Fewer men are being given PSA tests to screen for prostate cancer. As screening rates have fallen, so have the number of prostate cancer diagnoses. This probably also means that fewer men are receiving potentially unnecessary treatment, with its attendant negative side effects. At the same time, it isn’t yet clear whether that comes at the cost of more aggressive cancers being caught at an incurable stage. Better screening tests may make the difference in helping strike the right balance between limiting harm and preventing prostate cancer deaths.
A new study confirms that active surveillance is a safe and reasonable alternative to immediate treatment for prostate cancer. In recently published study that followed 1,300 men, the prostate cancer survival rate after 10-15 years of active surveillance, was 99%. For some men, a strong discomfort with “living with cancer” may steer them away from postponing treatment in favor of careful monitoring.
Treatment decisions are complicated for men with low-risk prostate cancer that grows slowly. These cancers may never become deadly during a man’s expected lifespan. And there is no conclusive evidence showing that treatment in these cases extends survival. So cancer specialists have been leaning toward monitoring low-risk prostate cancer carefully and starting treatment only when it begins to spread. This approach was once used only in academic cancer centers, but new research suggests that this strategy is becoming more common in urology practices throughout the United States and other countries as well.
If you’re a man, you’ve undoubtedly heard that lack of energy or sex drive, trouble concentrating, or feeling down or not quite yourself could be related to low testosterone, or “low T” — and that a little testosterone replacement could have you back on your game. But testosterone replacement is tricky business, and its safety and effectiveness remain controversial. Further, there can be many other causes for the symptoms of “low T.” A thorough evaluation to determine whether low testosterone is really the problem, along with a careful weighing of the potential risks and benefits of testosterone replacement, are essential before considering this drug.
Is brain damage an inevitable consequence of American football, an avoidable risk of it, or neither? An editorial published yesterday in the medical journal BMJ poses those provocative questions. Chad Asplund, director of sports medicine at Georgia Regents University, and Thomas Best, professor and chair of sports medicine at Ohio State University, offer an overview of the unresolved connection between playing football and chronic traumatic encephalopathy, a type of gradually worsening brain damage caused by repeated mild brain injuries or concussions. The big question is whether playing football causes chronic traumatic encephalopathy or whether some people who play football already at higher risk for developing it. The Football Players Health Study at Harvard University hopes to provide a solid answer to that and other health issues that affect professional football players.
If your fingers turn ghostly white and numb when they get cold, you may have Raynaud’s syndrome (or disease or phenomenon). This common condition Raynaud’s is an exaggeration of the body’s normal response to cold. It usually affects fingers and toes, but may also affect the nose, lips, ears, and nipples. Named after the French physician who first described it in 1862, Raynaud’s is a problem in the body’s arteries. They spasm and collapse in response to cold or stress. Without a steady supply of warm blood circulating through them, the affected body part becomes pale. When the spasm ends and the arteries reopen, allowing blood to flow again, the finger, toe, or other body part turns pink or red. It may throb or tingle. Prevention—staying warm—is the best medicine. It’s possible to cut an attack short by running your hands under warm water, putting them in your arm pits, or waving your arms in circles to get the blood flowing. Other options include thermal feedback and relaxation techniques. More experimental options include Botox injections and sildenafil (Viagra).
“Replacing” a hormone the body normally makes when it is running low isn’t necessarily the safest thing to do. Women and their doctors learned this with estrogen after menopause. Now the FDA is sounding a warning that testosterone therapy can cause potentially dangerous blood clots in men. Such blood clots, called deep-vein thrombosis (DVT) and pulmonary embolism kill as many as 180,000 Americans each year, more than the number of people who die from breast, prostate, colon, and skin cancers combined. The new warning is not related to the FDA’s evaluation of possible links between testosterone therapy and stroke, heart attack, and death. Experts recommend testosterone therapy for men with a low testosterone level and one or more of the “classic” symptoms. For the rest? They get a talk-with-your-doctor recommendation. The warnings highlight that taking testosterone isn’t risk free. Combined with the lack of evidence about who really benefits, it means that the decision to start testosterone therapy is an individual one. A man must weigh the potential benefits against the potential increased risks of heart attack, stroke, and blood clots. If the balance tips in favor of moving forward, then trying testosterone is reasonable thing to do.
A study published in JAMA Internal Medicine this week found that men who used the erection-enhancing drug sildenafil (Viagra) were 84% more likely to develop melanoma, the most dangerous form of skin cancer, over a period of 10 years. That finding makes for an attention-grabbing headline. But it doesn’t tell the real story—that the study found an association (not cause and effect), that this hasn’t been seen in other studies of men, and that, even if it holds true, the absolute increase is small, from 4.3 cases of melanoma for every 1,000 men who didn’t take Viagra to 8.6 of every 1,000 men who took it. The take-home message is that it’s important to worry about melanoma—which is largely caused by getting too much sun—but not yet about Viagra and melanoma.
Taking supplements of selenium or vitamin E, once thought to prevent prostate cancer, seems to do just the opposite. A new report shows that men who take vitamin E or selenium are at higher risk for developing prostate cancer. Bottom line: men shouldn’t take selenium or vitamin E as a way to prevent prostate cancer, or anything else for that matter.
Mass marketing of testosterone therapy may have men eager to try this seemingly simple fix. But the latest science should have them scratching their heads and putting away the credit card—at least for now. A new study published in the online journal PLOS One shows an increase in the risk of having a heart attack in the months after starting testosterone therapy. The potential for danger was highest in older men. A report in the November 6, 2013, issue of JAMA showed that men who used testosterone therapy didn’t fare as well after artery-opening angioplasty as men who didn’t take testosterone. Neither was the type of study that can prove cause and effect. They can only show associations, or links. That means there’s no smoking gun here that testosterone therapy is harmful. But the studies do suggest caution. Given the uncertainly over the benefits and risks of testosterone therapy, what’s a man to do? Take a cautious approach, advises the Harvard Men’s Health Watch.