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Urinary Symptoms

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How do you discriminate between BPH and PD as the cause of urinary symptoms in men?  I was diagnosed a few years ago with tremor dominant PD.  Parkinson's meds were ineffective for me, and a year and one half ago I had DBS (which controlled the tremor very well).  I am currently not on any PD meds.  I was put on Flomax by a urologist.  The Flomax gives me a stronger stream, but does little to reduce urinary urgency or incomplete voiding. 

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This is a tough one and sometimes impossible to know for sure which is PD and which BPH and it can be both.  Also, there are believe it or not physical therapy exercises that can help!

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Dr. Okun,

I also have BPH symptoms. For the past several years per my PCP, and my Urologist, I've been taking Flowmax, and 5mg Cialis every day, and everything has been great. Including my ED issues. Last September I had to change insurance carriers, (went from Premera Blue Cross to United Healthcare), and now United wants me to try a drug called "Finasteride", before they will approve the Cialis for me. Well I went to Drugs.com to see what this Finasteride" was, and the side effects scared the hell out of me.

1) according to my most recent Urology check up last September, my prostrate is just fine, no problems at all, and my BPH/ED symptoms are due to my PD. Yet according to what I read, Finasteride's" main purpose is to shrink the prostrate. How can it shrink a normal prostrate??


2) what scares me is that some of the main side effects of Finasteride" are:

More common

•Decreased interest in sexual intercourse
•inability to have or keep an erection
•loss in sexual ability, desire, drive, or performance

Then there's

•breast enlargement and tenderness 
•Clear or bloody discharge from the nipple
•dimpling of the breast skin
•inverted nipple

Postmarketing Experience

The following adverse reactions have been identified during post approval use of Finasteride. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure:

Hypersensitivity Reaction: hypersensitivity reactions such as rash, pruritus, urticaria, and angioedema (including swelling of the lips, tongue, throat, and face);

Reproductive System: sexual dysfunction that continued after discontinuation of treatment, including erectile dysfunction, libido disorders, ejaculation disorders, and orgasm disorders; male infertility and/or poor seminal quality (normalization or improvement of seminal quality has been reported after discontinuation of Finasteride); testicular pain. [see Adverse Reactions (6.1).]

Neoplasms: male breast cancer;

Breast disorders: breast tenderness and enlargement;

Nervous System/Psychiatric: depression


Also there is this..... FYI I am 56 years of age, and my last check in Sept.? My Dr. did a digital exam and my prostrate was NORMAL, and my PSA was well within normal limits.


Increased Risk of High-Grade Prostate Cancer with 5α-Reductase Inhibitors

Men aged 55 and over with a normal digital rectal examination and PSA ≤3.0 ng/mL at baseline taking Finasteride 5 mg/day (5 times the dose of Finasteride 1 mg) in the 7-year Prostate Cancer Prevention Trial (PCPT) had an increased risk of Gleason score 8 to 10 prostate cancer (Finasteride 1.8% vs placebo 1.1%). [see Adverse Reactions (6.1). ] Similar results were observed in a 4-year placebo-controlled clinical trial with another 5α-reductase inhibitor (dutasteride, AVODART) (1% dutasteride vs 0.5% placebo). 5α-reductase inhibitors may increase the risk of development of high-grade prostate cancer. Whether the effect of 5α-reductase inhibitors to reduce prostate volume, or study-related factors, impacted the results of these studies has not been established



So, what do YOU think??? I think the insurance co. is off base............


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I will post this for you, but I have no expertise on this drug or prorate cancer.  I am so sorry.

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