Many men take these supplements to reduce symptoms of benign prostate hyperplasia (BPH). Men with a family history of prostate cancer may take supplements to reduce their risk. BPH symptoms include a weak urine stream, frequent urination, and an urgent need to urinate. BPH is very common and increases every year after age 40. By age 60, about 60 percent of men will have some symptoms of BPH. Prostate cancer affects about 11 percent of men. Having BPH does not increase your risk of prostate cancer.

It would be great if supplements improved prostate health, and many supplements have been studied, but the results are mixed. According to Harvard Medical School, the most common supplements are saw palmetto, selenium, zinc, and beta-sitosterol. The National Center for Complementary and Integrative Health (NCCIH) adds lycopene, African plum tree, and stinging nettle as supplements that have been studied for prostate health.

What’s the Best Prostate Supplement?

Without more and better studies, it is not possible to say which supplement is best for prostate health. Probably the most common and most studied is saw palmetto. Saw palmetto is an extract from the fruit of a palm shrub. Some studies have supported this supplement for reducing BPH symptoms. However, in 2012 a review of 32 studies in over 5,000 men concluded that saw palmetto was not effective. On the other hand, a 2020 review of studies involving over 1,000 men found that after 6 months, saw palmetto improved BPH symptoms as much as a prescription medication. Other common supplements include:

• There is some evidence that this mineral may reduce the risk or slow the growth pf prostate cancer, but other studies have found no benefit. More studies will be needed.
• Prostate cells have more zinc than other cells of the body. Some lab studies suggest that zinc may play a role in prostate health and that zinc deficiency may increase the risk of BPH. However, human studies have not shown that zinc supplements help BPH and high doses of zinc may increase the risk of prostate cancer.
• Beta-sitosterol. This supplement is a chemical called a plant sterol. A 2020 study found that combining beta-sitosterol with saw palmetto for 12 weeks improved BPH symptoms, but this was a small trial with only 33 men taking the supplement combination.
• Lycopene is an antioxidant similar to vitamin A. In lab studies it seems to protect prostate cells from cancer. There is little evidence to support this supplement for prostate health in humans. A review of eight trials concludes that there was not enough evidence to support or recommend against Lycopene for prostate health. Lycopene may cause side effects that include low blood pressure, and an increased risk of bleeding.
• African plum tree (Pygeum africanum). Extracts from the bark of this tree have been used to reduce inflammation in traditional medicine, and it may reduce symptoms of BPH. A recent review of studies in 2015 found this supplement may help BPH symptoms, but cautions that the studies were short and small.
• Stinging nettle (Urtica dioica). Extract from the roots of this plant may reduce BPH symptoms. A trial of 620 men with BPH found that this supplement worked better than a placebo and another trial of 257 men found that this supplement was effective when combined with saw palmetto. Neither of these studies is recent and both called for more research

Prostate Supplement Cautions

Supplements are regulated by the FDA as a subcategory of food, not as medicines. The FDA does not check for safety, effectiveness, or accuracy of the claims or the ingredients on the labels. All these supplements qualify their claims by printing somewhere on the label that the product is not intended to treat or prevent any disease.

A 2017 review of prostate health supplements in the journal Urology, analyzed 27 herbal supplements advertised for prostate health on Amazon to see what active ingredients they had. They found a total of 58 active ingredients. The average product had between 8 and 9 ingredients. Although about 70 percent had at least one ingredient with some scientific support, all the products contained at least one ingredient with no science to support or evaluate effectiveness or safety.

The Harvard Medical School review notes that studies on supplements in general consistently show a healthy diet gives better results than any supplement. The best diet for prostate health is one with plenty of whole fruits and vegetables, whole grains, nuts, olive oil and more fish than red meat.

If you have symptoms of BPH or you are concerned about your risk for prostate cancer, talk to your healthcare provider. Ask your provider if he or she recommends any supplements. Your provider may also suggest a prescription medication.

Two medications that have been consistently effective in studies are hormone blocking medications called alpha blockers and alpha inhibitors. A common brand of alpha blocker is Flomax. This drug relaxes muscles in the urinary tract to increase urine flow. A common alpha inhibitor is Proscar. This medication shrinks your prostate, and reduces the risk of prostate cancer by 25 percent.

