Book Review | Health and Prostate

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What is the best medical treatment for BPH?

Posted by admin on March 7th, 2010 No Comments

Lepor H, Williford WO, Barry MJ, Brawer MK, Dixon CU. The efficacy of terazosin, finasteride or both in benign prostate hyperplasia. N Engl J Med 1996; 335:533-9. Research question There are two main types of medications for the treatment of benign prostate hyperplasia (BPH): the first are α-adrenergic-antagonist drugs (eg, terazosin) that relax the smooth muscle in the prostate and the second are 5-α-reductase inhibitors (eg, finasteride) that block formation of dihydrotestosterone and thereby shrink the prostate. Which works better? Does a combination of the two drugs work best? Type of article and design Randomized, controlled trial of therapy. Relevance to family physicians In the last few years you could hardly open a medical journal without being bombarded with information about finasteride (Proscar). Many of us were using terazosin (Hytrin) also to treat BPH patients who had symptoms or were tired of "watchful waiting." Terazosin is cheaper, is covered on most provincial formularies, and works faster, but we often wondered which drug was more effective and whether a combination Read more [...]

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Private Parts. An Owner’s Guide to the Male Anatomy

Posted by admin on January 24th, 2010 No Comments

Yosh Taguchi McClelland & Stewart Inc, Suite 900, 481 University Ave, Toronto, ON M5G 2E9 1996/320 pp Strengths Easy to read, no-nonsense language, mostly accurate information Weaknesses Not always strongly evidence-based, sometimes too much emphasis on surgery, not patient-centred This is Dr Taguchi's second and updated edition of his "Canadian bestseller" first published in 1988. He is a well-known Montreal urologist who says he wrote this as "... the answer to all those questions I have ever been asked... in my office." Further, as it says on the jacket, "Most men know more about their cars than about the workings of their own bodies." Many family physicians would agree. This book is a cleanly laid out, how-to manual for men who want to know more about their genitourinary system. The first chapter deals with basic anatomy and functions. The rest covers various problem areas, such as impotence (when will the medical establishment call this erectile dysfunction?), infertility, vasectomy, lumps, prostate problems, sexually transmitted diseases, and incontinence. The information Read more [...]

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Review: Benign Prostatic Hypertrophy

Posted by admin on December 31st, 2009 No Comments

Finasteride reduced symptoms and need for surgery for benign prostatic hypertrophy. Commentator, Barry, M. Massachusetts General Hospital, Boston, MA, USA. Evidence-based Medicine, 3(4): 107, July/Aug. 1998. The following article is briefly presented The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. McConnel, J., Bruskewitz, R., Walsh, P. et al. N Engl J Med, 338: 557-563, 26 Feb. 1998. This was a 4-year randomized double-blind placebo-controlled trial involving around 3000 men who had BPH with moderate to severe lower urinary tract symptoms, decreased maximal urine flow rates and an enlarged prostate. They were randomized to receive either finasteride at 5 mg/day or placebo for 4 years. The authors found the following: • Those who had received finasteride had significantly greater decreases in symptom scores. Significantly fewer men in the finasteride group had surgery or acute urine retention. •There was a significantly higher incidence of side effects in the finasteride group. Commentary The Read more [...]

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Prostate Cancer

Posted by admin on December 30th, 2009 No Comments

Editorial - Controversy in managing patients with prostate cancer. Mulley, A. and Barry, M. General Medical Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. BMJ, 316(7149): 19219-19220, 27 June 1998. and Dilemmas in treating early prostate cancer: the evidence and a questionnaire survey of consultant urologists in the United Kingdom. Donovan, J., Frankel, S., Faulkner, A., Selley, S., Gillat, E. and Hamdy, F. Department of Social Medicine, University of Bristol, Bristol, UK. BNU, 318(7179): 299-300, 30 Jan. 1999. The effectiveness of radical treatments (prostatectomy and radiotherapy) for prostate cancer over conservative management (surveillance plus hormonal therapy if required) is debatable. Also, quality of life after radical treatment may be poor compared with conservative management. Because of this lack of evidence, controversy still remains over the best form of treatment. Two surveys of British urologists (Savage asked 274 urologists, Br J Urol, 1997; Donovan asked 244 urologists, BMJ, Jan. 1999), found that most favoured active treatment Read more [...]

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Collection of papers on urinary incontinence

Posted by admin on December 28th, 2009 No Comments

Urinary Incontinence in the Elderly. Pharmacotherapy Treatment Editor: James W. Cooper The Haworth Press, Inc, 10 Alice St, Binghamton, NY 13904-1580 USA 1997, 72 pp Overall Rating Good Strengths Comprehensive, current, useful information Weakness Information is difficult to access, is in table format, and is in small print Audience Family physicians, other health care providers, and caregivers Urinary Incontinence in the Elderly is not so much a textbook as it is a collection of papers dealing with different aspects of urinary incontinence (UI). As such, the articles might be useful to different audiences. For physicians whose practices primarily involve the elderly, either in the office or in long-term care settings, this book has many excellent features. There is a comprehensive overview of the risk factors, clinical evaluation, and treatment of urinary incontinence. This information is presented primarily in table format. Although the title suggests only pharmacologie treatment, other management options, such as behavioural interventions and surgical treatments, Read more [...]

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Cancer therapy for some

Posted by admin on December 22nd, 2009 No Comments

, 2nd Ed Authors: Malin Dollinger, Ernest H. Rosenbaum, Greg Cable Editor: Richard Hasselback Somerville House Books limited, 3080 Yonge St, Suite 5000, Toronto, ON M4N 3N1 1995, 706 pp Overall Rating Good Strengths A good overview of cancer care for health professionals from a psychosocial, technical, and medical perspective. Forty-seven common cancers are concisely described in the last part of the book Weaknesses Content varies greatly in technical complexity, making it difficult reading for general readers. The book implies that it is accessible to everyone but remains a resource for health professionals Audience Health professionals, including family physicians, nurses, interns, residents, and medical students. Those very knowledgeable in health science could be a secondary audience I anticipated the opportunity to read this book because of my clinical care of people living with cancer, and more recently, my contact with family members living with cancer. The book is divided into five parts: diagnosis and treatment; supportive care; quality of life; new advances Read more [...]

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A Prostate Problem. Benign Prostatic Hyperplasia: A Physician’s Guide To Care And Counselling

Posted by admin on November 28th, 2009 No Comments

J. Curtis Nickel; Richard W. Norman Grosvenor House Press Inc, King West Centre, 2 PardeeAve, Suite 203, Toronto, 0NM6K3H5. Available through the Canadian Medical Association, PO Box 8650, 1867 Alta Vista, Ottawa, ON K1G 0G8, 1993, 88 pp This attractive softcover manual is part of the Canadian Medical Association's Disease Management / Patient Counselling series. Written by two urologists, the chapters, though short, cover essential material in enough depth that readers do not feel shortchanged or patronized. References are sufficient and up-to-date, and the text is well written, well organized, well presented, and well illustrated. Topics covered include the definition, pathology, pathophysiology, and natural history of benign prostatic hyperplasia. Symptoms and signs are lucidly explained. Investigative procedures that are sometimes necessary are explained, but needless investigations are discouraged. A variety of therapeutic options are described, including "watchful waiting"; medical therapy with α-adrenergic blockers, such as terazosin; 5-alpha reductase inhibitors, such as finasteride; Read more [...]

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