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Dear Dr. Roach: What’s your opinion on cooled thermotherapy for benign enlargement of the prostate? I recently was put on Flomax and finasteride, and was given the option of having this procedure to eliminate taking these two drugs.

My urologist has had great success, while my internist says the success rate is only 60 percent. My internist did say it’s great if it works.

S.V.

Dear S.V.: Benign enlargement of the prostate is very common in older men, and medications like tamsolusin (Flomax) and finasteride (Proscar) often are used, and are pretty effective in most men. The most effective treatment remains surgery, called transurethral resection of the prostate, TURP, which reduces symptoms by at least half in 98 percent of men. Unfortunately, TURP causes side effects in at least 20 percent of men, so there are several procedures designed to try to get the benefit of surgery without the drawbacks.

Cooled thermotherapy is a procedure using a microwave device to reduce prostate tissue. It isn’t as effective as TURP: Only 72 percent of men reduce their symptoms by half or more; however, it has reduced side effects, such as need for blood transfusion. Unfortunately, there were more symptoms of uncomfortable urination, urgency and need for a catheter after surgery.

I think both of your doctors are right: Some men have good experiences, but not everyone will get relief. Some serious side effects are better with thermotherapy, and others are worse. You need to decide how much taking the medications bothers you and if you can live with the symptoms the way they are.

Dear Dr. Roach: I am 68 years old, and will be having bypass surgery soon. After my surgery, will L-arginine be good for my heart? I know I will be walking every day.

G.J.S.

Dear G.J.S.: L-arginine, an amino acid, has been shown to increase nitric oxide in blood vessels of people with high blood cholesterol and blockages in their arteries. There are two studies I know of that showed no effect from arginine on blood flow or inflammation. On the other hand, one study showed that supplements of arginine, along with phytoestrogens, B vitamins and vitamins C and E (as part of a medical nutrition bar) in people with angina improved some blood flow measurements and the ability to exercise on the treadmill. It also has been shown to have some benefits in people with heart failure.

Based on these studies, I don’t recommend arginine after cardiac bypass surgery. However, there may some benefit, and since it is unlikely to be harmful, I wouldn’t try to dissuade someone who wanted to give it a try.

Email questions to ToYourGoodHealth@med.cornell.edu.

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