The post Can Prostate Supplements Reduce Your Risk of Prostate Cancer? appeared first on University Health News.

Robotic prostatectomy is used to treat prostate cancer. A man’s prostate gland is about the size of a walnut and it sits underneath the bladder. The main function of the prostate is to make ejaculation fluid. Prostate cancer is the most common cancer in men, but not all men need a prostatectomy.

Who Needs a Prostatectomy?

Prostate cancer is usually a slow growing cancer. If you have this type of prostate cancer, you and your doctor may decide to watch the cancer by doing blood tests, prostate exams, and prostate biopsy. In many cases, surgery is never needed.

Some prostate cancers grow quickly. These cancers can cause death if not treated. In fact, prostate cancer is the second leading cause of cancer deaths in men. Cancers that grow quickly are called aggressive. When you have a biopsy to diagnose prostate cancer, the cells will be examined and given a score for aggressiveness. This is called a Gleason score. A Gleason score less than 6 is a slow growing cancer. A score of seven is in the middle, and a score of 8 to 10 is aggressive. Prostatectomy may be the best treatment for an aggressive cancer.

What Happens During a Robotic Prostatectomy?

During a robotic prostatectomy, the surgeon will control robotic arms from computer controls.

You will be asleep under general anesthesia. Your surgeon will make 5 keyhole incisions in your lower belly. A robotic camera will be placed through one incision, and thin surgical arms will be placed through the others. Your surgeon will sit at the control console and maneuver the camera and robotic arms.

During the procedure, the camera will give your surgeon a clear view that can be magnified up to 15 times what would be seen without magnification. Using the surgical arms, tiny blood vessels and nerves can be avoided and spared. After freeing the prostate from the surrounding tissue, it is pulled out through one of the key holes.

Benefits of Robotic Surgery Over Open Surgery

Robotic arms are steadier than any human hand. The “wrists” of a robotic arm can move in all directions and angles. These advantages along with the magnified view result in these advantages compared to traditional open prostatectomy:

• Less bleeding
• Less pain after surgery
• Time spent in hospital is as short as one or two days
• Faster recovery at home and 90% of patients return to regular activities in only two to three weeks
• Less need for narcotic pain medication

What Are the Risks of Robotic Prostatectomy?

The risks of robotic prostatectomy are about the same as with an open prostatectomy. The two biggest risks are leaking of urine and erectile dysfunction (ED). Leaking of urine – called urinary incontinence – usually occurs in the days after surgery but gradually improves. Over 95 percent of men will regain good bladder control. ED is not being able to get or keep an erection. The likelihood of ED after surgery depends on a man’s age and how sexually active he was before surgery. Most men experience only temporary ED.

What Are the Warning Signs of Prostate Cancer?

Risk factors for prostate cancer include age, family history, race, and obesity. You may be at higher risk for prostate cancer if you are over age 50, have a family history of prostate cancer, are overweight, or if you are a Black man. See your doctor if you have any of these symptoms:

• Trouble passing urine
• A weak flow of urine
• Blood in your urine or semen
• Pain in your bones
• Unintentional weight loss

To learn more about prostate health and the latest breakthroughs and procedures, see our latest report Prostate Health written by the editors at Men’s Health Advisor in cooperation with Cleveland Clinic.

The post What Is Robotic Prostatectomy & The Advantages of Robotic Surgery appeared first on University Health News.

Further complicating the screening process is that several medications and a number of other modifiable factors may alter the results of the PSA lab test, leading to inaccurate readings that may overestimate or underestimate your risk of having prostate cancer found on a biopsy.

PSA is a liquid protein produced by the prostate that helps liquefy semen and is crucial to successful natural conception. The prostate normally secretes a small amount of PSA into the blood. The PSA lab test simply analyzes your blood to see how much PSA it contains. PSA is measured in nanograms (one-billionth of a gram) per milliliter (one-thousandth of a liter). The PSA lab test results are used to help assess a man’s need for a prostate biopsy, which is necessary to diagnose prostate cancer.

