Dr. Roach: Less-invasive procedures can help with prostate symptoms

Dear Dr. Roach: I am a 71-year-old male in good health with an enlarged prostate. I can’t stand going to the bathroom six times a night anymore. I tried prescription medications and didn’t like the side effects; they don’t work for me. What is the safest surgical method to correct this?

— J.M.

Dear J.M.: For many years, the most common and effective surgical treatment for men with an enlarged prostate has been the transurethral resection of the prostate (TURP). However, there are now many options of less-invasive procedures with reduced likelihood of side effects, including laser, heat, cold and microwave treatments. I don’t have the expertise to recommend one over another, and in my own practice, I refer patients to an experienced urologist who has expertise in one or more of these newer procedures.

I do want to emphasize that none of them offer a guarantee. Surgical treatments work very well for most people, but I still see men who are worse off after surgery than before they started, although that is quite uncommon.

Dear Dr. Roach: You recently wrote about the need for progesterone to reduce the risk of uterine cancer when treating women with estrogen. What is it about adding progesterone to hormone replacement therapy that dramatically reduces the risk of uterine cancer?

— H.R.

Dear H.R.: The effect of estrogen on the lining of the uterus is to increase the thickness of the lining and get it ready for a fertilized egg. If there isn’t a fertilized egg, estradiol levels normally decrease, while progesterone levels increase. Progesterone inhibits cell growth and promotes differentiation of the cells.

Women who menstruate almost never get uterine cancer because the progesterone is very effective at stopping cancer cells from developing, causing any that do develop to die through a process called apoptosis. Unfortunately, progesterone alone is ineffective as a treatment for advanced endometrial cancer.

In women treated with estrogen, such as women in menopause with symptoms of hot flashes, progesterone is very effective at preventing uterine cancer. It should be used to treat women who receive systemic estrogen, unless they have undergone removal of their uterus.

Dear Dr. Roach: I am a 74-year-old Caucasian male. I am not on a blood thinner, but I am taking amlodipine for blood pressure and Trelegy to control symptoms of chronic obstructive pulmonary disease. My forearms and hands bruise very easily, and the skin on my forearms is very thin and prone to tearing with even slight physical abrasion.

Over the years, I have spent a considerable amount of time outdoors, resulting in frequent sun exposure to my arms and hands. Is there any topical treatment or supplement that would help reduce the frequent bruising?

— A.R.

Dear A.R.: Solar purpura is a very common condition in older, lighter-skinned individuals where the skin bruises and even tears easily. As its name suggests, it is due to cumulative sun damage to the area.

A few years ago, a supplement made from citrus bioflavonoids was found to be effective at helping heal the lesions of solar purpura. I suspect a diet high in citrus and other fresh fruits and vegetables would be effective, but bioflavinoid supplements are inexpensive. Some experts use prescription vitamin A derivatives. You can see a dermatologist for an expert opinion.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.