Discussion: Athletes and Flomax with BPH

I've been a runner for 20+ years and ran a 10K today after starting Flomax 2 weeks ago. This is in addition to the proscar I've been taking. After reading the thread posted back in 2009 by a few guys, I'm convinced the cardiovascular effect of this drug will make you feel lousy. The previous 2 weeks I attributed my sluggishness training to a minor cold but today on race day, I feel good but my time was 6-7 minutes slower than usual and even had to walk a couple times to recoup. I never had to walk. I'm only 53 and diagnosed with BPH 4 years ago. I'm in the medical arena so I have a good grasp as to what the cardiovascular effects have with this drug. Athletes beware!

Sorry you're having to deal with Benign Prostatic Hyperplasia at such a young age. I too took Flomax (Tamsulosin), but it made me light-headed. So I stopped after a couple of months despite my urologist's urging. Rx'ing Flomax seems like a knee-jerk reaction sometimes; I think many guys incorrectly end up on Flomax for years when there are other, less toxic options that should be tried first.

BTW there may be better forums than a/p to discuss this problem. I learned a lot from other guys on a BPH-specific forum. But ultimately I had to research, study, experiment...become a pro-active patient. And then make my own decisions.

A couple of alternatives to relieve the symptoms of BPH you may wish to research: pumpkin seed oil, beta sitosterol, Bell's Prostate Ezee-flow Tea, a different alpha-blocker such as Uroxatral, prostate-specific formulations such as those from LEF, reducing your weight and getting your Body Mass Index down around 20, avoiding certain foods.

I've found some of these have worked for me. I no longer take Flomax. And my urologist is happy...at least as happy as urologists ever get. But I still run slowly. Good luck.

There may be better places to learn about the details of Flomax side effects, but I'm still grateful for the posting. As older athletes, we present differently than the general population.

I've been told that I might benefit from Flomax and was holding off, more out of a wary approach to drug taking in general, but particularly with a drug I'd have to take longterm. This has me redoubling my scepticism and my determination to make an informed decision. Time to spend more time consulting Dr. Internet.

Well don't wait too long to confront this problem. Urinary retention causes damage to the bladder, and may cause urine to back up into the ureters (connect kidneys with bladder) and the kidneys themselves, causing decreased function or even failure. Then dialysis and a kidney transplant are needed to stay alive.

You're right, many men (and their doctors) are completely unaware of developing urinary problems, which will affect half of all men by the age of 60. So men over 50 should periodically determine their IPSS - International Prostate Symptom Score, which is a quick method to monitor the health of your urinary tract. Any result above 7 on the test is reason to be concerned. More information from the American Urological Assn can be downloaded here.

Please note that I am not a doctor. This is just my opinion, based upon several years of dealing with BPH.

Thanks for your responses. Flomax did make me feel lightheaded, dull headaches and decreased exercise tolerance. I went on it because I was getting up more frequently in the night. I know there are dietary effects and I should explore that more. My IPSS is at 6 now and I am aware of the detrimental effects and this is why I'm trying to be proactive. This is a genetic problem and a couple of my family members taken care of it with surgery (greenlight laser and TURP) at an age less than 60. My Urologist isn't buying surgery yet but I surely don't want to wait until I develop more problems. Any opinions on TURP vs Greenlight laser?

I, too, was on Flomax for about 6 months, and couldn't figure out why my performance really plummeted. People who I always beat were passing me like I was standing still. I finally told my urologist my symptoms, and he said that wasn't that unusual. The problem in the US is that many elderly men are fat and don't exercise at all except to point the remote at the TV. For anybody who likes to exercise, and particularly compete, it is a drug to be avoided in my opinion. It is an alpha blocker, which is also used to treat hypertension, and acts by dilating the arteries, which lowers blood pressure, but the converse is that one can't increase the cardiac output necessary to run. I started using finasteride (Proscar) which actually shrinks the size of the prostate and for me eradicated my urinary symptoms. I can now sleep all night without having to get up to pee, and I no longer have urgency. However, it takes about 6 months to have its full effect, and for some mne, can cause decrease in libido and cause erectile dysfunction. I thought I was going to have to have some type of surgical procedure, but since my symptoms have gone away, I no longer am considering that option.

