DEAR DR. ROACH: I am taking terazosin and finasteride for my enlarged prostate. A friend has suggested taking zinc supplements and eating pumpkin seeds for additional zinc intake. Is there any proof that taking additional zinc will reduce the size of the prostate? — K.O.

ANSWER: There are some theoretical reasons, based on animal studies and benchtop research, as to why zinc might reduce the size of the prostate and even reduce the risk of prostate cancer. However, the clinical studies that have been done have not yet shown a reduction in risk, decrease in prostate size, or improvement in symptoms from taking zinc supplements or pumpkin seed oil. Further, I have seen a dramatic case of zinc overdose from zinc supplements, causing a copper deficiency with severe effects on the man who took the excess doses of supplements. Taking 100% of the recommended zinc levels won’t hurt you, but probably won’t help either.

The combination of terazosin and similar drugs (called alpha blockers) with finasteride (which blocks a form of testosterone that enlarges the prostate, as well as causes hair loss) is usually pretty effective. In men who aren’t getting adequate responses, I recommend a visit with a urologist to be sure that the problem is really the prostate and not the bladder. In men with proven prostate enlargement causing symptoms despite medication, it’s time to consider surgical therapies, of which there are many.

DEAR DR. ROACH: I am 62 and have had a golf-ball-sized lipoma sitting on my upper right arm near my shoulder for about three years now. It is squishy and feels like rubber under my skin. However, it is now beginning to hurt in the area. I would like to have it removed. Should I go to a surgeon or dermatologist?

I am right-handed. Will surgery affect the use of my right arm? — G.B.

ANSWER: I recommend leaving a lipoma, a common benign fatty tumor, alone unless it is causing symptoms. In those less-common cases when they do cause symptoms, such as discomfort, I usually refer patients to a general surgeon, unless I am fortunate to have a dermatologic surgeon with expertise in this area. Some plastic surgeons also remove lipomas, especially in cosmetically important areas.

I have had several patients return from surgery with reports that the surgery was much more complex and difficult than they expected. If the lipoma is attached to underlying tissues, the surgery can be technically challenging. These experiences have made me even more circumspect about recommending surgery for lipomas.

DR. ROACH WRITES: A recent column on nightmares with statin drugs generated many letters noting similar experiences. Most writers noted this potential side effect with atorvastatin or simvastatin, which are “lipophilic,” meaning they can cross into the brain (and are more likely to have the additional side effect of memory loss), as opposed to the “hydrophilic” statin drugs, like pravastatin and rosuvastatin (Crestor).

One writer noted that the nightmares went away with switching atorvastatin (Lipitor) from nighttime to morning. Cholesterol synthesis happens mostly at nighttime, which is why statins are recommended at night. But this is much less important with longer-acting statins like Lipitor and Crestor than with shorter-acting ones like simvastatin (Zocor).

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 or send mail to 628 Virginia Dr., Orlando, FL 32803.

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