-light laser treatment, which is available at King's College Hospital and Brighton and Sussex Hospital, is based on industrial-strength lasers.
Geoffrey Harris, a 61-year-old chartered accountant, was one of the first men in the UK to have the operation.
He says: 'For the past five or six years I have been increasingly inconvenienced by very poor flow and the need to empty the bladder far too often. 'In the couple of months before the operation I was getting up at least six times a night. I had a biopsy on my prostate, which confirmed it was large but benign.
'I arrived at the hospital at 7.30am, had the operation, woke up at 11 o' clock, and at 1pm went home for a nice lunch in the garden. In fact, it was less trouble than going to the dentist.
'This technique was so quick and so painless, and the improvement was instant. There were no stitches and no burning sensation.
'As the prostate healed, there was blood in the urine for just over a week, but I was told that would happen, so it wasn't frightening.
'I am just very grateful this new technique was around.'
{"status":"error","code":"499","payload":"Asset id not found: readcomments comments with assetId=187705, assetTypeId=1"}Dear Doctor: Men With Enlarged Prostate Glands Are At A High Risk Of Urinary Infections. Here's What To Look For
DEAR DR. ROACH: I am an 86-year-old male. Several years ago, I had about a third of my prostate removed because I couldn't pee. After the surgery, all was well with a steady stream. That is, until about two weeks ago, when during one of my many trips to the bathroom, I had a hard time starting. The stream was stop-and-go. This continues to this day. The symptoms are much worse at night.
Any thoughts about the sudden change in my urinating? -- D.S.
ANSWER: A sudden change in urinary symptoms should make your physician consider a urine infection. Men with enlarged prostate glands are at a high risk for this. If the urine test doesn't show an infection, your urologist will consider other possibilities, such as the prostate gland continuing to enlarge. Despite the surgery, you have symptoms again. You might have developed a stricture, which is a kind of scar tissue near the surgical site. Certainly, a visit to your regular doctor or urologist is called for.
I would also be sure you aren't taking any medications that can exacerbate prostate symptoms. Over-the-counter cold/allergy medicines -- both antihistamines and decongestants -- are the most common. If you just started taking these for allergies, they could be the likely cause.
DEAR DR. ROACH: I am a female who is 68 years old and in generally good health. In September 2021, after a couple episodes of faintness when tilting my head back, I was given a CT angiogram with contrast. The diagnosis was fibromuscular dysplasia (the report noted a "beaded appearance" of the artery), with no dissection or hemodynamically significant stenosis. At the time, I was told to take aspirin daily and not to look up.
It seems to be getting worse, as I cannot tilt my head back for more than a few seconds before noticing an effect (i.E. When drinking, especially from a bottle, or looking for something on an upper shelf). Are the "beads" going to continue to grow, resulting in more problems and me having to constantly look down? Is a stroke inevitable from the lack of blood flow at some point in the future?
When I do have a more significant episode (I haven't completely passed out yet), is there anything I can do to help restore equilibrium (maybe a boost of oxygen)? Are there things that may make it worse, like lifting heavy boxes or vibrations from a sonic toothbrush? -- C.B.
ANSWER: Fibromuscular dysplasia (FMD) is a disease of blood vessels caused by excess fibrosis of the blood vessel itself. It is not atherosclerosis. Cholesterol is not found in the artery, and it is not an inflammatory disease. It isn't known why people get it.
Headaches are more common than the lightheadedness you noticed. Other organs can be involved, including the kidney, and FMD is one of the more-common causes of "secondary" high blood pressure, even though it is not a common problem. (The best estimate is only 0.02% of the general population.)
The good news is most experts find that this condition does not worsen over time. Most people like you with FMD in the carotid arteries did not progress with follow-up repeat imaging studies. A stroke is not likely and certainly not inevitable. Ultrasounds are preferred over CT scans to look for progression because an ultrasound does not have ionizing radiation. Careful monitoring of blood pressure and kidney function is wise.
If you do have another episode, keeping the neck in a neutral position is important. Oxygen isn't helpful. I don't think lifting or brushing your teeth is likely to cause your symptoms.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.Cornell.Edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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Breakthrough 'take-at-home' Prostate Cancer Drug Gets Green Light For NHS Use, Sparing Patients From Lengthy Hospital Visits Throwing A Lifeline To 40,000 Men
Thousands of men with advanced prostate cancer are set to benefit from the first at-home treatment in what has been hailed a 'major advance' for the disease.
