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No link found
between prostate cancer and vasectomy
Good news for the millions of men worldwide who've had vasectomies:
a new study disputes a link between this birth-control operation and
prostate cancer. Two 1990 studies that connected prostate cancer and
vasectomies caused men to question the procedure, even though no medical
explanation for the connection could be found. Other research has both
confirmed and denied the association in the past 10 years.
But the new study, published in the June 19, 2002, Journal of the
American Medical Association, should ease men's minds. It involved
over 2,000 men of European descent living in New Zealand, the country
with the highest rate of vasectomies.
Researchers asked 953 men with prostate cancer and 1,260 who were cancer
free about their medical histories — including whether they had
had a vasectomy. It turned out that slightly fewer men with prostate
cancer had undergone the surgery, which supports claims that going under
the knife doesn't cause cancer. The same held true for the 38% of men
studied who had had the procedure more than 25 years ago, which suggests
that there are no long-term effects.
One reason why the link may have been found in earlier studies is that
men who have vasectomies generally see their urologists more often, which
may lead to more tumors being found in these men as compared to others,
the researchers said. The study also found no link between prostate cancer
and history of sexually transmitted disease, smoking, drinking alcohol,
and number of children.
Prostate cancer will be diagnosed in 198,000 Americans this year, and
it will take 31,500 lives. Although prostate cancer lags behind heart
attacks, strokes, and lung cancer as the leading cause of death in American
men, it's the disease many men fear most.
August 2002 Update
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Annual PSA Test May Not be Necessary for All
Prostate cancer is the second leading cause of death for men in the
United States. And while the chance of being diagnosed with prostate
cancer over a lifetime may be as high as 20%, the chance of dying of
prostate cancer is only about 3%. But the risk of prostate cancer increases
with age. More than 75% of all cases occur in men over 65, and about
40% of men over 80 have the disease. When it is diagnosed early, prostate
cancer is more likely to be treated successfully. Cure rates are excellent
for cancer that is discovered and treated when it is still confined to
the prostate gland. About 95% of men with localized prostate cancer treated
by surgery are alive after five years.
The prostate-specific antigen (PSA) test is a primary test for finding
early-stage prostate cancer. PSA is a protein produced by the prostate
gland, and PSA levels become elevated in men with prostate cancer. Although
some respected groups recommend an annual PSA test for all men over age
50, the annual PSA test remains controversial. That is, in part, because
it has a high chance of being falsely negative (20%-40% of men with prostate
cancer have normal levels of PSA) or falsely positive (PSA levels may
be elevated in men with noncancerous prostate conditions).
At a meeting of the American Society of Clinical Oncology, researchers
presented findings that indicated that an annual PSA test may not be
warranted in men over 50 with an initial normal PSA (04 nanograms/milliliter).
For five years, researchers tracked the annual PSA test results of 27,863
men ages 5574 whose PSA levels were initially normal. . They found
that 98.6% of men with a PSA result of less than 1 ng/ml at baseline
would remain negative after 4 more annual tests and that 98.8% of men
with a baseline PSA of 12 ng/ml would have a negative PSA test
the following year.
Based on these results, the researchers concluded that performing a
PSA test every five years on men with an initial PSA less than 1 ng/ml
and every two years for men with a PSA of 12 ng/ml would reduce
the number of PSA tests performed by 55%. This would save money and help
men avoid the anxiety associated with yearly prostate tests.
July 2002 Update
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Comparing the Side Effects of Prostatectomy vs. Radiation
Prostate cancer is the most commonly diagnosed non-skin cancer among
men in the United States. When caught early, it is also among the most
treatable. Two of the more aggressive and common methods
of treatment for early stage prostate cancer are radiation therapy and
surgery (radical prostatectomy) to remove the prostate gland. Although
both options have favorable outcomes, physicians have not reached a consensus
on which therapy is more effective. This means that men who are treated
with either surgery or radiation can usually expect to live for many
more years. The caveat is that they often have to live with the side
effects of their treatment. Deciding on a treatment option, then, becomes
a question of which side effects are more likely with each therapy, and
also which side effects are more tolerable to a particular patient.
A recent analysis of data from the Prostate Cancer Outcomes Study helps
to clarify this issue by comparing the side effects of the two therapies
in men between the ages of 55 and 74, two years after treatment. The
results showed that men in both treatment groups experienced significant
decreases in sexual function. Of the men in the surgery group, 80% became
impotent, compared to 62% of the men in the radiation group. Age and
status of sexual function prior to treatment affected these outcomes.
Twelve percent of the men who underwent surgery experienced dripping
or leaking urine, compared to only 2% of the men who had radiation therapy.
Few men in either group were bothered by bowel problems. Of the men who
were affected, however, radiation patients experienced more diarrhea,
bowel urgency, and painful hemorrhoids (33%, 30%, and 19%, respectively)
compared to surgery patients (22%, 16%, and 10%).
Overall, this study showed that men who opt for surgery can expect to
have more urinary and sexual problems, while men who choose radiation
are more likely to suffer from bowel disturbances. A man's age and initial
health are also important factors in the development and duration of
long-term side effects from either treatment. Physicians and their patients
should use this information, as well as a discussion of the patient's
priorities, preferences, and concerns, to help decide which treatment
method is appropriate.
March 2001 Update
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Side Effects After Prostate Surgery (Prostatectomy)
The prostate gland is located underneath the bladder and produces a
fluid that carries sperm out of the penis. Prostate cancer occurs when
normal cells undergo a malignant transformation and begin to divide at
an uncontrolled rate. An estimated 179,000 men were diagnosed with prostate
cancer last year. If the cancer has not spread outside of the prostate,
the most common treatment is surgery. The operation involves removing
the prostate and some of the tissue around it. The downside of surgery
is that erectile dysfunction and urinary incontinence often result.
Previous investigations into the frequency of these side effects have
been limited to unselected, population-based patients. Researchers from
the Prostate Cancer Outcomes Study wanted to determine if the past findings
were representative of men throughout the country. This investigation
evaluated nearly 1,300 black, white, and Hispanic men across six geographic
regions in the U.S. All these men had undergone radical prostatectomy.
Researchers based their findings on self-reported data from the patients
themselves, rather than relying on medical records. Before surgery, nearly
80% of the men said they had total urinary control. A year after surgery,
only 31% said they did. With regard to sexual function, about 73% said
they got erections firm enough for intercourse. A year after surgery,
only 14.7% said they did. After two years, urinary and sexual function
improved slightly. Despite the potentially significant side effects,
most men were satisfied with their surgery; 71.5% said they would choose
radical prostatectomy again. To learn more about the prostate, see page
1095 of the Family Health Guide.
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