Prostate Problems

Last September 2002, after a long time (well more than a year, maybe two, I'd guess) of increasingly uncomfortable and worsening urination problems (frequency, *URGENCY* ¹ ), I went to a Urologist. You all know the drill, several blood tests over a month or two - high/rising PSA ^2a (s)- 5-6+ area, digital exam(s), ("56%" chance of cancer with all these indicators"), biopsy ^2b (in November), diagnosed Benign HyperPlasia ³ (got really lucky there), followup exam 2-3 months later (February)- no change except PSA higher (over 6). "We'll just have to keep an eye on it. Come back in 3 months"

In early June 2003 the digital exam took an EXCEPTIONALLY long time and getting really uncomfortable I was just about to say something when he pulled his finger out. "Mr. Lovgren, I don't know how to tell you this but your prostate is perfectly normal. In size and in smoothness. No need to come back for another year."

I was stunned. And from his tone and attitude, he seemed to be too. Some small talk, I mentioned how much I had changed or added to my diet which he *seemed* to dismiss. Really I was not prepared to go further asking more questions, I was so taken aback.

Afterwards, I realized just how much the urination problem really had subsided. The immediate urgency had pretty much disappeared (not unusual to be able to wait 15 minutes to half hour, or even more, after first urge if I wanted to now). No more having to stop in the car, urinating in a bottle on even short 15-20 minute trips). Sleeping through the night, *maybe* only having to get up once, instead of the 5-6 times like before.

I often drink a lot of water (not gallons but probably a couple quarts in a day) ⁴ . After the November biopsy, in February 2003 with a pad/pen in the bathroom I kept track of how many times I went. It was not unusual to have to go 4 or 5 times in a hour over a 3 day period if I was drinking a lot of water. Even once an hour or more during the night, despite not drinking much water before going to bed. I don't have to to recount to anyone with prostate problems what it's like. Going out anywhere was an adventure that had to be well "planned" in advance. - Nothing to drink for hours beforehand, were bathrooms readily available and convenient?, nothing to drink while out, ....

I really hadn't noticed the changes (improvements) in urination patterns as they were gradual, just like the onset of this whole business (which I suspect was taking place over a couple years).

At this point, it's important, even critical, to understand this Uro is a (maybe even "the") top man in the area where I live (within 75 miles or so of NYC). He's in a practice with 4 other uros and I've known him (and of him) for over 30 years. He took care of my father. His father was a uro. This is a doctor (surgeon) of considerable experience, wide background, impeccable integrity and untarnished reputation within and outside the medical community. Any chances of his making a misdiagnosis of my condition from the start is, in my well considered opinion, nil.

Okay, what had happened? In December 2002 (week or so after biopsy results) my wife and I had gone to see a talk on nutrition (sponsored by a drug company and the American Cancer Society) given by Dr. Gary Mowat(?). Len Dawson (Football Hall of Fame Quarterback of the Kansas City Chiefs) was also a speaker (about being a PC survivor). Anyway, Dr. Mowat was VERY interesting (Dawson wasn't so bad either). My wife took something like 12 pages of notes, an unusual occurrence in itself. He talked about nutritional effects on the body of various foods, vitamins, etc. and what the literature shows.

Three things that stuck out in my mind were licopene (in tomatoes and other red fruits), orange juice and flax seed. So, of course, I started mugging up on them. Always liked tomatoes and just luckily we had a lot in the freezer (we had gotten from a farmer friend the previous summer) my wife had made sauces with a food processor.

Flax seed we found in a health food store. (Flax seed is about the size of fine pencil leads maybe a half inch long.) Sprinkled it on top of salads and sandwiches, probably between a teaspoon and a tablespoon a day (when I can remember). Ain't a whole lot of flavor to it, but it does add texture.

Okay, all well and good. Couple or three months eating a lot of the tomatoes, flax, oj, vitamins, ... and I don't notice any real improvement. There may have been some since I did the 3 day measurement in February 2003 but it was not marked. Sometime in April (as I recall), we were in our local Price Club (CostCO) and I noticed Flax Seed Oil Gels (NatureMade - 200 gels in bottle) for $10. Picked up a bottle. Couldn't hurt, right?

Took one gel a day along with other pills ⁵ . Never really noticed any improvement in urination problems but obviously there was. I just didn't fully realize it until the prostate exam on June 1, 2003. Urination is not like something one constantly thinks about. Just something that has to be taken care of when the urge arises. (What WAS in my mind, of course, was "When is this going to be cancer?").