Relugolix has been given the go-ahead on the NHS, potentially helping 40,000 men with advanced hormone sensitive prostate cancer.
Unlike similar drugs which must be given as injections, the pill can be taken from home - sparing men from gruelling hospital trips.
Last night, experts said it will be a 'gamechanger in terms of men's experience of treatment' while keeping the disease in check.
Known by brand name Orgovyx, trials found it also lowers the risk of heart attacks and other cardiovascular problems linked to this type of treatment.
Relugolix has been given the go-ahead on the NHS, potentially helping 40,000 men with advanced hormone sensitive prostate cancer
Prostate cancer is the most common male cancer, with more than 52,000 diagnoses and 12,000 deaths ever year. Relugolix, also known by brand name Orgovyx, tackles the disease and also lowers the risk of treatment-related heart attacks and other cardiovascular problems
An androgen therapy, it works by blocking the production of testosterone which prostate cancer needs to grow.
It is expected to be available to patients on the NHS within three months of the National Institute for Health and Care Excellence's (NICE) final draft guidance being published.
Last night, Prostate Cancer UK said it was 'fantastic news' for patients, providing a more convenient and comfortable treatment for thousands of men.
Amy Rylance, assistant director of health improvement at the charity, said: 'This drug can not only help keep the cancer at bay but could be a game changer in terms of men's experience of treatment.
She added: 'Even better, trials suggest it has a lower risk of heart problems sometimes associated with these sorts of treatments.
'All this makes it a major advance on what came before, and we're pleased to see so many men getting access to kinder, effective treatments like this one.'
Prostate cancer is the most common cancer among men, with more than 50,000 new diagnoses and 12,000 deaths annually.
Patients with the advanced forms of prostate cancers are usually offered hormone therapies, surgery or radiotherapy.
Made by UK-based Accord, evidence suggests relugolix is better at reducing testosterone to levels that stop cancer growth in the longer term than the alternative, leuprolide.
It comes as a landmark prostate cancer screening trial, called Transform, is getting underway in the UK, with a national screening programme likely to follow.
Transform will test the effectiveness of diagnosis techniques including MRIs when compared to the current standard, prostate specific antigen (PSA) blood test.
The Mail has campaigned on improving prostate cancer outcomes for more than two decades.
Helen Knight, director of medicines evaluation at NICE, described it as an 'innovative and effective treatment' for prostate cancer.
She said: 'Relugolix provides a convenient and flexible treatment option compared with therapies that need to be injected, helping people to avoid travel and time off work and the evidence shows it can improve people's quality of life.'
WHAT IS PROSTATE CANCER?How many people does it kill?
More than 11,800 men a year - or one every 45 minutes - are killed by the disease in Britain, compared with about 11,400 women dying of breast cancer.
It means prostate cancer is behind only lung and bowel in terms of how many people it kills in Britain.
In the US, the disease kills 26,000 men each year.
Despite this, it receives less than half the research funding of breast cancer and treatments for the disease are trailing at least a decade behind.
How many men are diagnosed annually?
Every year, upwards of 52,300 men are diagnosed with prostate cancer in the UK - more than 140 every day.
How quickly does it develop?
Prostate cancer usually develops slowly, so there may be no signs someone has it for many years, according to the NHS.
If the cancer is at an early stage and not causing symptoms, a policy of 'watchful waiting' or 'active surveillance' may be adopted.
Some patients can be cured if the disease is treated in the early stages.
But if it is diagnosed at a later stage, when it has spread, then it becomes terminal and treatment revolves around relieving symptoms.
Thousands of men are put off seeking a diagnosis because of the known side effects from treatment, including erectile dysfunction.
Tests and treatment
Tests for prostate cancer are haphazard, with accurate tools only just beginning to emerge.
There is no national prostate screening programme as for years the tests have been too inaccurate.
Doctors struggle to distinguish between aggressive and less serious tumours, making it hard to decide on treatment.
Men over 50 are eligible for a 'PSA' blood test which gives doctors a rough idea of whether a patient is at risk.
But it is unreliable. Patients who get a positive result are usually given a biopsy which is also not fool-proof.
Scientists are unsure as to what causes prostate cancer, but age, obesity and a lack of exercise are known risks.
Anyone with any concerns can speak to Prostate Cancer UK's specialist nurses on 0800 074 8383 or visit prostatecanceruk.Org
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