I agree with you totally about Flomax effects on exercise performance. I'm also on Proscar for about a year now and yes it has helped but I guess I was expecting more. I think I might explore other options like previously suggested by an earlier reply. I spoke with a physician that's into vitamins and he spoke highly about "Purity Products". He swears by them so that's one avenue and another of course is nutritional. I'm not overweight although my BMI is 27 and I'm 5'6" tall and 165 lbs. If I was a BMI of 20 I'm not sure if anyone would see me when standing side ways. Does anyone else take supplements (OTC) that they feel really helps? I guess the jury is out. Like medicines doctors order, everyone may respond differently.

What about Avodart (dutasteride)? Is that about the same as Proscar (finasteride)?

Never thought there was a difference but I guess there is a slight difference after looking them up. Brand names vs generic are a big difference in price with my insurance. That's probably the reason most are being prescribed Proscar.

Yes but if you order through our friends in Canada, you can get a generic dutasteride (Avodart) which most guys prefer over Proscar.

Avodart is a dual 5alpha-reductase inhibitor for the treatment of benign prostatic hyperplasia. Avodart differs from finasteride [Proscar] as it inhibits both isoenzymes of 5alpha-reductase and results in near-complete suppression of serum dihydro-testosterone. Similar to finasteride, Avodart reduces serum prostatic specific antigen by approximately 50% at 6 months and total prostate volume by 25% in 2 years.

Randomised, placebo-controlled trials conducted over 2 years have shown the efficacy of Avodart in symptomatic relief, and peak urinary flow rate, and reduction of acute urinary retention events and the need for surgery. The main Avodart side effects are erectile dysfunction, decreased libido, gynacomastia [man boobs] and ejaculation disorders.

Canada is an option. I'll see what my Urologist has to say and go from there. Can you direct me to where it's stated that Avodart is the preferred med? What is your (chitownclark) status with BPH if you don't mind me asking? Any of those OTC vitamins/supplements really help you?

I don't think you're ever going to find any absolutes in the medical world...just trial results and theories, such as the above. Since Avodart causes nearly complete suppression of dihydro-testosterone (DHT) many guys prefer it. DHT as I understand it, acts like "super" testosterone. So suppressing it would reduce the symptoms of BPH...as well as Male Pattern Baldness. :-)

I don't really know which of the various supplements I take has helped my BPH. It is evident from recent studies that some very popular remedies such as Saw Palmetto have no merit.

My status? Even understanding how much BPH I might have from one year to the next is difficult without physical catheterization, and actually measuring the amount of fluid remaining in the bladder after voiding. The ultrasound units that doctors like to use, both belly and transrectal, render suspicious, contradictory results from my experience.

One way to monitor BPH is to actually measure the amount you're able to void when you really have to go. Keep a measuring cup or a graduated beaker by the toilet and try to fill it up several times. Establish a "maximum volume" baseline, and then see how that might decline over the years as your frequency, urgency, and retention increase.

Clark, I think your last method of determing the degree of BPH is probably fallacious. What your want to evaluate is the amount of "residual urine following voiding", not total bladder capacity. As a general rule, the worse the BPH, the greater the residual urine. As a means to compensate, the bladder enlarges (it is a muscular organ, similar to the uterus, and can greatly increase in size) and frequently, men with severe BPH will have large residual urine volumes and also huge bladder capacities. I have seen bladders that come up to the umbilicus, similar in size to a pregnant uterus. So trying to measure bladder capacity as a measure of severity of BPH is not particularly helpful. Symptomatology is more significant. If you have to urinate 3 or 4 times a night, or even every hour, is a better guage of how to evaluate severity. The BPH Symptom Score, http://men.webmd.com/enlarged-prostate-your-bph-sy...,
is a simple screening test, frequently used by urologists, to give a quick evaluation of the severity of BPH.

