Preventive treatment for prostate cancer?
DEAR DR. DONOHUE: I just learned of a new feature of finasteride (Proscar). It is likely that it is a deterrent for prostate cancer. It has been used for enlarged prostate glands. I have had an enlarged gland for three decades, but two biopsies found no cancer. I urinate more frequently than when I was 40, but I handle it. I phoned my urologist. His nurse said that unless I was having urinary problems, he wouldn’t prescribe it. I then phoned my GP, whose nurse said that I should make a formal appointment to talk it over with him. How should I proceed? — B.R.
ANSWER: About five years ago, the news of finasteride’s potential for preventing prostate cancer first broke. The story goes like this: The male hormone testosterone is responsible for many male attributes, like larger bones and bigger muscles. A body enzyme, 5-alpha reductase, converts some of the hormone to another hormone, dihydrotestosterone, DHT. This testosterone byproduct enlarges the prostate gland.
Finasteride blunts the action of the reductase enzyme, with a resulting shrinkage of the prostate. That’s the reason for which the drug was originally marketed — reducing the size of a big gland. In addition to gland shrinkage, it reduces the cancer rate by 25 percent. The original study on cancer prevention, however, suggested that it might cause a more-aggressive form of prostate cancer in a few, so enthusiasm for its use as a preventative waned.
Recent re-examination of the original information demonstrated that the threat of finasteride’s promoting more-aggressive cancer in a few is not on solid ground. With this information, the American Urological Association and the American Society of Clinical Oncology have stated that finasteride has a place in prostate cancer prevention for some men. One example is a man with a family history of this cancer.
Certainly discuss the value of finasteride with your doctors. They’ll help you decide if it’s a drug for you.
The booklet on the prostate gland discusses both prostate enlargement and prostate cancer. To obtain a copy, write: 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 a cousin who has AIDS. You wouldn’t know it. He looks the picture of health. I talk with his sister often, and she speaks of his T-cell count. She says it’s good. What does that mean? — R.C.
ANSWER: Your cousin is infected with HIV (human immunodeficiency virus), but he doesn’t have AIDS. AIDS indicates that the virus has weakened the body’s defenses so much that the infected person has come down with other life-threatening infections, or certain cancers. With today’s medicine, most HIV-infected patients can count on an active life with close to normal life span.
T-cells are lymphocytes, one of the white blood cells that fight infection. HIV depletes the body of T-cells. A normal T-cell count indicates that the body still has a robust defense against the deadly infections that were once so common in this illness.
DEAR DR. DONOHUE: I had been on birth-control pills for four years or more. I stopped because my husband and I would like to have another child. We’ve been trying for seven months, and I am still not pregnant. Did four years of pill use make me infertile? — B.W.
ANSWER: Infertility is defined as not becoming pregnant after one full year of trying. After discontinuing the birth-control pill, many women’s periods are not normal for the first three months. Deduct those three months from your seven months of trying to conceive, and you really have only four months of trying. You should wait another eight months before beginning an investigation for infertility.
Experts have answered this question for us. They tell us that birth-control pills do not lead to infertility. Your chances for a successful pregnancy are very good.
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.