Archive | November, 2010

Red or Processed Meat No Longer Linked to Prostate Cancer

As prostate cancer awareness grows every year, so do concerns over developing prostate problems.  One previous suggestion was that a link existed between the dietary intake of red or processed meat and prostate cancer.  However, according to a new meta-analysis of 26 studies, researchers have found that consumption of red meat or processed meat has no positive association with the occurrence of prostate cancer.

These most recent results of the study were published in Nutrition Journal.  The study looked at data from 15 large scale studies on red meat and 11 studies investigating processed meats and cancer risk.  Overall, no association with prostate cancer was found.

“The results of this meta-analysis are not supportive of an independent positive association between red or processed meat intake and prostate cancer,” stated the researchers, led by Dr. Dominik Alexander of Exponent Health Sciences Practice.

Although red or processed meats may not be associated with prostate cancer, the idea of looking to diet and lifestyle choices is a start in reducing the mortality rate of cancer.

The average, Westernized diet is often studied, and many researchers are finding that those who adopt the Western diet have a higher risk of malignancy.  “As a result, diet has been the focus of numerous epidemiologic studies of prostate cancer, although findings have not been consistent,” stated the authors.

In one recent systematic review of dietary factors, published in Journal of Human Nutrition and Dietetics, researchers suggested that high meat consumption may increase the risk of prostate cancer.  But these same authors confess that other studies are not producing the same results to suggest a positive association.

In their 2007 report on diet and cancer, the World Cancer Research Fund/American Institute for Cancer Research concluded that there was “limited evidence from sparse and inconsistent studies suggesting that processed meat is a cause of prostate cancer,” and the authors noted that this determination was based on only four cohort studies.

The recent study conducted by Dr. Alexander and his colleagues found no association between consumption of high versus low intake of red meat and total prostate cancer in the meta-analysis of 15 prospective studies.

The researchers also found no association per 100 gram increment of red meat for prostate cancer in a dose-response regression meta-analysis.

“The results of this meta-analysis of prospective studies do not support an independent positive association between intake of red meat or processed meat and prostate cancer,” concluded the researchers.  “Summary results for processed meat were weakly elevated; however, the association across the more recently published studies that adjusted for key factors was attenuated and not statistically significant.  Furthermore, there was evidence of publication bias across the cohort studies of processed meat,” they added.

The researchers stated that not enough data is available on consumption preferences and dietary mutagens to fully evaluate any potential associations between these factors and prostate cancer.

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Golf Legend Palmer Raises Prostate Cancer Awareness

Although he is better known for his amazing success in the golf arena, seven-time major champion Arnold Palmer is now the vanguard of another movement: educating the public about prostate cancer. The National Cancer Institute estimates that there will be almost 218,000 new cases of prostate cancer diagnosed in the United States this year.

His new website, myprostatecancerroadmap.com, is aimed at men diagnosed with advanced prostate cancer. As part of his ongoing crusade to increase awareness of this disease, the website aims to disseminate information about how to live with it.

Palmer received his diagnosis in 1997, and feels fortunate that he had a prostate-specific antigen test that detected the cancer early. Now 80 years old and thirteen years post-surgery, he said he has never felt better, which he attributes to a change in his lifestyle and diet along with regular check-ups.

“I feel like I’m 25,” Palmer said. “I feel some obligation to the world and the public to help them understand prostate cancer. I think a lot of people don’t think prostate cancer is a big deal.”

“I think there’s a lot of misinformation out there,” he added. “I had the good fortune to have a doctor who made me aware that prostate cancer isn’t as bad as you can think and you can live a long life after being diagnosed with it but that there are conditions toward making that happen.”

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Testosterone Therapy is Questionable

According to a new study published in Drug and Therapeutics Bulletin (DBT), taking synthetic testosterone to fight symptoms of “male menopause” is questionable.

Researchers are even beginning to question whether or not male menopause actually exists.  Male menopause, sometimes called late-onset hypogonadism, has been regarded as a condition where the testes produce little or no hormone.  Usually, testosterone levels decline by only 1 to 2 percent per year in men age 40 onwards, but production of the hormone does not cease.  Yet low testosterone levels are not absolute.  In fact, approximately 80 percent of 60-year-old men and 50 percent of those in their 80s still have testosterone levels within the normal range for younger men.