What Affects the PSA Lab Test and PSA Levels?

A number of factors are known to affect, to varying degrees, your PSA levels:

1. Age

PSA levels, on average, rise as men get older, possibly because the prostate leaks more PSA into the bloodstream.

2. Benign prostate enlargement (BPH)

BPH is a non-cancerous enlargement of the prostate that occurs with age. As men get older, the risk of BPH rises.

3. Prostatitis

This prostate disorder is an infection or inflammation of the prostate. It also can cause PSA elevations. (See our post Prostatitis Causes More Than Pain.)

4. Urinary tract infections

UTIs can affect PSA levels.

5. Prostate procedures

Examples include prostate surgery, cystoscopy, or a prostate biopsy. Your doctor will inform you about how long you should wait after one of these procedures before undergoing a PSA test.

6. Sex

Ejaculation can cause the prostate to transiently leak more PSA into the blood for about one to two days.

7. Prostate stimulation

Prostatic massage or a digital rectal exam may cause minor PSA elevations.

8. Riding a bicycle

Bicycle riding for a long distance may cause temporary spikes in PSA, possibly because the seat applies pressure on the prostate. You may have to abstain from bicycle riding at least 24 hours before having your PSA measured.

9. Obesity

Being very overweight can result in lower PSA levels.

10. Medications

A number of medications can trigger lower PSA results. The medications that can affect PSA results are:

• 5-alpha reductase inhibitors—dutasteride (Avodart) and finasteride (Proscar)—which can reduce PSA levels by about 50 percent in many men who take them.
• Some herbal and dietary supplements
• Aspirin
• Statins
• Thiazide diuretics

So, if you choose to undergo PSA screening, it’s important to understand these factors that can influence your PSA lab test results and inform your physician if any of them apply to you.

Don’t Rely on PSA Levels Alone

Given the inexact nature of the PSA lab test and the various factors that can influence its results, experts recommend that the test be used in conjunction with a digital rectal exam (DRE). During that procedure, a doctor inserts a gloved finger into the rectum to feel the prostate through the rectal wall and find any lumps or other abnormalities that might indicate cancer. If you decide to be screened, ask for both tests, because that combination is least likely to miss cancer. DRE is usually done after your blood test to prevent falsely raising PSA from the exam.

For more on prostate health, see our special report written by the editors of Men’s Health Advisor with Cleveland Clinic: Prostate Health.

The post What Can Skew a PSA Test? These 10 Factors Can Affect Your Numbers appeared first on University Health News.

Studies show that PSA screening saves lives for people with prostate cancer, because it finds cancer early when it is most treatable. [1] Prostate cancer is the second leading cause of cancer deaths in men after lung cancer. [3] So, you would think all men should get PSA testing throughout their lives to screen for prostate cancer. Unfortunately, it is not that simple. [1-4]

What’s a Normal PSA?

The main problem with PSA is that it is not a very reliable test. There is no settled normal range that can tell if you have prostate cancer. [2] You can have a normal PSA and still have prostate cancer, and you can have an abnormal PSA and not have prostate cancer. In fact, most men with a high PSA don’t have prostate cancer. [1]

A PSA level goes up with prostate cancer but it also goes up with age. PSA can go up with two very common prostate conditions, benign prostatic hyperplasia (BPH) and inflammation of the prostate (prostatitis). [1-3] PSA can even go up after having sex or riding a bicycle. [2]

PSA is measured in nanograms per millimeter (ng/mL). Although most doctors would consider a PSA of less than 4 ng/mL normal, some doctors say anything over 2.5 is abnormal. This is what the studies say:

• About 15 percent of men with a PSA under 4 have prostate cancer.
• About 25 percent of men with a PSA between 4 and 10 have prostate cancer.
• About 50 percent of men with a PSA over 10 have prostate cancer. [2]

The Problem With Prostate Cancer Screening

The only way to diagnose prostate cancer is with a prostate biopsy. You would think it would be worthwhile to do PSA screening for all men and a prostate biopsy on every man with an abnormal PSA, but that is not the case. [1-4] Prostate biopsy has risks. It can cause bleeding, pain, urinary retention, and a urinary tract or prostate infection. [4] Since most men with a high PSA do not have prostate cancer, these risks are important to consider. [1-4]

