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Prostate Cancer Archive
Reducing prostate cancer risk: Good news, bad news, or no new news?
Prostate cancer is an important disease; in fact, it's the most common internal malignancy in American men. Prostate cancer is a variable disease; many cases are slow growing, even harmless, but some cases are aggressive and even lethal. And it's a puzzling disease; some cases are passed down from father to son, but most occur without apparent rhyme or reason.
Important, variable, and puzzling — it is no wonder that men pay attention when research reports that common dietary elements appear to reduce risk. Two studies have attracted a lot of press; both contain surprising information, but to understand what they mean for you, you'll have to dig behind the headlines and sound bites.
Unexpected benefit for digoxin?
Most medications have potentially harmful side effects, such as stomach upset with aspirin. A team from Johns Hopkins and Harvard universities found what looks to be a beneficial side effect for digoxin — lowered risk of prostate cancer. Digoxin, which was originally extracted from the foxglove plant, has been used for decades to treat heart failure and some heart rhythm problems.
Using an automated system, the researchers tested the ability of nearly 3,200 compounds to halt the growth of prostate cancer cells. Digoxin was one of the top five. As a real-world check, the researchers looked at nearly 48,000 men in the ongoing Health Professionals Follow-up Study. Those who had routinely taken digoxin were 24% less likely to have developed prostate cancer over the 20-year period of the study (Cancer Discovery, published online April 3, 2011).
Bladder cancer: Men at risk
Genitourinary malignancies are a worry for men. In adolescents and young adults, testicular cancer is the main concern. One of the unappreciated benefits of growing older is that cancer of the testicles becomes rare — but as men outgrow that risk, they face the problem of prostate cancer. With these well-publicized diseases to head their worry list, it's easy for men to overlook bladder cancer — but that would be a mistake. In fact, about 53,000 American men will be diagnosed with the disease this year alone, and over 10,000 will die from it.
Bladder cancer is the fourth most common internal malignancy in American men; it is also one of the 10 deadliest cancers, and it saps our strapped economy of almost $3 billion a year. But there's good news, too. Early diagnosis can nip the disease in the bud, and new treatments are improving the outlook for patients with advanced disease. And when it comes to good news, you'll also be glad to know that you can take simple steps to reduce your risk of getting bladder cancer.
Testosterone replacement: A cautionary tale
Every man desires to live long," wrote Jonathan Swift, "but no man would be old." Much has changed over the centuries, but the desire to retain youthful vigor during the golden years has endured. Fortunately, modern medicine has developed a plan for successful aging. It includes getting regular physical activity and mental stimulation; eating right; controlling blood pressure, cholesterol, and blood sugar levels; staying lean; building strong interpersonal relationships; and avoiding tobacco and other risky exposures and activities.
A wise lifestyle can help extend life and slow the aging process — but it takes effort and discipline, especially for gents who have started down the wrong path. So it's no surprise that men continue to look for a medicinal shortcut. One of the most tempting is testosterone.
Penile rehabilitation after prostate cancer surgery
Think rehab, and you may conjure up the image of an athlete working his way back from a torn ligament or an older guy getting back on his feet after a total hip replacement. Penile rehabilitation is harder to picture. Indeed, it may sound more like a creative pick-up line than serious therapy, but it's a real, if unproven, program advanced by many urologists.
Before you decide that penile rehabilitation sounds like fun, remember that it's triggered by a diagnosis of prostate cancer. About 218,000 American men will receive that diagnosis this year, and all will face the difficult decision of what to do next. Some men will choose to defer treatment ("watchful waiting" and active surveillance programs). Others will decide to have radiation therapy (external beam radiation or brachytherapy with implanted seeds). And many men will opt to "get it all out" by undergoing the radical prostatectomy operation; it's a particularly good choice for younger men with life expectancies of over 10 years and aggressive-looking cancers still confined to the prostate itself.
Treating prostate cancer: No rush to judgment
At your annual check-up, your doctor discusses the pros and cons of a PSA test. You decide to go ahead, and a week later you get a call with the unwelcome news that the result is high. The next step is a repeat test, with another week of waiting. High again, so you're referred to a urologist. It takes three weeks to get the appointment, another week to get your ultrasound-guided prostate biopsy, then a really long week of waiting. Now the verdict: You have prostate cancer. Fortunately, though, it looks like early disease that's very likely curable.
By now, nearly two months have elapsed since your first PSA test. Since your PSA was just 6 nanograms per milliliter, your risk of widespread disease is extremely low, and so you don't need to spend time lining up scans and waiting for more results. You're eager to get on with treatment, but your primary care doctor tells you it's not so simple. You have a choice of treatment, since surgery, radiation, and even deferred therapy ("active surveillance") are all reasonable. Your doctor sets up appointments with the urologist, a radiation oncologist, and a medical oncologist so you can get a full range of opinions. It takes another month to make the rounds, and then you spend a long weekend at a country inn to think things over with your wife.
Lifestyle therapy for prostate cancer: Does it work?
Prostate cancer is the most common internal malignancy in American men; it's second only to lung cancer among the leading causes of male cancer deaths. That makes it an urgent problem, and it is finally getting the scientific respect it deserves. Still, despite thorough investigations that have yielded major advances, many aspects of the disease remain unknown.
One area of uncertainty is the cause of prostate cancer. Genetics certainly play an important role, but heredity cannot explain most cases. Lifestyle factors have also been implicated; the leading candidate is diet. A high consumption of saturated fat from animal sources is linked to an increased risk of prostate cancer, while whole grains, tomatoes, some vegetables, fish, and soy appear protective. Although the data are less complete, red wine may be protective, while a very high consumption of calcium may be harmful. Some studies also implicate alpha-linolenic acid, the omega-3 fat in flaxseeds and canola oil, as a risk factor. Other lifestyle elements that have been linked to the disease include obesity, lack of exercise, and heavy smoking and drinking.
Testosterone, prostate cancer, and balding: Is there a link?
We can thank the Greeks for the name doctors apply to male hormones. Androgen comes from the words meaning "man-maker," and it's a well-chosen term. Testosterone is the most potent androgen, and it does make the man. It's responsible for the deep voice, increased muscle mass, and strong bones that characterize the gender, and it also stimulates the production of red blood cells by the bone marrow.
In addition, testosterone has crucial, if incompletely understood, effects on male behavior. It contributes to aggression, and it's essential for the libido or sex drive, as well as for normal erections and sexual performance. Testosterone stimulates the growth of the genitals at puberty, and it is one of the factors required for sperm production throughout adult life.
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.
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