Later in June 2003 I wote a letter to the doctor (as my next exam wasn't scheduled until June 2004) asking the following four questions (He responded in July):

• Question 1: Is it an uncommon thing for the prostate to return to normal, as it did in my case? If so, how unusual?

  Doctor's Response: "... As far as common or uncommon for the prostate to improve, usually it requires some kind of theapy to improve. However there are a lot of other factors which are unknown such as herbal therapies, emotional stress, and psychological factors that cannot be quantified. Therefore in answer to your question yes it is normal. As far as it being common, it is just not rare. It is mildly common if I can use that phrase."

  Q2: Is it uncommon for the urination problems I experienced to go away? If so, how unusual?

  Response: " ... the urinary problems similar to the above issue, usually related to the prostate which is under the control of hormonal factors, extrinsic factors such as diet, medications, herbs and emotions."

  Q3: If my prostate had remained enlarged, would that have increased the likelihood of future prostate cancer? And if so, how much?

  Response: "... the statistics relating to the size of the prostate related to cancer are really the same through all of the degrees, from small to large prostate. Therefore that should not be an issue."

  Q4: Is it very likely there was some other agent other than diet involved in the return to normal of the prostate?

  Response: "... diet is one of many factors involved with sensitivity of the prostate."

• 2004 - June - Yearly Checkup at Uro showed a PSA count of 5 (was over 6). Protate was normal.
• 2005 - May - Yearly check of PSA is 6.7.
  
  Uro in June said "Everything fine. Elevated PSA is not worrisome at this point. Could be a result of exertion or exercise (not in my case), difficult bowel movement (possibility), or sexual intercourse (possible, thanks to Levitra)."
  
  Have had several doctors looking up my ass since last year for as part of regular checkups (had a colonoscopy on recco by regular doctor as part of normal maintenance for a man my age - 66) and everything fine as far as they could tell. Presumably they would have felt an enlarged prostate.
  
  Do have occasional bouts of frequency/urgency but nothing like before.
• 2006 - July - PSA was up to 8 and Uro was concerned (from a low of 5.? up to 8 in 3 years). Thought it would be a good idea to have a biopsy. I declined (see reasons stated earlier). Otherwise condition is about as it had been. Maybe a little increased urination urgency but nothing too serious.
• 2006 - November - I think I will try some hot sauce a few times a week to see if it has any lowering effect on PSA next checkup (June 2007). (see "Capaicin & PCa" link on left). Nothing to lose.
• 2007 - July - You may recall, when I had my prostate exam last year, the uro reccoed a biopsy as my psa was up 50% or more in two years. I declined and he was clearly in disagreement. Even went so far as to inform my wife of his clear displeasure when she went to see him on another matter. (Remember I have a comfortable relationship with this doctor going back 35 years so and that probably prompted expressing his concern to my wife.)
  
  At any rate was back for my yearly this kinda dreading it as if psa was up again, I would have to make another unpleasant decision (either way, biopsy or no biopsy). He started off by mentioning how long we had been together ("You know Mr Lovgren, you are (one of) my oldest patients ..." which I figure was a prelim to getting to more serious stuff about how reckless I was being ...) I don't think he had seen the PSA results on the chart yet. DRE was normal (again) and PSA was down (8.6 last year to 7.5 this) and he was *very pleased*. We then had a long (for doctors) conversation about psa, etc. I told him I had read the study about capascin (stuff that makes peppers hot) reducing PSA (see sidebar for link), had been taking it several times a week since December and then bet him it would be lower yet next year. He was very interested and I send a copy of it to him.
  • Here is a summary in a medical history report I take to any doctor I go to any more (Note report also contains meds, family history, patient history, blood pressure readings, other stats, etc.):
  • Prostate biopsy Oct 2002 (Dr .....), negative,
    Diagnosed BHP which was alleviated With Flax Seed Oil capsules.
    Annual visits.  PSA counts:
    2002/09   4.9   DRE found enlarged prostate.
    2002/10   6.0   Had biopsy (negative) BHP diagnosed
    2003/03   5.6   DRE prostate still enlarged
    2003/06   ?.?   DRE normal again (after starting flaxseed oil)
    2004/05   4.8   DRE normal
    2005/05   6.7   DRE normal
    2006/06   8.6   DRE normal declined biopsy (strongly indicated) by doubling of PSA in 2 years.
    2007/06   7.5   DRE normal (had started using capsaicin In December '06 as a food seasoner 3-4 times a week).

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• The Taint - From an emailer - My problem is that dribble. And often a few drops more will squeeze out after I put it away. Embarrassing (to myself). Seldom visible to others (spots on pants) but humiliating nonetheless.
  