There is also a problem with prostate cancer itself. Even if a biopsy shows prostate cancer, many men with prostate cancer will never have any serious problems from their cancer. They will die from something else. For these men, the treatment can be worse than the disease. Treatment can cause serious urinary and sexual problems. [1-4]

Because most men with a high PSA do not have prostate cancer and many men with prostate cancer do not need treatment, guidelines for PSA screening rely heavily on a discussion of the risks and benefits with your doctor. [1-5]

PSA Screening Recommendations

Different medical organizations have slightly different guidelines. These are the guidelines for PSA screening from the  American Urological Association, the specialists who diagnose and treat prostate cancer:

• PSA is not needed under age 40.
• PSA is not needed for men ages 40 to 54 unless they are at higher risk for prostate cancer. Being African American or having a family history of prostate cancer puts you at higher risk.
• PSA should be considered for men ages 55 to 69 after discussing the risks and benefits of the test and of prostate cancer treatment.
• PSA is not recommended for men age 70 or older. [5]

What Happens After a PSA Test? 

If you and your doctor decide to do a screening test and the test is normal, you may not need to think about another test for a few years. If the test is abnormal, you and your doctor will discuss the risks and benefits of further testing:

• You may have another screening test before or after your PSA called a digital rectal exam (DRE). During DRE, your doctor places a gloved finger into your anus to feel your prostate. If your prostate feels enlarged or abnormal, your doctor may recommend further testing or a biopsy.
• Further testing could include another PSA test or a more specialized PSA blood test that may tell your doctor more about your prostate cancer risk. There are many options including tests called prostate health index, PSA velocity, PSA density, free PSA and others.
• Further testing may include an imaging study (MRI or trans rectal ultrasound)) of your prostate. [2]
• Your doctor will consider any further testing, your PSA test, and your DRE, along with your age, overall health and your risk factors. You and your doctor should use this information to weigh the risks and benefits of a prostate biopsy. [1-4]

The bottom line on PSA as a screening test for prostate cancer is that it is still a valuable test when used along with your DRE, other tests, and your personal risk factors to help you and your doctor decide if you would benefit from a prostate biopsy. [1-5]

Other Uses for Prostate Specific Antigen Testing

Outside of prostate cancer screening, there are other uses for PSA testing. If you have had a biopsy that shows a slow growing prostate cancer, your doctor may advise watchful waiting. In this case, PSA testing may be done periodically to see if your cancer becomes more active. Any increase in PSA could be considered abnormal. If you have been treated for prostate cancer, periodic PSA testing may be done to see if there are any signs of cancer coming back. Any increase would be abnormal. [3]

If you have symptoms of prostate cancer, PSA testing may be done to find out if you have prostate cancer. When you already have symptoms, PSA is no longer considered a screening test. It is a diagnostic test. [3] Let your doctor know if you have any of these prostate cancer symptoms:

• Problems passing urine, like slow flow, increased frequency, or loss of control
• Blood in your semen or urine
• Trouble getting or keeping an erection
• Weakness or numbness in your legs or feet
• Bone pain in your hips, back, or ribs [6]

RECOMMENDED FOR YOU

• How to Avoid Prostate Cancer
• 12 Risk Factors for Prostate Cancer
• Beyond the PSA Test: Options for Screening
• It Isn’t Time to Abandon the Prostate-Specific Antigen Test Just Yet
• PSA Lab Test Results: These 10 Factors Can Affect Your Numbers 
• An Abnormal PSA Result: What Comes Next?
• Are You Keeping Tabs on Your PSA Levels?

SOURCES

1. Memorial Sloan Kettering Cancer Center, Prostate Cancer Screening
2. American Cancer Society, Screening Tests for Prostate Cancer
3. American Society for Clinical Chemistry, Lab Tests Online, Prostate Specific Antigen (PSA)
4. CDC, Prostate Cancer, What Are the Benefits and Harms of Screening? 
5. American Urological Association, Early Detection of Prostate Cancer (2018)
6. American Cancer Society, Signs and Symptoms of Prostate Cancer

The post PSA: What’s a Normal Prostate Specific Antigen? appeared first on University Health News.

