2017 Annual Report on Prostate Diseases

Most men eventually develop some type of prostate problem, and when they do there are usually no easy solutions. More than a primer on prostate conditions, this Special Health Report, the Annual Report on Prostate Diseases, includes roundtable discussions with experts at the forefront of prostate research, interviews with men about their treatment decisions, and the latest thinking on complementary therapies. This report will provide you with the information you need to understand the current controversies, avoid common pitfalls, and work with your doctor to make informed choices about your prostate health.

2017 Annual Report on Prostate Diseases  Cover

A Guide to Men's Health Fifty and Forward

This Special Health Report, A Guide to Men's Health Fifty and Forward, offers steps and strategies to lessen — or prevent — threats to a man's well-being and longevity. It provides a wide-ranging, clear-eyed look at the leading causes of death for men at midlife and beyond. It examines those factors that put them at risk for a variety of health problems and explains the important measures that can be taken…

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Most men eventually develop some type of prostate problem, and when they do there are usually no easy solutions. The three most common prostate problems are benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer. Men with the same condition and symptoms might opt for very different treatments — or choose to do nothing at all.

Right now, one of the major controversies in prostate treatment involves the PSA test that is used for routine screening. This report explains why the test has fallen into disfavor and provides crucial information on how to proceed if your test results are abnormal. It also discusses the increasing use of active surveillance — a monitoring strategy that allows men with low-risk prostate cancer to delay and perhaps avoid treatment altogether — and intermediate treatment strategies for those who aren’t comfortable forgoing therapy. Plus you’ll learn about emerging tests — so called biomarkers and even genetic-based tests.

You’ll be briefed on the latest treatments that address “going” and “growing,” an outpatient laser procedure that is gaining in popularity over the traditional “roto-rooter” techniques. You will read about advances in prostate cancer treatment that are minimizing side effects, increasing longevity, and dramatically preserving — and improving — quality of life. You’ll learn about the
risks and rewards of “active surveillance,” the controversial role of robotic surgery, and more. Plus, the report will update you on treatment options for prostatitis, a medication for difficult-to treat erectile problems after prostate cancer surgery, and lifestyle changes that can improve health and lower the risk of developing prostate disease.

That’s why this unique publication is more than a primer on prostate conditions; it includes roundtable discussions with experts at the forefront of prostate research, interviews with patients about their treatment decisions, and the latest thinking on complementary therapies.

The goal of this publication is not to relate easy answers. Rather, our mission is to provide you with the information you need to understand the current controversies, avoid common pitfalls, and work with your doctor to make informed choices about your prostate health.

Prepared by the editors of Harvard Health Publishing in consultation with Marc B. Garnick, M.D., Gorman Brothers Professor of Medicine, Harvard Medical School, and Physician, Oncology Division, Beth Israel Deaconess Medical Center. 119 pages. (2017)

1. A year of progress in prostate research

  • Treating the primary tumor improves survival in men with metastatic prostate cancer
  • Some men on active surveillance for prostate cancer face higher odds of metastases
  • Researchers report 10-year survival and quality-of-life data for men choosing active monitoring, surgery, or radiation for localized prostate cancer
  • Olaparib (Lynparza) approved for BRCA-positive advanced prostate cancer  
  • Study suggests men with metastatic prostate cancer should be tested for inherited DNA-repair defects  
  • Parallel trends: Prostate cancer deaths fall in tandem with declines in smoking rates  
  • Declines in PSA screening matched by declines in prostate cancer diagnoses  
  • Medicare drops a proposal to penalize for PSA screening
  • Where prostate cancer spreads may affect survival time

2. An introduction to the prostate gland

3. Inflammation of the prostate (prostatitis)

  • What is prostatitis?  
  • Diagnosing prostatitis
  • Treating prostatitis

4. Prostate enlargement (benign prostatic hyperplasia)

  • How BPH progresses  
  • Getting help  
  • Treating BPH

5. Prostate cancer

  • What causes prostate cancer?
  • Risk factors
  • Can prostate cancer be prevented?
  • Screening 
  • Imaging
  • Biopsies and diagnosis
  • Active surveillance
  • Surgery
    • A patient’s perspective: One man’s experience with Peyronie’s disease following prostate cancer surgery
  • Radiation therapy
  • Focal therapy
  • Hormonal therapy
  • Chemotherapy
  • Bone-targeting treatments
  • Immunotherapy

Special Section: Biomarkers: Coming to the fore

  • Roundtable Discussion: Assessing new imaging tools
  • and biomarkers for predicting outcomes in prostate cancer

6. Erectile dysfunction and urinary incontinence

  • Treating erectile dysfunction  
  • Treating urinary incontinence  

7. Take charge of your condition

  • Participate in a clinical trial
  • Join a support group
  • Make smart lifestyle changes
  • Use herbs and supplements with care

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Resources

Glossary

Time to develop your own game plan

This report is published each year around the time of the NFL playoffs. And if you’re a football fan, as I am, it’s hard to escape the steady barrage of ads for drugs to treat benign prostatic hyperplasia (BPH) and erectile dysfunction, or the celebrity pitches urging men to undergo PSA screening for prostate cancer.

It can be overwhelming. That’s why this publication is intended to help you become the quarterback when it comes to treatment decisions about BPH, prostatitis, erectile dysfunction, and other common prostate problems. And if I can stretch the football analogy a little further, I’d like to call for a whole new game plan when it comes to diagnosing and treating prostate cancer.

Research published over the past year has made it even more evident that widespread PSA screening is detecting cancers at such an early stage that it is doing more harm than good. In May, the U.S. Preventive Services Task Force recommended against prostate-specific antigen (PSA) screening for any man, regardless of age, race, or family history—arguing that for most men screening does not save lives and causes serious and long-lasting harms. Certainly the consensus has been building in this direction for quite a while, but the USPSTF is one of the nation’s most authoritative voices on this matter. Meanwhile, a long-awaited American study, the Prostate Cancer Intervention Versus Observation Trial (PIVOT), concluded that men who underwent surgery for localized prostate cancer were no more likely to survive than those who avoided treatment.

But it wasn’t all bad news. Several new drugs for late-stage prostate cancer have come on the market, and others are far along in the pipeline. These developments have helped to redefine metastatic disease from a death sentence to a condition men can live with—often for years, and without the disabling pain and crippling bone problems of the past.

That’s why this unique publication is more than a primer on prostate conditions; it includes insights from experts at the forefront of prostate research, interviews with patients about their treatment decisions, and the latest thinking about diet and complementary therapies. The companion website, www.HarvardProstateKnowledge.org, offers additional features and research updates throughout the year.

The goal of this publication is not to relate easy answers—because in many instances there are none. Rather, our mission is to provide you with the information you need to understand the current controversies, avoid common pitfalls, and work with your doctor to make informed choices about your prostate health.

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