CONVERSATIONS WITH CHATGPT ABOUT PROSTATE ISSUES By Alan Silverstein, ajs@frii.com Last update: April 4, 2023 For whatever it's worth, here are some questions and answers, plus [comments] inserted, about prostate issues, that I put to ChatGPT in March, 2023. Bear in mind that today's AIs are often confidently wrong in their responses! --- > What are the parts of the male prostate? The male prostate is composed of two main parts: the peripheral zone (PZ) and the central zone (CZ) [incomplete]. The PZ is the larger portion of the prostate, accounting for roughly 75% of its total volume. It surrounds the urethra and is responsible for producing most of the seminal fluid. The CZ is the smaller portion of the prostate, accounting for roughly 25% of its total volume. It lies immediately adjacent to the bladder neck and contains the prostatic ducts, which secrete prostate fluid. > Difference between prostate central and transition zones. The central zone (CZ) of the prostate is the smaller portion of the prostate, accounting for roughly 25% of its total volume. It lies immediately adjacent to the bladder neck and contains the prostatic ducts, which secrete prostate fluid. The transition zone (TZ) [so now there's a third zone?] is a thin band of tissue that lies between the CZ and the peripheral zone (PZ). It is responsible for producing most of the seminal fluid and is more susceptible to the development of benign prostatic hyperplasia (BPH) than the other two zones. The TZ is much less active than the PZ and does not enlarge with age as the PZ does... [???] > Which part of the prostate enlarges with BPH? The transition zone (TZ) of the prostate is the most susceptible to the development of benign prostatic hyperplasia (BPH). This is because the TZ is much less active than the peripheral zone (PZ) and does not enlarge with age as the PZ does. Therefore, when the prostate enlarges due to BPH, it is usually the TZ that is affected... [Say what?] > What do you know about post finasteride syndrome? Post-finasteride syndrome (PFS) is a condition that can occur after taking the drug finasteride. Finasteride is commonly used to treat benign prostatic hyperplasia (BPH) and male pattern baldness. Symptoms of PFS can include erectile dysfunction, decreased libido, depression, anxiety, fatigue, and cognitive impairment. PFS is not well understood, and the cause is not known. Treatment typically involves a combination of medications, lifestyle changes, and counseling. > Why does the prostate continue to grow, after initially shrinking, > while on finasteride long-term? The exact cause of why the prostate continues to grow, after initially shrinking, while on finasteride long-term is not known. However, it is thought that the hormone dihydrotestosterone (DHT) may be partly responsible. DHT is a metabolite of testosterone and is believed to be involved in the growth of the prostate, even when finasteride is taken. Therefore, it is possible that DHT can still affect the prostate, even after finasteride is taken, leading to continued prostate growth. [OK I know finasteride, unlike dutasteride, although equally effective, only blocks ~91% of DHT conversion, in the prostate only, meaning some should remain as an additional trigger. But then why is there any initial shrinkage? Maybe the prostate adapts to the lower DHT level, or some tissue shrinks while other increases?] > What fraction of HoLEP surgery patients have negative outcomes? It is estimated that approximately 7-10% of patients who undergo holmium laser enucleation of the prostate (HoLEP) surgery have negative outcomes. These negative outcomes can include decreased urine flow, urinary incontinence, and urinary retention. While these complications are rare, it is important to discuss potential risks with a doctor prior to undergoing any surgical procedure. > Which portions of the prostate are removed by various transurethral > surgeries like TURP and HoLEP? Transurethral surgeries such as transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) both involve the removal of portions of the prostate. During TURP, the central and transition zones of the prostate are usually resected, while during HoLEP, the entire prostate is often removed. It is important to discuss the specifics of a particular procedure with a doctor prior to undergoing any surgical procedure. > How does TURP or HoLEP allow the urethra and other tubing in the > prostate to continue to connect, or rejoin, afterwards? After a transurethral surgery such as transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP), the urethra and other tubing in the prostate may be reattached using sutures or staples. This allows the urethra and other tubing to continue to connect and function properly after the surgery. > Why is HoLEP surgery so time-consuming? HoLEP surgery is time-consuming because it involves the precise cutting and removal of the entire prostate gland. This is done using a holmium laser, which is used to cut and remove the prostate tissue in small pieces. This is a very precise and delicate