  The reply from another - Here's a $750 fix for the problem (what my Uro guy charged Aetna when he did a biopsy on me 9 years ago). I complained about the dribblies then also. Thought it was part of getting old.
  
  His suggestion - when finished, but before you put it away, press upward on your "taint" (taint this and it taint that), the area between your anus and your balls. That squeezes out the pee remaining in the plumbing like a sink trap. Works for me.

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• PVP Surgery - A new surgery to hollow out the prostate is coming into vogue (more info here. Also see link on left) that is being highly touted and sounds good. Here is an experience from a friend who had it:

  Date: Thu, 01 Sep 2005 18:14:52 -0400
  Subject: Re: PeeVPee?
  
  To: "G. H. Lovgren" <gosta @ SwedesDock.com>

  (At 06:39 09/01/05, I wrote to him:)

  What's the latest on the PVP saga? Any news?

  (His reply):

  • Week 1: Occasional blood in urine (from prostate). Comes and goes. No problem starting, but hurts (aches) at the end. Throat still sore from air tube installed during operation.
    
    Trick: To catch dribbles, wrap about a foot of toilet paper around it when done . . . a form of precision mini-diaper. Stays put until next time. (But . . . fell off during bowling, below).
    
    
  • Week 2: A lot less blood (only occasional), Still aches at end. Lasts about a minute. Was going to attempt to bowl, but decided at last minute not to (good thing).
    
    Week 3: Virtually no blood, easy to start, very tiny ache at end. Mowed lawn, bowled, no problem. Sat in dentist chair for 1 hour, no problem.
    
    Week 4: No blood (extremely tiny tint at start). Ache almost all gone. About 90% recovered. Bad news, now I have to go back to work (deferred home projects).
    & 
    
    Still haven't decided whether it was worth it or not. I'll save about $1k per year in Avodart pills (which I didn't want to take anyway). Basically, I can't pee any better (so far) but if it saves another trip to the emergency room at 2:00 AM (due to prostate infection which stopped flow), then it will be worth it. Dr. says prostate could grow back slowly in about 10 years, but by then I'll be 90, and may not care. He thought my prostate was actually about 150 gms (initial estimate 100 gms), and he may have removed about 50 gms.
    
    

    Note: Procedure was supposed to be one day, no catheter, but I was held over for an extra day with catheter installed. Removed next day. Bloody mess. Drove myself home that afternoon (99º weather). Operation causes frequent desire to pee, but getting better now, almost normal. The extra ache at end causes extra bowel movements, but that is getting better also.

  (Two months later: At 11/21/05, Update:)

  Question- Will this treatment reduce the frequency of my trips to the head.

  It might, but not for the first month. For that, you have to go more often, but I think that is true for most procedures. Right now, I'm back to more or less normal. Still have to get up at least once in the night however (age = 79).

  Is the procedure generally accepted in the medical industry?

  It's still fairly new, and most Urologists don't know much about it. My main doctor and my Urologist didn't know much about it at all, but my Urologist OKed it, as did my main Dr. I got my actual practitioner off of the Laserscope site, and took a chance with the 1st guy on the list (in Englewood hospital, figured should be OK). Operation was in Englewood hospital under full anesthesia. No pain afterward, except when I peed, then very uncomfortable when stopping (bladder spasms). Subsided in a few days. Not bad at all after a week or so - except for the "dribblies". I used to wrap a foot or so of toilet paper around it to catch them. Cheaper than diapers.

  Are most doctors trained to administer it?

  Very (relatively) few, actually. See the above.

  Find a DR here from the Laserscope list:

  
  http://www.laserscope.com/surgical/consumers/fad.php

  Additional info here:

  http://www.annieappleseedproject.org/greenligktpl.html
  http://www.valleymed.org/media/OtherNewsInfo.asp?id=148

  Conclusion: I was an early enthusiast for PVP when I first heard about it. I definitely didn't like the sound (side effects) of what I read about all the other procedures. The Laserscope site is overly optimistic about it however, as I experienced more blood than their videos show, but I would still recommend it over the others (unless your Dr knows better what to expect).

  Hope this helps. Good luck with what ever you do.

  PS - I just checked their Dr. list and it's pretty much the same as it was.

  PS2 - Here's a $750 tip for you (from my Urologist). When finished peeing, press upward on your "taint" (taint this and it taint that), halfway between your (balls) and your (asshole) - sorry for the language. It's like the trap under your sink, pushing up on it squeezes out what remains.