The National Institute of Health (NIH) has divided prostatitis into four categories: acute bacterial prostatitis (category I), chronic bacterial prostatitis (category II), chronic prostatitis/chronic pelvic pain syndrome (category III), and asymptomatic inflammatory prostatitis (category IV).

All forms of prostatitis are non-cancerous conditions. Some studies have suggested a possible link between prostatitis and prostate cancer but others studies have shown no association between the two conditions. Research investigating whether or not there may be a relationship is ongoing.

Men with asymptomatic inflammatory prostatitis (category IV), as the name implies, do not experience any symptoms. Men suffering from one of the other three categories often experience one or more of the following prostatitis symptoms:

• Urinary Frequency: Men with prostatitis often experience the need to urinate often.
• Urinary Urgency: Prostatitis can cause the sensation of an urgent, immediate need to urinate.
• Urinary Retention: Symptoms related to the obstruction of urine flow caused by the inflamed prostate often occur with prostatitis. These can include difficulty initiating urination, a weakened urine stream, and the inability to completely empty your bladder.
• Painful Urination/Painful Ejaculation: Prostatitis can cause pain both during urination and ejaculation.
• Lower Abdominal Pain/Perineal Pain: Prostatitis can cause pain in the lower abdomen, groin, and/or the perineum, the area between the scrotum and rectum.

Men with acute bacterial prostatitis will additionally often experience systemic symptoms such as fever and chills and will notice that their symptoms begin suddenly and intensely. Men with chronic bacterial prostatitis may have low-grade fevers but their symptoms often are much milder than those experienced with acute bacterial prostatitis. Men with chronic prostatitis/chronic pelvic pain syndrome may have symptoms that range in severity and wax and wane unpredictably.

Acute Bacterial Prostatitis (ABP)

Acute bacterial prostatitis is the least common form of prostatitis, accounting for less than 5 percent of prostatitis cases. It occurs when bacteria infect the prostate gland causing the sudden onset of painful inflammation. It is most often caused by the bacteria Escherichia coli (E.coli), a common cause of urinary tract infections, but it can be caused by many other bacteria including sexually transmitted organisms such as Chlamydia trachomatis and Neisseria gonorrhea.

Chronic Bacterial Prostatitis (CBP)

Chronic bacterial prostatitis is caused by the same organisms that can cause acute bacterial prostatitis and many of the symptoms are the same, although the symptoms are generally milder in CBP and last longer.

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)

CPPS is the most common form of prostatitis, accounting for 90-95 percent of all prostatitis cases. Some estimates suggest that 10 to 15 percent of U.S. men suffer from chronic pelvic pain syndrome. CPPS can be a frustrating condition for both patients and physicians because the cause is often unknown and treatment options are limited. It is thought that CPPS might possibly be due to an undetectable bacterial infection, an immune response to a past infection, or pelvic nerve impairment.

Asymptomatic Inflammatory Prostatitis

This is the rarest form of prostatitis and is usually an incidental discovery found when a doctor is testing for another urinary tract or reproductive disorder such as infertility. The only finding in asymptomatic inflammatory prostatitis is the presence of white blood cells in the urine or semen after prostatic massage. All other laboratory and physical exam tests are normal and the patient is always asymptomatic. No treatment is required and there are no known complications.

The post Prostatitis Symptoms: What You Should Know appeared first on University Health News.

Your doctor may elect to biopsy your prostate based on whether or not you have possible symptoms of prostate cancer, on your PSA levels, and/or on your digital rectal exam (DRE) findings.

There are differing opinions among professional medical organizations about whether performing a biopsy based on abnormal PSA results alone is appropriate. A number of other tests (e.g., PCA3 and PSA velocity) have been developed as screening tools in an effort to either avoid unnecessary biopsy or improve prostate gland cancer detection. Most experts agree, however, that there isn’t enough evidence yet to make them part of a routine screening process. You and your healthcare provider should discuss these options prior to a biopsy.