It seems like Clark is saying to measure absolute volumes "when you really have to go", and then observe the trend of that data. He is measuring bladder capacity because it's the only convenient value that can be measured this way, but his intent is to observe any deviation from that "normal" volume, indicating retained volume.

Or that's how I read his comment.

I could appreciate what you're saying because I recently started a diary of how many times I go and how much comes out. Not surprised to see that my 24 hour frequency was 10-15x's/day with anywhere from 50 to 100 mls each time. Urologist wants to do a scope/flow study. Maybe the prostate is obstructing the bladder neck and causing bladder spasms. I'm always trying to diagnose. Who knows--going out for a 5 mile run. Thanks

Absolutely correct cedarcreek. But of course Evan is correct too...for as far as he goes. I provided a link to that Int'l Prostate Symptom Score test above, and I've been tracking my score on the test for years. It has been up and down.

From my experience that score is waaaay too subjective. For instance, how do I really know if I "had the sensation of not completely emptying..." Exactly what "sensation" is that? I've had a lot of "sensations" down there over the years...but not completely emptying is not one with which I'm familiar. So on a given day, I can attain a "Symptom Score" anywhere between 7 and 15, depending upon my mood.

You're kind of over a barrel with BPH. It is an insidious problem that creeps up on all of us men over the years. Doctors are slow to concern themselves with BPH...has your annual checkup ever really assessed urinary symptoms? There are few tests and little research in this area; spending on urinary issues and prostate cancer research is only a small fraction of what is spent on breast cancer. In fact, the medical world seems to be in a state of complete disorder regarding men's urinary problems. Just today there was front-page news in the NYTimes that seems to reverse everything we've been told:

Healthy men should no longer receive a P.S.A. blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided...

Complete confusion! If you are concerned about your whole urinary tract, IMO you should continue to get PSA tests...and yes, continue to monitor your BPH symptoms as best as you can. And for me, I want more than those "symptom scores."

Evan may be correct, that voiding volume has no relevance to worsening BPH. Maybe it is a little boy's thing. But it is the only absolute I can measure. And finding I can still expel 500-600ml gives me pleasure...and peace of mind.

The PSA test controversy is really difficult. Nobody wants to die of an early or unnecessary cancer, and if there is a test that may indicate an early stage of cancer and allow treatment that might prevent an early death, initially it seems like a no brainer to have your PSA tested. However, the problem is that prostate cancer is an extremely vairable disease. Certainly there are prostate cancers that kill, but there are also an extremely large number of slow growing, indolent prostate cancers that most men will die with, not because of. The problem is that at this time we can't distinguish which ones are going to be the killers, and if we test, biopsy and treat every prostate cancer, certainly there will be a lot of relatively benign prostate cancers that are treated but would not have caused any problem in the man's life. Since I am almost 71, I have been debating whether to continue to have my PSA tested, and with the proposed recommendation, probably will stop. My PSA has always been low, I am taking finestaride which supposedly lowers the incidence of prostate cancer by 30%, and the prostate cancers found in older men tend to be the more indolent type. People tend to forget that there is a risk in doing a test, because if it is positive, then further evaluation has to be done, including possible biopsy. A prostate biopsy is relatively benign, but it is uncomfortable, and there is a risk or a complication: bleeding, infection, perforation of blladder or rectum, etc. Then if it is positive, what do you do? Surgery, external beam radiation, seed, hormones, castration, watchful waiting. Certainly they more aggressive therapies carry risk: incontinence, ED, diarrhea, bleeding, infection, perforation of an organ, anesthetic complication. And then maybe it wasn't necessary. Certainly the studies are now showing that testing for PSA does not prolong life. The decision is not easy.