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Prostate Gland

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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 Older Men

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 (0–4 nanograms/milliliter). For five years, researchers tracked the annual PSA test results of 27,863 men ages 55–74 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 1–2 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 1–2 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 Therapy

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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