DEAR DR. ROACH: I am 88 years old and in good health except for a small stroke I had a year ago with no lingering deficiencies. I have had an enlarged prostate for most of my adult life, but a biopsy showed no cancer. I have had problems with urgency. I tried a medication, doxazosin, with poor results, if any. My last visit, they recommended nothing more than medication. Is removing the prostate not advisable because of my age? What's the reason they don't remove it completely? -- C.W.S.
ANSWER: Symptoms of an enlarged prostate in men without cancer are common, and the condition is called benign prostatic hypertrophy. BPH can be treated with either medication or surgery. For most men, medication works well. Saw palmetto is used by many men, but well-done trials have shown it to be no better than placebo. Medications like doxazosin, including tamsulosin (Flomax), often are the first ones tried and usually work pretty well, but finasteride (Proscar) and dutasteride (Avodart) are effective as well. A combination is probably most effective of all. However, even that doesn't work for some men.
The most common prostate surgery nowadays is a TURP (transurethral resection of the prostate). This is far less invasive and has fewer risks than the old open method, and generally has good results. However, as with any surgery, there is never a guarantee of success, and I have seen several men get worse after TURP, even though most get better.
Age in and of itself does not necessarily preclude surgery. However, a history of stroke does make surgery a bit more risky. I don't recommend surgery lightly, and since you haven't reported giving finasteride or dutasteride a chance, either alone or in combination, I would recommend a good trial of those before contemplating surgery.
The booklet on prostate enlargement and prostate cancer deals with these common male problems in detail. Readers can order a copy by writing: Dr. Roach -- No. 1001W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. ROACH: My husband has numerous skin tags under both arms. Now he's starting to get them around his neck and on his eyelids. We've been told to tie a string around them, or a dermatologist he saw told him to get a good pair of cuticle scissors and cut them off, but there's way too many to do that. Is there anything else we might try? -- R.L.
ANSWER: Skin tags are benign growths that are very common on the neck, armpits, groin or other places where skin rubs. They are harmless, and nothing needs to be done about them unless they are cosmetically important. The best way to remove them is to have a dermatologist or other expert remove them directly. I don't recommend trying to remove them yourself with scissors, since I have occasionally seen them bleed enough after removal to require a stitch.
The last time I wrote about skin tags, several readers wrote to recommend Tag Away, an over-the counter product. It may be worth a try, although the reviews about this product are rather mixed.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.