One sex-related problem that men are sometimes reluctant to talk about—and doctors are unlikely to ask about—is called anorgasmia. It’s the inability to reach a climax during usual sexual activity. Until now, there hasn’t been much in the way of medication that can help. Researchers from Baylor College of Medicine are reporting that a drug called cabergoline (Dostinex, generic) restored half of men with anorgasmia to normal orgasm. Cabergoline raises the amount of prolactin in the bloodstream. In the Baylor study, 50 of 72 men with anorgasmia said their orgasms improved after taking 0.5 milligrams of cabergoline twice a week for an average of 10 months.
Breast cancer isn’t just a woman’s disease. Men can get it, too—about 1% of breast cancer is diagnosed in men. Since few men know that, they often fail to recognize its earliest signs and end up seeing a doctor later in the process than women do. The result: Men face treatment for larger and more advanced tumors, and their cancer is more likely to have spread to other parts of the body. The largest study to date on outcomes in men with breast cancer indicates that the five-year survival rate for women with breast cancer was 83%, compared to 74% for men. Even men diagnosed with early stage breast cancer still fared worse than women, although the gap closed for men and women diagnosed with later-stage disease. Since breast cancer in men isn’t often on doctors’ radar screens, men should be aware and check themselves.
Yesterday’s announcement that men should not get routine PSA tests to check for hidden prostate cancer is sure to spark controversy for months to come. But the U.S. Preventive Services Task Force (USPSTF) made the right decision. On the surface, rejecting the use of a simple blood test that can detect cancer in its early and still-treatable stage sounds foolish. Cynics have been saying it is the handiwork of a group concerned more about health-care rationing and cutting costs than about health. The decision is wise, not foolish, and will improve men’s health, not harm it. The word “cancer” usually brings to mind images of a fast-growing cluster of cells that, without aggressive treatment, will invade other parts of the body, damage health, and potentially kill. That certainly describes many cancers. But not most prostate cancers. Most of the time, prostate cancer is sloth-like. It tends to grow slowly and remain confined to the prostate gland, with many men never knowing during their entire lives that a cancer was present. These slow-growing prostate cancers cause no symptoms and never threaten health or longevity. That means many men with prostate “cancer” never need treatment.
A simple blood test to check seemingly healthy men for hidden prostate cancer does more harm than good and shouldn’t be part of routine medical care. That’s the long-awaited final recommendation from the United States Preventive Services Task Force (USPSTF), published today in Annals of Internal Medicine. About half of men over age 40 get this test as part of a regular checkup. It measures the amount of a protein called prostate-specific antigen, or PSA, in the bloodstream. An above-normal PSA level can signal hidden prostate cancer. But it can also be a sign of prostate infection, an enlarged prostate, and other problems. Hunting for hidden disease in the absence of any outward signs or symptoms is called screening. The task force says that for every 1,000 men who have routine PSA tests, 0 to 1 deaths from prostate cancer will be prevented. But that is offset by 3 serious cardiovascular deaths due to treatment, along with 47 men who will live with treatment-related erectile dysfunction or incontinence.
A large study from Europe does little to resolve the controversy over whether men should have a simple blood test to look for hidden prostate cancer. In the study, the number of deaths over the course of the 11-year study were the same in men tested for prostate-specific antigen (PSA) and in men who didn’t have the test. Because prostate cancer usually grows very slowly, detecting it in an older man generally isn’t helpful. Some men live with the side effects of treatment—notably impotence and incontinence—for a cancer that would have had no effect on the length or quality of their lives. This study and others suggest that we rethink the widespread use of PSA testing, especially the yearly screening that is common in the United States.
Many prostate cancers grow very slowly and never escape the prostate. They cause no symptoms, and never threaten health or life. Yet almost 90% of men told they have prostate cancer opt for immediate treatment with surgery or radiation therapy—which often cause trouble getting or keeping an erection and an assortment of urinary problems. Yesterday, a panel of experts convened by the National Institutes of Health recommended that many men with localized, low-risk prostate cancer be closely monitored, and that treatment be delayed until there was evidence that the disease was progressing.
At least for men, being more fit may have a bigger health payoff than losing weight, according to a new study of more than 14,000 well-off middle-aged men who are participating in the Aerobics Center Longitudinal Study. Researchers followed their health, weight, and exercise habits for 11 years. Compared with men whose fitness declined over the course of the study, those who maintained their fitness levels reduced their odds of dying from cardiovascular disease or any other cause by about 30%, even if they didn’t lose any excess weight. Those who improved their fitness levels saw a 40% reduction. For optimal health, being fit and maintaining a healthy weight are best. But if you are overweight and inactive, this study and others suggest that getting more activity is the best place to start to improve your health.
As many as 32 million American women and men have some degree of incontinence—the unintended loss of urine or feces that is significant enough to make it difficult to do ordinary activities without frequent trips to the restroom. The most common causes of incontinence are childbirth and aging in women; prostate disorders and their treatment in men. Treatments include exercises to strengthen the pelvic floor, fluid management, medications, and surgery. For people with urinary incontinence, fluid management is an easy place to start, explains Better Bladder and Bowel Control, a new Special Health Report from Harvard Medical School. This involves drinking only when you are thirsty, limiting your fluid intake from all sources to six to eight 8-ounce cups of fluid per day from all sources, and minimizing caffeinated and carbonated drinks, as well as alcohol.
For many men, trouble getting or keeping an erection, formally known as erectile dysfunction, is often an early warning sign of heart disease or other circulatory problems. Atherosclerosis, the same disease process that clogs coronary arteries with cholesterol-filled plaque, does the same thing to the arteries that supply blood to the penis. Since an erection depends on extra blood flow to the penis, any obstructions can prevent an erection from occurring. According to Erectile Dysfunction, a Special Health Report from Harvard Medical School, blood vessel problems are the leading cause of erectile dysfunction and serve as an early warning sign of trouble in the heart or elsewhere in the circulatory system. Simple lifestyle changes like losing weight, exercising more, or stopping smoking can improve erections, as can Viagra and other erectile dysfunction drugs, devices, and sex therapy.
Alzheimer’s disease is a “disease of behaviors” that can wear down family and loved ones. In a talk called “Dementia and Cognitive Decline (Aging Gracefully)” Barbara Moscowitz, coordinator of geriatric social work for the Geriatric Medicine Unit at Harvard-affiliated Massachusetts General Hospital, offered helpful insights and tips into caring for people with Alzheimer’s disease. Moscowitz drew not only her 30 years of professional experience, but also on the personal experience of helping take care of her mother, who suffered from dementia the last several years of her life.