БРОНХИАЛЬНАЯ АСТМА – BRONCHIAL ASTHMA

Chronic Bacterial Prostatitis is also caused by bacteria, and is treated by antimicrobial drugs. It can be a recurring illness, coming back periodically for years after an initial episode of acute bacterial prostatitis. Its symptoms include: Difficult, frequent, urgent, burning or painful urination; and pain in one or more of these sites—the lower back, perineum (the area between the rectum and scrotum), penis, scrotum, and pubic region. A doctor might suspect that a patient has chronic bacterial prostatitis when a urine test shows bacteria in the absence of any other symptoms (although other problems, such as infected kidney stones, also might show up in this way). The symptoms of chronic bacterial prostatitis usually don’t manifest themselves until sufficient amounts of bacteria have built up.

Chronic bacterial prostatitis is one of the most common causes of a repeated urinary tract infection in men, as the same bacteria tend to be involved in both problems. The disease is linked so intrinsically with urinary tract infections that many doctors believe that if you don’t have a urinary tract infection, and if you’ve never had one, you probably don’t have chronic bacterial prostatitis. One reason the situation remains chronic is that, even though the urine becomes free of bacteria and the symptoms of a urinary tract infection go away after treatment, the bacteria persist in the prostate because many antibiotics are not as effective there; these drugs do not diffuse well in the prostatic tissue.

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The good news is that,/or most men, surgery for BPH has no effect on sexual function or performance. One aftereffect of prostatectomy that may take some getting used to is a phenomenon called «dry,» or retrograde, ejaculation. It’s pretty much what it sounds like— semen is not expelled out the urethra when a man reaches sexual climax. Instead, it goes the other way—back into the bladder. This happens because part of the bladder neck is usually resected along with the prostate tissue, so the bladder neck does not contract at the time of ejaculation—and there’s nothing to prevent semen from heading in that direction. For most men, this does not alter the pleasant sensation of orgasm. Also, having semen in the bladder does no harm; it is eliminated from the body the next time a man urinates.

This «dry» ejaculation is the most common sexual side effect, and it has nothing to do with a man’s ability to have an erection or to reach a sexual climax. If you are not planning to father children, this is nothing to worry about.

Some 10 to 15 percent of men who have BPH surgery report problems with impotence, or difficulty with erections. Even this does not have to be a permanent problem. There are many options to help men with impotence (see Chapter 8), now more than ever before.

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A BAD COMBINATION: DIFFERENT CELL TYPES, PLUS TIGHTENING MUSCLE

BPH involves different kinds of cells, and their growth seems to be stimulated by many factors. (This is frustrating for researchers seeking treatment for BPH, because what works on one group of cells may have little effect on another.)

BPH is not merely a matter of prostate cells on the rampage; the problem involves two kinds of tissue. One is glandular tissue, made up of epithelial cells, which secrete fluid that becomes part of the semen. The other is smooth muscle tissue, made up of stromal cells, which contract automatically to launch these secretions out of the prostate and into the urethra. This is the same kind of tissue found in the walls of the intestines and in blood vessels; the actions of this tissue are involuntary responses to signals from the nervous system. Because this dynamic, nerve-rich tissue is easily stimulated, it seems to be set off by the glandular cell build-up in BPH, and it responds with varying degrees of tension. So, together, these prostate cells act as a «double whammy» on the urethra: As the glandular tissue enlarges and begins to clog the urethra, the smooth muscle tissue tightens, and clamps the urethra.

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Radiation to the prostate is aimed at a specific, limited area—the prostate and surrounding tissue. Therefore, frankly, radiation isn’t going to have any effect on the cancer cells growing outside this targeted area. Nor will hormone therapy cure this advanced prostate cancer; at this point, it simply isn’t good enough to eliminate all the cancer cells growing outside the prostate. Also, unfortunately, at present there is no effective form of chemotherapy able to achieve this vital goal, either.

At the writing of this book, there is not any form of treatment that will eliminate all the cancerous cells once the cancer has reached the lymph nodes.

And so, again, the big, tough question: What should you do? Although all these forms of treatment may be necessary someday, we believe that taking any of these steps now will not prolong your life. (And conversely, not taking them now will not shorten your life.) All that will happen, if you begin these forms of treatment now, is that your quality of life will be disrupted.

For these reasons, we believe that men in this situation should opt for watchful waiting now. This decision of watchful waiting may be one of the hardest you’ll ever have to make, but remember: Watchful waiting doesn’t mean being passive. It means treating specific symptoms if and when they arise. In this case, watchful waiting should also mean that your doctor will monitor your health very carefully and that you will have a physical examination, including a digital rectal exam, PSA, and serum creatinine tests, every three to six months, as well as a bone scan every six to twelve months.

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Results, too, vary widely, depending on such factors as the stage and grade of tumors, the length of time after treatment a patient is followed, and the criteria used to define cancer control. Many studies just look at results of prostate biopsies—not incorporating other important signs that something is wrong with the prostate, like a lump that can be felt in a digital rectal exam, or symptoms of urinary obstruction (from a tumor that is large enough to disrupt urinary flow), or changes in PSA or acid phosphatase levels. It’s significant that the best results for cancer control—a zero percent failure rate in some cases— generally come from the studies with the shortest follow-up time. How can an eighteen-month study possibly be as thorough, or ultimately helpful, as a ten-year study?

One long-term study predicted a local relapse rate (where cancer returns to the prostate or surrounding tissue) of 52 percent at fifteen years, with a failure rate during this time of about 11 percent a year. The average time it took for local recurrence to be diagnosed was nine years.

With external-beam radiation treatment, the five-year mark after treatment is a big milestone; in most cases, if cancer’s going to come back, it happens before then. But with interstitial brachytherapy, in a significant number of men cancer comes back after five years. In one study, for instance, only 57 percent of the men who ultimately would have a relapse were diagnosed within five years. In another study, it took at least six to eight years before half of the men experienced local relapse.

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