The DTB points out that older men who have low testosterone levels do not necessarily experience symptoms, and that many men who have normal testosterone levels can experience symptoms sometimes attributed to low hormone levels.  Therefore “evidence that an age-related reduction in testosterone levels causes specific symptoms is weak.”

According to DTB, testosterone therapy has unwanted side effects, including a rise in prostate specific antigen (PSA), development of breasts (gynecomastia), risk of prostate cancer, urinary tract blockage, and aggravation of epilepsy, sleep apnea, and ischemic heart disease.

The authors of the study concluded that there are very limited opportunities to prescribe testosterone treatment for men who have low levels of the hormone related to age.  They insist, “There is no place for testosterone therapy in older men without symptoms, or without clearly low testosterone concentrations on more than one occasion.”

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Maca Root for Sexual Health

The maca root (Lepidium meyenii) is a cruciferous plant related to broccoli, cauliflower, and kale.  Its native country is Peru, and now it is being touted as a plant that can boost men’s sexual health.  BMC Complementary and Alternative Medicine published a review on the maca root in August of 2010, presenting what has been discovered about the root and its effect on libido and erectile dysfunction.  The review’s results are based on a limited number of randomized controlled studies conducted so far.

The utilization of maca root has a unique history and goes back to the time of Incan warriors.  According to Incan folklore, warriors took the plant before they went into battle because it increased physical strength.  The warriors also began to notice that the maca root increased their libido, which was unacceptable for war purposes.  Leaders eventually prohibited their soldiers from taking it during wartime.

Recently, researchers have begun to explore the claims of enhanced sexual function and stamina associated with maca, looking into the biochemistry behind the root.  In addition to the claims of improved sexual health, maca also belongs to the Brassicacae family, which is known for its anticancer properties.  Because of this, speculation is also arising that it may be helpful in protecting against prostate cancer or other prostate conditions such as benign prostatic hyperplasia.

The department of urology at Margagni-Pierantoni Hospital in Italy conducted a double-blind trial to test the maca root.  Fifty men who had mild erectile dysfunction participated.  Half were given 2,400 mg maca daily and the other half received placebo.  After 12 weeks, men in the maca-treatment group experienced a more significant increase in the International Index of Erectile Function (IIEF-5) than men in the placebo group.  The scientists concluded that maca supplements provide a small but significant effect on sexual health and well-being in men who have mild erectile dysfunction.

In regards to prostate health benefits, the type of maca used matters in the effectiveness of the root.  Maca comes in red, yellow, and black, and in a 2009 study researchers compared the impact of each one on prostate size in rats with induced benign prostatic hyperplasia (enlarged prostate).  Red maca appears to have a prostate-reducing effect, while yellow offers a mild impact and black has no impact.

In addition, three other studies on the effects of maca on a man’s libido are important.  In the first, researchers evaluated the effect of 1,500 mg and 3,000 mg of maca compared with placebo in a 12-week trial.  After 8 weeks, men who took maca reported an improvement in sexual desire in one while men in the placebo group did not.  The second study found that maca increased sperm count, sperm motility, and seminal volume, which could improve fertility.  Finally, the third study, conducted at Massachusetts General Hospital, involved depressed men and women.  The participants in this study took 3,000 mg maca daily and reported an improvement in sexual dysfunction.

So how does maca root work?  The enhanced sexual health may be attributed to several different components of the root.  Maca contains higher levels of glucosinolates than its cruciferous cousins, and substances hydrolyzed from these glucosinolates reportedly inhibit certain types of cancers in rats.  The enhanced libido may be attributed to maca’s polyunsaturated fatty acids.  But experts are not certain how maca works in relieving erectile dysfunction.  The root does not affect levels of testosterone, estradiol, and other hormones.  One theory is that it acts on the receptors for these hormones, not the actual hormones themselves.

Maca is available as capsules, powder, tablets, and an extract.  Several studies have shown 3,000 mg daily to be an effective and safe dose, but it is best to take maca according to package directions and to consult a knowledgeable healthcare provider.

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Peyronie’s Disease: Explanation and Treatment

What is Peyronie’s disease?

Peyronie’s disease is a disorder in which plaque (a layer of hard material) forms under the penile skin. The plaque can cause pain as well as bending, shortening, or indentation of the penis during erection. These changes may make intercourse painful or impossible.

This disease can occur at any age, but generally affects men between the ages of 45 and 60. Elderly men and men with diabetes are at a higher risk for this disorder. The cause is not known, but it is thought to result from genetic factors, immune system malfunction, or trauma to the penis during intercourse or surgery.

