Dr. Keith Roach
Dear Dr. Roach: I was diagnosed with an enlarged prostate two months ago. I thought I had to pass another kidney stone, but my urethra was completely blocked. I went home from the emergency room with a catheter in place for two weeks. My urologist prescribed finasteride and alfuzosin 5 mg.
I spend the winter in Florida and my Florida urologist told me not to use finasteride because it doesn’t work. I’m currently torn between prescriptions. As an expert, what do you think about taking finasteride?
— DT
Dear DT: Urologists in Florida are too opinionated. Studies clearly show that finasteride (Proscar), like its cousin dutasteride (Avodart), is effective in treating enlarged prostates. There is strong evidence that they shrink the prostate, slow the progression of prostate enlargement, improve symptoms, and reduce the need for surgery, all of which are good things. It also reduces the risk of prostate cancer, with an estimated 25% to 50% reduction in the relative risk of developing prostate cancer.
What’s true, and what urologists really mean, is that these drugs work very slowly. This is about half the effect that can be obtained with six months of treatment. This is in contrast to alpha blockers like alfuzosin, which are effective from the day they are taken.
Many urologists prescribe both classes of drugs to men who are at high risk of not responding to alpha blockers alone. The fact that there was complete occlusion seems to support the prescription of finasteride, and the sooner it is started, the sooner the effect will be seen. Although this decision requires clinical judgment, the data usually support the initial urologist’s decision.
Dear Dr. Roach: In recent weeks, there has been a lot of news about disposing of black utensils due to flame retardants and other chemicals. They say that 85% of black dishes and pots can have this problem. My husband and I are both in our early 80s and in good health. Should this really be a concern?
— EM
Dear EM: Research was published in October showing that many household items made from black plastic are contaminated with flame retardants. The authors noted that these are often made from recycled materials, some of which contain large amounts of flame-retardant chemicals.
Some of these chemicals have health concerns, such as increasing cancer risk, disrupting hormones, and potentially causing developmental problems in children. Although these chemicals are largely banned, they are still recycled and reused. The study did not provide an estimate of how large the risk would be, but the levels it found are certainly above recommendations.
I often see studies where negligible risks are unreasonably exaggerated in the press. This may be something similar. However, it is not difficult to reduce the risk, so it makes sense to replace the black plastic products you use every day with safer ones such as metal, wood, bamboo or silicone. I did that.
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