Understanding and treating urinary problems in aging men PROSTATE HEALTH

August 30, 1994|By Linell Smith | Linell Smith,Sun Staff Writer

Baltimore Colts football legend Johnny Unitas will launch a national program tomorrow to inform men about benign prostate enlargement, a noncancerous condition that eventually affects most men over the age of 60.

The 61-year-old former quarterback, who is being treated for the condition, is spokesman for "The Partnership for Prostate Health," a project organized by the Prostate Health Council, the National Council on Aging and various prostate health centers. It is paid for by Merck & Co. Inc., which manufactures Proscar, a drug that treats the condition.

Mr. Unitas discovered his prostate was enlarged after talking to his physician about his increasing tendency to urinate frequently at night. He is following a course of "watchful waiting," seeing his doctor every three months to discuss any change in symptoms.

"I had no idea that my urinary problems were caused by prostate enlargement or that I could do something about them," he has said about his condition. "I've learned first-hand that there's no reason to let fear or embarrassment keep you from getting medical attention that can keep you healthy."

The most common symptoms of this disease are problems with urinating such as sudden, uncontrollable urges to urinate, getting up to urinate frequently at night, feeling as if the bladder has not emptied, difficulty in beginning to urinate, and a slow or weak urinary stream.

Complications can include urinary tract infections, sudden inability to urinate and gradual bladder and kidney damage.

Benign prostate enlargement, also known as benign prostate hyperplasia, is caused by aging and hormones. There is nothing men can do to prevent it. The prostate is a walnut-sized gland just below the bladder and makes the fluid that carries sperm. The gland wraps around the urethra, the tube that conducts urine from the bladder through the penis. Through aging, the prostate can become larger than normal, squeezing a man's urinary tube until it eventually blocks the flow of urine.

The chances of developing prostate trouble increase as men age; the disease rarely occurs in men younger than 50. More than half of men over the age of 60 are affected by benign prostate enlargement. An estimated seven million men in the United States show urinary symptoms now, according to the Prostate Health Council. However, only some men with actual symptoms require treatment.

The first step in treating the problem involves educating men to realize they have the condition, physicians say.

"A lot of men are fearful of mentioning urination problems to their doctor because they are afraid it might be prostate cancer," says Dr. Michael Naslund, director of the Prostate Center of the University of Maryland Medical Center who is working as a spokesman with Mr. Unitas.

Although it usually causes no symptoms in its earliest, most treatable stages, prostate cancer may cause urinary symptoms in its later stages. Every year, roughly 35,000 men in the United States die from prostate cancer and 200,000 new cases are diagnosed.

"Older men don't want to admit vulnerability, to admit that something may be wrong with them," says Dr. Naslund. "But it's not in a man's interest to worry about his urination difficulties and not find out what's wrong."

For most men, benign prostate enlargement is not about pain, but about altering their lifestyle, says Dr. Naslund. "And it's a condition that the patient and physician have to talk about: Men can't really diagnose it themselves."

Treatments for the condition range from "watchful waiting" to surgery. Surgery offers the best chance for relieving symptoms, but also the greatest risk for complications, according to the Agency for Health Care Policy and Research of the U.S. Department of Health and Human Services. (For a copy of its booklet on benign prostate enlargement, call toll-free [800] 358-9295.)

According to patient guidelines issued recently by the federal agency, men with benign prostate enlargement can consider these treatment options:

* Watchful waiting: If symptoms are not too troublesome, men can schedule regular exams to monitor the condition. Some physicians may suggest consuming fewer liquids before going to bed and eliminating over-the-counter cold and sinus medicines with decongestants, which can worsen a prostate condition. Without treatment, the condition may get better, stay the same or get worse.

* Alpha blocker drug treatment: These drugs are taken by mouth once or twice a day to help relax muscles in the prostate. Although some men will notice urinary symptoms improve, there is no evidence that alpha blockers reduce the rate of prostate enlargement complications or the need for future surgery. Potential side effects include headaches as well as feeling dizzy, lightheaded or tired. Because this treatment is new, doctors do not know its long-term effects. Currently, terazosin (Hytrin) is the only alpha blocker approved for prostate enlargement treatment the Food and Drug Administration.

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