Men afflicted with Peyronie’s disease may not experience symptoms all the time, because the condition often has periods of improvement.

Treatment:

Your doctor will likely first prescribe oral medications to decrease swelling, or vitamin E supplements. If the condition does not improve, drugs may be injected into the plaque in an attempt to dissolve it.

If oral and injected medications do not help, surgery may be recommended.

There are a variety of procedures to choose from based on your specific symptoms:

-          Nesbit placation: During this procedure, the doctor will pinch or remove tissue on the side of the penis opposite to the plaque to correct bending.

-          Graft repairs: The plaque is removed, and skin from other parts of your body is utilized to cover the area.

-          Plaque incision with saphenous vein graft: The surgeon makes several cuts in the plaque to allow straightening of the penis, and then covers the cut with a grafted vein.

-          Penile prostheses: Small rods are implanted into the penis that can then be manipulated to stimulate an erection.

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Implanted Pacemaker for Overactive Bladders

More than 200 million people suffer from an over-active bladder; many of these victims feel like they are held hostage by their own bathrooms.

One over-active bladder patient, Sue Nelson, says soda pop used to be a nightmare.  “You have to constantly be close to a bathroom.”  Nelson, like the 25 million people living with bladder control issues, had a bladder condition that kept telling her it was full, even though it was not.  The result:  she could not leave the house very often.

“People get embarrassed because it is not something you sit down and talk about over dinner,” said Nelson.

In fact, Dr. Christopher Smith, MD, at Baylor College of Medicine said, “It’s almost like the bladder reverts back to a child-like bladder.”

But a solution now exists that is similar to the same technology doctors use on heart problems.  It is called sacral nerve stimulation (InterStim Therapy) and is a pacemaker that has been implanted into many patients, like Sue, who are experiencing over-active bladder syndrome.  The device weighs just an ounce and works by sending an electric stimulation signal to the base of the spine, telling patients when their bladder is truly full.

“It filters these signals, these overactive signals—between a patient’s bladder and their brain,” explains Dr. Smith.

And studies are showing just how effective this bladder pacemaker is.  Over 56 percent of users actually cut their bathroom trips in half, and 46 percent of patients experience zero bladder control issues.

Sue Nelson, who has had the device successfully implanted, happily recommends the product: “It’s like, back to my old life.  This [over-active bladder problem] is just something that happens to some people, and there is hope.”

Experts say up to 75 percent of people suffering from over-active bladder do not respond to medication.  With so many suffering from the condition, researchers have been searching for a solution with minimal intrusion, and patients seem to agree this is one successful answer.

Those who want the device can wear an external version for seven days before committing to full implantation.

Over 75,000 worldwide patients have gone on to receive the full version of sacral nerve stimulation.  The therapy is minimally invasive and is indicated for patients who suffer from urinary urge incontinence, urinary urgency-frequency, or non-obstructive urinary retention.  Permanent implantation is done under general anesthesia and requires a one-night stay in the hospital.  The neurostimulator is about the size of a pocket stopwatch and is inserted under the patient’s abdomen.  Wires, or leads, running from the stimulator carry electrical impulses from the stimulator to the sacral nerves located in the lower back.  The device does contain a battery inside the neurostimulator, and this battery typically needs to be replaced every three to five years.

If you have long suffered the inconveniences and embarrassment of an over-active bladder, please discuss the symptoms with your doctor in order to determine if this therapy is right for you.

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High Failure Rate for SUI Surgery if Patient Has Urge Incontinence

A recent study published by Dr. Holly E. Richter of the University of Alabama at Birmingham and presented at the annual meeting of the American Urogynecologic Society shows high failure rates for stress urinary incontinence (SUI) surgery in many patients.

The failure rate at 12 months after women underwent midurethral sling surgery for stress incontinence was twice as likely if they also had urge incontinence symptoms at baseline.  In fact, Dr. Richter determined that the risk of treatment failure for the surgery increased by 94% for every 10-point increase in the MESA (Medical, Epidemiologic, and Social Aspects of Aging) urge score.

Stress incontinence is defined as urine leakage when coughing, sneezing, laughing, standing up, lifting something heavy, exercising, or performing any pressure-increasing activity that may lead to unintentional urine loss, especially when the bladder is full.  On the other hand, urge incontinence, which is sometimes referred to as overactive bladder or spastic bladder, is an involuntary loss of urine that usually occurs when a person has a strong, sudden need to urinate.  With urge incontinence, the bladder experiences abnormal contractions strong enough to override the sphincter muscles of the urethra, allowing urine to pass out of the bladder.