procedure, and requires a high level of skill and experience. Therefore, the procedure can take several hours to complete. > What are various tricks or methods to use during acute urinary > retention to drain the bladder without catheterization? Various tricks or methods to use during acute urinary retention to drain the bladder without catheterization include the Valsalva maneuver, Crede's maneuver, and the abdominal compression technique. The Valsalva maneuver involves bearing down as if trying to have a bowel movement, while Crede's maneuver involves putting pressure on the lower abdomen to encourage the bladder to contract. The abdominal compression technique involves pressing down on the abdomen with both hands to facilitate the expulsion of urine. It is important to speak with a doctor before attempting any of these techniques. > What causes occasional difficulty urinating at night in men with BPH > including vesicular protrusion? Occasional difficulty urinating at night in men with benign prostatic hyperplasia (BPH) is commonly caused by vesicular protrusion. This is when the enlarged prostate presses against the bladder wall [huh? I thought some of the lobes protruded INTO the bladder], making it difficult for the bladder to empty completely. This can lead to a feeling of needing to urinate during the night, even though the bladder is not full. Other causes of difficulty urinating at night can include urinary tract infections, bladder stones, or bladder tumors. > Do hyperplastic prostate median and lateral lobes grow only out of the > transition zone? No, hyperplastic prostate median and lateral lobes can grow out of both the transition zone and the peripheral zone. The transition zone is the most active area of the prostate and is where most BPH occurs, but there are cases in which the peripheral zone is also affected. It is important to speak to a doctor to determine which zone is affected in order to receive the most appropriate treatment. > Does the prostate transition zone really start at just 5% of the total > 20-25cc in a young male, but almost all growth occurs there, so a > large prostate, like 150cc, is nearly all transition zone? No, the transition zone does not necessarily start at 5% of the total volume of the prostate in a young male. The transition zone typically accounts for 10-15% of the total volume of the prostate, but this can vary depending on the individual. Additionally, the transition zone does not necessarily account for all of the growth of a large prostate, such as one that is 150cc in size. In some cases, the peripheral zone can also contribute to the growth of the prostate. > How does full prostatectomy allow the urethra to reconnect between the > bladder and sphincter? After a full prostatectomy, the urethra is reattached between the bladder and sphincter using sutures or staples. This allows the urethra to reconnect and function properly after the surgery. > Is it that tamsulosin loses effectiveness, or that the prostate just > grows more, even on finasteride? If so, which parts, how, and how > fast? How much warning would I get before full relapse? Tamsulosin can lose effectiveness over time as the prostate continues to grow, even when finasteride is taken. This is due to the hormone dihydrotestosterone (DHT) which is a metabolite of testosterone and believed to be involved in the growth of the prostate, even when finasteride is taken. The growth of the prostate can occur in the peripheral zone and transition zone, and can occur at a rate of several millimeters per year. If tamsulosin loses effectiveness, it is important to speak to a doctor to discuss other treatment options. [Didn't answer my question about warning before relapse.] > Is it safe to even consider cutting or stopping tamsulosin while > staying on finasteride? It is not generally recommended to cut or stop taking tamsulosin while staying on finasteride, as tamsulosin can help to reduce symptoms associated with benign prostatic hyperplasia (BPH). Tamsulosin helps to relax the smooth muscle of the prostate and bladder neck, which can reduce urinary symptoms. Finasteride can help to reduce the size of the prostate, but it cannot reduce the symptoms associated with BPH. Therefore, it is important to speak to a doctor before considering cutting or stopping tamsulosin. > How accurate, precise, and repeatable are prostate size measurements > via TRUS, MRI, etc? Prostate size measurements via transrectal ultrasound (TRUS), magnetic resonance imaging (MRI), and other imaging techniques are generally very accurate and precise. The accuracy of the measurements can depend on the imaging technique used, as well as the experience of the person performing the imaging. However, prostate size measurements are typically repeatable and reliable. [Odd, this disagrees with some anecdotal postings in Facebook prostate groups, where men report very different sizes from different methods or somewhat different times.] > Is tamsulosin linked to kidney cancer? Tamsulosin is not linked to kidney cancer, but it has