Notes -

• {1}Urination Urgency - If I got the urge, it HAD to be responded to immediately, and I mean minutes. Otherwise I'd be like that woman on tv (hoppping back and forth on one foot). I had often marveled at how it always seemed to be at the last second of holding back when I found a relief station (toilet, urinal or other, aaahh... "facility" - let's just say men have a lot more options than women in this regard). This was a condition that had been developing/worsening it seemed like for several years. (Twice in recent years I just couldn't hold it the few seconds more it would have taken me to get to a facility.) (Return)

• {2a} - PSA - Prostate Specific Antigen - A substance created by the Prostate thought to be an indicator for cancer. Presence of PSA in the blood is NOT PROOF of cancer, only an indicator of the possibility. Nor is it a precursor for cancer. In some men it occurs naturally, and other times it can be as a result of a prostate infection (like a cold say). (Return)

• {2b} Biopsy - A biopsy (as I'm sure you know) is a small nip of the suspected cancer area that is then lab tested for malignancy. While not pleasant, a prostate biopsy isn't all that bad. Go to sleep and then wake up. A few slightly uncomfortable days, a little blood in the urine and stool and that's it.

  However, after reading up (and thinking) quite a bit on this prostate business I'm not so sure, at my age (over 60), I'd have another biopsy. Prostate Cancer is pretty slow growing and it's not likely to be fatal, or even be manifested in any major discomfort (not counting the urinary problems mentioned above, which were a pita but not intolerable), for many years.

  What my concern with a biopsy is that if a cancer area is found and is nipped, some cancer cells will escape into the blood stream and quickly spread to other areas. Whereas if no biopsy had been taken, it might (I think probably) be many years before it spreads from the prostate.

  Now this is strictly conjecture on my part but it seems to me that more than a few men are diagnosed with Prostate Cancer (PCa) and soon die (often in excurciating pain) shortly (less than a year or two) thereafter (the cancer has metastasized to other areas of the body). A prostate operation leaves a guy in pretty sad shape for a long time and it's not a price I think I am willing to pay.

  Lots of PC survivors (who have had Radical Prostectemies (RP)) will disagree vehemently and I don't blame them but it's not something I think I want to go through at my age. And if that's the case (not having an RP or something similarly unpleasant), there's no sense having a biopsy which may (and in my opinion almost certainly) accelerate the cancer in the first place.

  Now all that said, it's a easy position to take when one does not have to actually make a decision. (Return)

• {3} - Begnign HyperPlasia -

  "Benign" is non harmful. (Though if you have it, it's not exactly "harmless" - see American Prostate Society link on the left.)

  "HyperPlasia" is a swelling of an organ (or tissue too I think) caused by the growth in size of the cells of the organ. An analogy would be like muscles growing in size as a result of use (like weightlifing for example).

  There is another type of swelling called "HyperTrophia" which is caused by addtional cells being added to the organ. An analogy would be blowing up a balloon (more air - "cells" - are being added). (Return)

• {4} Water consumption - We all know water is good for you. One gets constant and continual reminders of that from all sorts of health "authorities". What sold it for me though, is I read a few years ago that water is an almost perfect solvent. Almost everything will mix with water. So most of the time, I drink water in place of milk/tea/coffee/soda/... in the theory it will dilute/wash out whatever toxics build up in the system.

  We have those Britta Water Purifiers and keep them filled with tap water. After a short while, for me anyway, it became the preferred beverage. And on top of that, I was able to cut my BP medicine in half (10 mg minoxidyl once a day instead of twice). Note - Minoxidyl is a Stage 3 BP med and is only used in the most persistent and difficult of cases (One in several 1,000 according to the druggist and my doctor). And keeps my BP almost "perfect" ("Perfect"" is considered 120/80), usually around 130 over 80, plus or minus a few points, which is quite remarkable given my almost 20 year struggle with high blood pressure. (I had a major debilitating stroke in 1985.)

  I used to drink a lot of iced tea (a powdered brand) every day. (I'm talking pitchers here.) It may well be the BP improvement I saw was a result of the reduction of tea intake. My cousin recently advised me his doctor told him that high tea intake could be the reason for his circulatory problems (aches in legs, etc.). Since he cut it out the pains have eased considerably. (Return)

• {5} Pills I take every day - Vitamin E gel, multi-vitamin (Centrum A-Z), 81 mg aspirin tablet, the flaxseed gel, a fish oil gel, a pericolase derivative pill (a mild constipation easer). Plus doctor prescribed blood pressure meds (10 mg minoxidyl, 10 mg Corguard). (Return)

  I drink probably 16 oz Calcium fortified OJ (almost) every day as well. Another thing Dr. Mowat said was especially good. (High pulp, I like the pulp.) Calcium is a critical factor in the body, not just the bones, and is something worth looking into elsewhere. (Return)