Harvard Perspectives on Prostate Disease

Confronting controversies, suggesting solutions

A message from Editor in Chief Marc B. Garnick, M.D.

The positive response to the inaugural issue of Perspectives on Prostate Disease has been gratifying and indicates that we are on target in providing the type of unique, compassionate, and unbiased information that readers are looking for. In this second issue of Perspectives, we continue our examination of the thorniest problems facing men with prostate disease. In particular, we examine three controversial topics that are of great interest to patients, but where no consensus yet exists about the best medical advice or treatments.

  • Complementary therapies. Our lead article explores alternative and complementary therapies for various types of prostate disease. This topic is of obvious interest, as many men with prostate disease use such therapies. (Surveys indicate, for example, that at least one-third of men with prostate cancer do so.) We assembled a panel of Harvard experts, each with a unique perspective on this issue, to provide a frank and no-nonsense discussion about which therapies work, which do not, and what you should think about before trying anything. In this article, you will learn the views of an epidemiologist who studies population trends of disease and correlates them with intake of food, vitamins, and other nutrients; an oncologist specializing in integrative medicine, who provides cancer patients with advice about complementary therapies; and a primary care physician who has been in practice more than 30 years, who provides a common-sense approach to choosing and using complementary therapies.

  • Biochemical recurrence. Anywhere from 15% to 30% of men treated for prostate cancer will experience biochemical recurrence "" meaning that a follow-up PSA test indicates that their prostate cancer has returned. The news can be terrifying. If you find yourself in this position, what are your options and when should you undergo additional treatment? This article explores the controversies about what really constitutes a biochemical recurrence, what factors your doctor weighs in making a recommendation about whether to undergo a second (salvage) therapy, and what to consider when deciding among treatments.

  • Erectile dysfunction. Researchers are continually trying to find new ways to address the problem of erectile dysfunction, which can occur both as a consequence of prostate disease and as a side effect of treatment. To augment the information provided in Sex and the Prostate, a supplementary publication that was sent to all new subscribers, in this issue of Perspectives we provide the latest information about the controversial topic of penile rehabilitation. Although a number of hospitals are advertising penile rehabilitation programs aggressively "" and the research looks promising "" the jury is still out about how effective it is. This article explains what you should know about the timing of interventions, the choices available, and what, realistically, your chances of success are.

But prostate disease is about more than just controversy. Other articles suggest solutions to common and vexing challenges in prostate disease. This issue of Perspectives includes the second part of our Harvard experts' discussion about the best treatment for benign prostatic hyperplasia, this time focusing on options in surgical management. Our panel not only discusses medical factors to think about but also delves into financial considerations that may influence a doctor's recommendation. This is information doctors usually don't volunteer, and the type that you are unlikely to read about anywhere else.

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