Discussion: Aging male athletes: think twice before taking Flomax

As an aging old fart, I have symptoms of a big prostate, or BPH (benign prostatic hypertrophy). You all know the symptoms if you watch any TV at all: nocturia, frequency, hesitancy, slow stream and urgency. I saw my doctor, and he suggested I take an alpha blocker, which blocks the effects of norepinephrine on smooth muscle. Since many of the symptoms of prostatism are thought to be related to muscle spasm around the urethra, the alpha blockers help keep the muscle relaxed. However, they also relax other smooth muscles, which are found in the wall of arteries. In fact, these drugs were first developed for and still are used for hypertension. Initially I was placed on Hytrin, but it didn't seem to be helping my symptoms much, so my urologist recommended Flomax, which is supposed to be more "prostate specific" and not have as much effect on the arteries. I started that, and Proscar, which is another drug that works differently in that it actually shrinks the prostate, and thus relieves the symptoms of prostatic obstruction. However, it takes about 6 months before Proscar reaches its full effectiveness. (It also has been reported in one large series that it cuts down the incidence of prostate cancer by 30%).



I chose the medication route, because I didn't think I was symptomatic enough for a surgical procedure. Also, since there is a reported 18 % morbidity with these procedures, including incontinence and stricture, I decided to postpone any surgery as long as possible. The other alternative, herbs, such as saw palmetto, have shown to have no statistically significant difference in relieving symptoms when compared to a placebo.



So in October, I started taking the 2 drugs. My symptoms improved somewhat, particularly the decreased urgency and nocturia. However, I noticed that I really could not run very well. In fact, to call it running would be very generous. It's hardly a jog, and more of a slog. I attributed this to just getting old, but after a while, it seemed like I suddenly declined very fast. I have a 7.1 km run that I do frequently. Prior to going on Flomax, I would run it in 41-46 minutes. Recently, I couldn't break 50 minutes, and the last time it was 52:25. Plus I felt horrible, both during the run and afterwards. I had no energy, and could not run hills at all, and I used to be a fairly good hill runner. It was no fun running anymore, so I decreased the frequency of running, and took to walking. Plus I was getting beat in orienteering by people whom I have almost always bested. I have even had trouble finishing some of the recent brown courses.



So I decided that I would stop the Flomax, and see if it had any effect on my exercise tolerance. I usually do a spin class at the gym most Saturdays, and frequently, I had to sit down before the end of a song. Last Saturday, I was able to finish every song. And yesterday I did my 7.1 k run in 47:10 minutes, 5 minutes faster than 2 weeks ago. Plus it was fun again.



So, if you consider yourself an athlete (and I still do since I do a sport, I train for it, and I put a lot of effort when I compete), and are an older male with prostatic symptoms, consider twice before taking an alpha blocker, or plan on doing it only for a short while before the Proscar can kick in.



I wrote my urologist that I had stopped taking the Flomax and why, and he said he has heard that story before.

Interesting.
Okay. I am 54, a marathoner (for 39 years now) and was diagnosed with prostate cancer last year. I have some of the symptoms you describe.
I chose, partly because I am married to a younger woman, to try to the "watchful waiting" route and also be very proactive with any natural 'cures' and lifestyle changes I could do.
My PSA dropped from 4.7 at diagnosis, to 2.6 six months later. Symptoms were also negligible.
What did I do....
quit coffee
cut back, way back on beer. (still drink wine)
take many supplements a day (more on this later)
REFUSED surgery and pharmaceuticals.
eliminated dairy! (look at the correlation ~ prostate disease and dairy consumption.)

It's easy to just tell the doc to "cut it out!" but the route I am taking allows me to enjoy a normal sex life, avoid peeing my pants, and be healthier to boot. I'm not arrogant enough to say unequivically that this will "cure" my cancer, but I think it is the best route (you orienteerers may relate to that) to health.
Read Roger Mason's "The Natural Prostate Cure" for info on supplements. It really works guys.

You're talking about 2 different things: prostate cancer and BENIGN prostatic hypertrophy (BPH). I was only discussing the obstructive symptoms of BPH.

Evan..and tolvo54, congratulations on becoming "proactive" patients. I think every person needs to question diagnoses, and research these urological dilemmas. Quality of Life is an important consideration for us, and not often considered by docs eager to apply their brand of "cure." So you must be brave enough to reject their proffered treatment, and go your own way, into difficult and confusing terrain, as it were. Hardly a new experience for orienteers.

Evan, if you are going to stop Flomax, how will you address your BPH symptoms...slowness, urgency, nocturia, and possibly urinary retention? Have you ever measured your retention by catheterization? I don't think those ultrasound devices are accurate, compared with cathing.

I too went through the same reasoning, with Uroxatral, another alpha-blocker similar to Flomax. And came to the same conclusion...stop taking it. But my urologist is not happy with me...says I'm jeopardizing the health and function of my kidneys and bladder. Proscar (Avodart) has successfully reduced the size of my prostate, but has not alleviated my BPH symptoms.

Tolvo54 thanks for the recommendation of Roger Mason's book. Cutting out beer, potatoes, tomatoes, and many other common foods seems pretty extreme; have you been successful in adopting his diet completely?

Evan: True, but some suffer from both maladies. My prostate is larger than average and I had most of the symptoms of BPH. Diet can affect BPH symptoms as well. I certainly notice the negative changess if I let coffee and beer slip back into my life.
Chitown: I take some of what Mason writes with a grain of salt. He's somewhat of a nut really. But he is a trained chemist, and has some good success stories. I don't buy his ideas on the "nightshade" foods. I was a vegetarian prior to my diagnosis, and have subsequently become a vegan. I don't feel that it's extreme. I enjoy my food, my half-bottle of red wine most nights. But I do indulge in too many sweets probably. So, no...I am not a born-again Masonite, but the changes I have adopted have certainly helped keep the PSA down, and the symptoms of an enlarged prostate at bay.

Clark,

Since probably 95% or so of American men over 65 don't exercise, and since many have prostatic symptoms, it is not unreasonable for physicians to prescribe a drug that relieves those symptoms for a lot of that population. It probably won't affect their ability to point the remote at the TV.

Since I do ultrasound, I tend to disagree with your assessment that an ultrasound evaluation of the estimated amount of residual urine is not reliable. Admittedly, it is not as accurate as catherization, but a cath is an invasive procedure, uncomfortable, and as with all medical procedures, prone to have some, although small, risk. If it is a matter of 10 ml, 50 ml, or 250 ml residual urine, I think ultrasound can give a reasonable estimate.

My current symptons are under control with the Proscar, now that it has taken effect. However, should I go into urinary retention (can't urinate and have to be catherized) or develop hydronephrosis (blockage of the renal collecting systems with back up of urine due to obstruction of the ureters) and decreased urinary function, I would have a surgical procedure. Or if the symptoms become intolerable, such as having urgency every hour or having to get up 4 or so times a night, then I would have a procedure.

If your urinary function has decreased (as measured by a blood creatinine level) and it is due to hydronephrois caused by blockage of the ureters by an enlarged prostate, I definitely would have a procedure. I knew a pathologist who kept watching his creatinine rise, and finally he had a renal ultrasound, with 4 plus hydronephrosis and a bladder that went up to his umbilicus, probably over 500 ml residual. He finally had a TUR. I think that is waiting too long.