Dr. Richter’s study shows that in addition to a high failure rate due to the duel symptoms, women who had prior urinary incontinence surgery were 96% more likely to experience treatment failure.

“There is one covariate to me that really stands out,” says Dr. Richter at the American Urogynecologic Society meeting.  “We’ve spent millions of dollars, two big trials, almost 1,200 patients, and I think if we learned one thing, [it’s that] urge incontinence symptoms are problematic.  I think that in studies we do in the future regarding women [who] undergo stress incontinence surgery, we need to take a more robust look at this.”

In the TOMUS study, investigators randomized 597 women to receive a transobturator or retropubic midurethral sling.  All patients suffered from stress-predominant urinary incontinence.

In order to investigate the level of success of the surgery, researchers set up objective and subjective categories for cure rates.  Objective cure meant a negative stress test, a negative 24-hour pad test, and no behavioral, pharmacologic, or surgical retreatment for SUI.  Subjective cure meant no self-reported symptoms of SUI, no self-reported leakage on a 3-day voiding diary, and no retreatment for SUI.

After 12 months following the surgery, the women were re-examined.  Nearly 54% of the women met all the criteria for objective and subjective cure.  Of the remaining 46%, 42% had both objective and subjective failure, 50% had subjective failure only, and 6% had objective failure only.

“This information may assist in counseling women regarding efficacy and setting appropriate expectations for women at increased risk for failure,” concludes Dr. Richter.

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Study Proves Prostate Cancer is More Difficult to Detect in Obese Men

A recent study from Duke University revealed that prostate cancer may be more difficult to detect in obese men, causing an increased risk of death from a delayed diagnosis. Published in the Journal of Urology, researchers reported that, as obese men tend to have larger prostates, a biopsy may be more likely to leave tumors undetected.

Dr. Stephen Freedland and colleagues also reported that obese men often experience lower levels of prostate-specific antigen (PSA), which increases the likelihood of a false-negative PSA test. The data showed that increasing BMI was greatly associated with greater prostate weight in men younger than 63, but not in men age 63 or older. The trend leveled off and started to reverse in morbidly obese men (BMI of 35 or greater).

“Assuming an equal sized tumor, an enlarged prostate at biopsy would make cancer detection less likely,” the researchers reported. Additionally, the researchers reported that the combination of lower PSA levels and larger prostates could cause the general biopsy screening approach following an abnormal PSA test to miss as many as 25% of prostate cancers in obese patients.

With this in mind, Dr. Freedland warned that delayed diagnosis can place obese men at a heightened risk of dying from this disease. He also advised doctor to screen obese patients more aggressively, with a “careful” digital rectal examination and serum PSA measurement.

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Common Pediatric Urological Problems

Children can experience a wide range of urological problems. These issues are more likely to affect boys than girls, and can range from harmless to life-threatening. Here are the most common problems reported by pediatric patients:

Bed wetting – This is one of the most common pediatric urological issues. Usually it is just a developmental stage, and generally occurs when the child is 6 or 7 years old. During this period, sometimes the bladder is unable to function properly at night. If this continues for more than few months, ask your doctor about medication.

Undescended Testes – Around 2 to 5% of boys will have undescended testicles. This is most common in premature births, and usually it is just one testicle that has not descended into the testicular sack. Usually the testicle will move into place after a few months, but in some instances surgery may be required.

Hypospadias – In this condition, the opening of the urethra is located on the underside of the penis instead of the top. A surgical procedure is required to reposition the opening, and it is recommended that the surgery is performed between the ages of 3 and 18 months. If untreated, hypospadias can affect toilet training and lead to sexual problems later in life.

Ureteropelvic Juntion Obstruction – A ureteropelvic junction obstruction is a congenital abnormality that blocks the urine passage from the kidneys to the bladder. Most commonly found in newborns, this backup of urine can cause damage to the kidneys. Antibiotics are often prescribed to prevent infection, and a procedure called a pyeloplasty may be required.

Urinary Tract Infections – Commonly found in children, a urinary tract infection (UTI) can be the result of either poor hygiene or congenital issues. Symptoms include burning during urination, a low fever, and back pain. A simple urine test can determine if an infection is present, and the infection can be resolved with antibiotics.

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