been linked to an increased risk of prostate cancer. In some cases, tamsulosin can cause the prostate to enlarge and this can lead to an increased risk of prostate cancer. It is important to discuss the potential risks with a doctor prior to taking any medication. [But I read that the cancer risk has been rebutted by later studies!] > Trabeculations, cellules, distension: I see authoritative but > conflicting information on bladder distension healing, some saying it > never improves, others that it takes varying amounts of time. Can my > bladder recover completely? Is it worth doing urodynamics (later) to > check status? Could any problems be healed? It is possible for bladder distension to improve over time, but it can vary from person to person. Urodynamics testing can be used to assess the current status of the bladder and determine if any issues can be treated or improved. This testing can also help to identify any underlying causes of bladder distension, such as trabeculations, cellules, or other abnormalities. It is important to speak to a doctor to discuss the best course of action. [Not a very helpful answer.] > What causes bladder trabeculations? Bladder trabeculations are a medical condition characterized by the thickening and hardening of the bladder wall due to the formation of ridges or folds called trabeculae. The condition is often associated with chronic bladder outlet obstruction, which can occur due to a variety of reasons, including prostate enlargement, bladder neck stenosis, or urethral stricture. [My BPH caused these, and I saw them during cytoscopy.] Chronic bladder outlet obstruction can cause the bladder muscle to hypertrophy or thicken over time as it works harder to empty the bladder. This can lead to the formation of trabeculae, which are essentially muscle bundles that bulge out into the bladder lumen. The trabeculae can be seen on imaging studies such as ultrasound or cystoscopy, and can cause symptoms such as urinary frequency, urgency, and incontinence. Bladder trabeculations can also be associated with other conditions, such as neurogenic bladder, chronic urinary tract infections, or bladder cancer. In some cases, bladder trabeculations may not cause any symptoms or require treatment, but in more severe cases, treatment may include medications to relax the bladder muscles, surgery to remove obstructions or repair the bladder wall, or other interventions to manage symptoms and prevent complications. > If bicycling doesn't cause acute urinary retention that night, and > doesn't make protrusion worse, why worry about a special bike seat, or > "pressure on prostate"? Although bicycling does not typically cause acute urinary retention or worsen prostate protrusion, there are still potential risks [like what?] associated with riding a bicycle. A special bike seat can help to reduce the amount of pressure on the prostate, as can wearing padded shorts. Additionally, it is important to take frequent breaks from riding to reduce the risk of developing any issues related to pressure on the prostate. > What are the potential prostate risks associated with riding a > bicycle? The potential prostate risks associated with riding a bicycle include pressure on the prostate, urinary tract infections, and erectile dysfunction. Pressure on the prostate can cause discomfort and even pain, while urinary tract infections can lead to pain, burning, and even blood in the urine. Erectile dysfunction can also occur due to pressure on the prostate, as well as due to a decrease in blood flow to the penis. It is important to take frequent breaks when riding a bicycle to reduce the risk of developing any of these issues. [Since I don't seem to have any of these problems from frequent biking, nor any correlation to difficulty voiding, I don't worry about it.] > Why does kidney output vary so greatly from one night to the next? There are several factors that can influence the output of the kidneys from one night to the next, including: Fluid intake: The amount of fluid a person drinks throughout the day can have a significant impact on their urine output. If a person drinks more fluids, their kidneys will produce more urine to remove the excess fluid from the body. Hormonal fluctuations: Hormones such as antidiuretic hormone (ADH) and aldosterone play a key role in regulating the body's fluid balance. Fluctuations in these hormones can cause changes in urine output. Medications: Some medications, such as diuretics, can increase urine output by promoting the excretion of excess fluid from the body. Health conditions: Certain health conditions, such as diabetes and kidney disease, can affect the functioning of the kidneys and lead to changes in urine output. Exercise: Physical activity can increase fluid loss through sweating, which can lead to a decrease in urine output. Overall, the variation in kidney output from one night to the next is likely due to a combination of these and other factors, and may not necessarily be a cause for concern unless there are other symptoms or health issues present.