Men’s Health

Long-term hormonal therapy benefits men with locally advanced prostate cancer

Charlie Schmidt
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Disease

Long-term hormonal therapy, which blocks the effect of testosterone on prostate tumors, was once reserved for prostate cancer that has spread. But recent research has found that it had enormous benefits for men with earlier stages of prostate cancer, slashing their risks of metastasis and death from prostate cancer. However, some questions remain — for example, exactly how long to use “long-term hormonal therapy” is still up for debate.

Why men often die earlier than women

Robert H. Shmerling, MD
Robert H. Shmerling, MD, Faculty Editor, Harvard Health Publications

Although it may sound alarming, the statistics don’t lie: on average, men are likely to die at earlier ages than women. There are a number of factors that might explain this; some of them can’t be changed, but others can. Regardless of the reasons, the best thing men can do to enjoy a long life is to proactively protect their health, with their doctor’s help.

Promising results for a targeted drug in advanced prostate cancer

Charlie Schmidt
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Disease

The same BRCA mutations that increase a woman’s risk of breast and ovarian cancers can also increase a man’s risk of dying from prostate cancer. Recently, an ovarian cancer drug intended for BRCA-positive women has shown impressive results in BRCA-positive men with metastatic prostate cancer. This drug, and others like it, could provide another, much-needed treatment option for men with advanced prostate cancer.

Does fewer PSA tests mean less prostate cancer?

Charlie Schmidt
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Disease

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.

Active surveillance is safe for low-risk prostate cancers

Charlie Schmidt
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Disease

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.

Following low-risk prostate cancers before starting treatment becoming more common

Charlie Schmidt
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Disease

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.

Is treating “low T” really safe and effective?

Daniel Pendick
Daniel Pendick, Former Executive Editor, Harvard Men's Health Watch

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.

Editorial calls for more research on link between football and brain damage

Patrick J. Skerrett, Former Executive Editor, Harvard Health

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.

Cold hands: Could it be Raynaud’s?

Patrick J. Skerrett, Former Executive Editor, Harvard Health

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).

FDA warns about blood clot risk with testosterone products

Howard LeWine, M.D.
Howard LeWine, M.D., Chief Medical Editor, Internet Publishing, Harvard Health Publications

“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.