If prostate cancer is suspected, your doctor will perform a biopsy guided by transrectal ultrasound. A small ultrasound probe is inserted into the rectum to guide the biopsy needle to the biopsy locations. The needle is inserted through the wall of the rectum into the prostate gland to retrieve small pieces of tissue. Typically, at least 12 samples of tissue are taken from different areas of the prostate. This can be done on an outpatient basis and is usually a brief procedure.

The tissue samples are sent to a pathology lab for examination. If cancer cells are evident, they typically are graded using a system called the Gleason score, an indicator of how likely the cancer is to spread. Tissue from two different parts of the prostate gland are examined and given a score from 1 to 5; the numbers from each part are then added together to create the Gleason score. A lower score suggests a lower likelihood of spreading, while a higher score suggests a greater chance.

Once a diagnosis of prostate cancer has been made, additional tests will be performed to determine whether or not the cancer has spread beyond the prostate. These test results, along with the Gleason score, will be used to assign the disease a prostate cancer stage. The system most often used is the American Joint Committee on Cancer “TNM” system, which provides a Roman numeral staging score from I-IV based on the size of the primary Tumor, whether or not there is lymph Node involvement, whether the tumor has Metastasized, the PSA level at diagnosis, and the Gleason score.

First line of defense in detecting prostate cancer is the digital rectal exam (DRE), plus a measurement for prostate specific antigen (PSA) in the blood. These steps are controversial, however, because some contend PSA has led to over-diagnosis and debilitating over treatment for cancers that aren’t lethal.

The more advanced the cancer, the higher the TNM stage number. For example, in stage I prostate cancer, the cancer has not spread beyond the prostate itself while in stage IV prostate cancer, the cancer has spread beyond the prostate, either to nearby organs and/or lymph nodes or to more distant sites in the body.

Tests performed to help stage the cancer may include:

• Computed Tomography (CT): CT scans are used to look for evidence of metastasis, particularly to lymph nodes.
• Magnetic Resonance Imaging (MRI): MRI is also used to look for evidence of metastasis.
• Bone Scan: Since bone is one of the most common places for prostate cancer to metastasize, bone scans are often used to look for disease spread.
• Positron Emission Tomography (PET): PET scans can also be used to look for evidence of metastasis. They are particularly helpful in looking for evidence of disease recurrence in men who have been previously treated for prostate cancer.
• Lymph Node Biopsy: Knowing whether or not your prostate cancer has spread to lymph nodes is an important part of determining what treatment regimen you should receive. Imaging tests such as CT scans can help provide information as to whether or not the lymph nodes are involved, but biopsying lymph nodes is the only way to definitively make this determination. If your doctor doesn’t anticipate surgery as a part of the treatment regimen, he may opt to biopsy your lymph nodes laparoscopically. In other situations, your surgeon may biopsy your lymph nodes during an operation to remove your prostate gland.

The post Prostate Gland Cancer: Testing and Diagnosis appeared first on University Health News.

In these asymptomatic men, prostate cancer is often detected during routine screening with tests such as a digital rectal exam, urinalysis, and possibly a prostate specific antigen (PSA) test by their healthcare professional. This is particularly true of men with early stage prostate cancer, but may also be true of men with more advanced cancer.

Other men with prostate cancer may experience symptoms ranging from mild to severe that may mimic symptoms of other prostate conditions, including benign prostatic hyperplasia/BPH (non-cancerous enlargement of the prostate gland) and prostatitis (inflammation of the prostate).

Some of these prostate cancer symptoms are more common than others and tend to occur in more localized prostate cancer (cancer limited to the prostate gland or adjacent tissues) while others are more likely to occur in men whose prostate cancer has spread or metastasized to other parts of the body. If you experience any of these symptoms, you should consult your healthcare provider immediately.

