Dear Dr. Roach: I am a 71-yearold male in good health with an enlarged prostate. I can’t stand going to the bathroom six times a night anymore.

I tried prescription medications and didn’t like the side effects; they don’t work for me. What is the safest surgical method to correct this? — J.M.

Answer: For many years, the most common and effective surgical treatment for men with an enlarged prostate has been the transurethral resection of the prostate (TURP). However, there are now many options of less-invasive procedures with reduced likelihood of side effects, including laser, heat, cold and microwave treatments. I don’t have the expertise to recommend one over another, and in my own practice, I refer patients to an experienced urologist who has expertise in one or more of these newer procedures.

I do want to emphasize that none of them offer a guarantee.

Surgical treatments work very well for most people, but I still see men who are worse off after surgery than before they started, although that is quite uncommon.

Dear Dr. Roach: You recently wrote about the need for progesterone to reduce the risk of uterine cancer when treating women with estrogen.

What is it about adding progesterone to hormone replacement therapy that dramatically reduces the risk of uterine cancer? — H.R.

Answer: The effect of estrogen on the lining of the uterus is to increase the thickness of the lining and get it ready for a fertilized egg. If there isn’t a fertilized egg, estradiol levels normally decrease, while progesterone levels increase. Progesterone inhibits cell growth and promotes differentiation of the cells.

Women who menstruate almost never get uterine cancer because the progesterone is very effective at stopping cancer cells from developing, causing any that do develop to die through a process called apoptosis.

In women treated with estrogen, such as women in menopause with symptoms of hot flashes, progesterone is very effective at preventing uterine cancer.