Common Prostate Cancer Symptoms

• Urinary frequency: Men with prostate cancer may feel the need to urinate more often, particularly at night.
• Urinary retention: Prostate cancer may cause the sensation of not being able to empty your bladder completely.
• Weak urinary stream: Some men with prostate cancer may feel that their urinary stream is diminished or that they dribble urine.
• Difficulty initiating urination: It may be difficult to begin urinating in some men suffering from prostate cancer.
• Painful urination: Urinating may cause pain or discomfort (dysuria) in some cases of prostate cancer.
• Blood in the urine: Prostate cancer can result in blood in the urine (hematuria) in some men.
• Painful ejaculation: Some men suffering from prostate cancer experience pain with ejaculation.

Other Prostate Cancer Symptoms

Some prostate cancer symptoms are less common and in some men may be associated with more advanced disease.

• Bowel problems: Because the prostate lies just in front of the rectum, prostate cancer that has caused significant enlargement of the prostate or that has spread into nearby tissues including the rectum, may cause intestinal problems such as constipation or diarrhea.
• Erectile dysfunction: Some men may experience impotence if the prostate cancer has affected nerves involved in an erection.
• Blood in the semen: The prostate gland secretes fluid that is part of semen. Cancer in the prostate may cause irritation and inflammation, leading to blood in the semen.
• Lymphedema: If the prostate cancer blocks flow of lymphatic fluid in lymph nodes or lymphatic vessels, men may experience swelling of the pelvic region or legs.
• Bone pain: When prostate cancer spreads, one of the tissues in the body that it often spreads to is bone. Pain in the back, hips, legs, or feet may result if the cancer has spread to bones of those regions.
• Unexplained bone fracture: Metastatic bone disease may result in fractures that occur with only very mild accidents or trauma that would normally not precipitate a break in bones.
• Numbness in the lower extremities: Prostate cancer that has metastasized to the spine may cause compression of nerves resulting in numbness or tingling of the hips, legs, or feet.
• Fatigue: Men with early stage prostate cancer may experience fatigue, but significant fatigue is more likely to occur with cancer that has spread.

If you experience any of these prostate cancer symptoms, you should consult your healthcare provider immediately. There are many tests and procedures available for prostate cancer diagnosis and many options for prostate cancer treatment.

Originally published in February 2016 and updated.

The post Prostate Cancer Symptoms: 15 Common (and Not-So-Common) Signs appeared first on University Health News.

While most men do not die from prostate cancer, it is the second leading cause of cancer-related death. Data from the National Cancer Institute estimates that 14 percent of American men will be diagnosed with prostate cancer during their lifetime. So, what is prostrate cancer?

There are two changes that can occur in the cells of the prostate that some research suggests might be precursors to prostate cancer. One of these is called high-grade prostatic intraepithelial neoplasia (PIN) in which the cells look abnormal but are not yet cancerous.

Twenty percent of men with high-grade PIN have cancer in another part of the prostate. Low-grade PIN is seen in half of all men by the age of 50 and does not necessitate any more aggressive monitoring. Proliferative inflammatory atrophy (PIA) is a condition in which the prostate cells are smaller than usual and have signs of inflammation. There is some evidence that having PIA might increase your risk of high-grade PIN or prostate cancer.

While researchers do not yet know exactly what causes prostate cancer, they have identified a number of risk factors for development of the prostate disease.

Risk Factors for Prostate Cancer

First line of defense in detecting prostate cancer is the digital rectal exam (DRE), plus a measurement for prostate specific antigen (PSA) in the blood. These steps are controversial, however, because some contend PSA has led to over-diagnosis and debilitating over-treatment for cancers that aren’t lethal.

There are a number of identified risk factors for prostate cancer, including:

• Family history: Having a first degree relative (father or brother) who has had prostate cancer increases your risk of the disease.
• Age: The risk of prostate cancer rises with increasing age.
• Race: African-American men have a higher risk of developing prostate cancer and dying from prostate cancer than men of other races.
• Obesity: Research has demonstrated an association between obesity and prostate cancer. Obese men appear to have an increased risk of developing aggressive prostate cancer and of dying from prostate cancer.
• Smoking: A history of smoking has been linked to an increased risk of aggressive prostate cancer in some studies. The relationship between smoking and prostate cancer risk appears to be dose-dependent such that men who smoke the most have the highest risk of developing aggressive prostate cancer.
• Diet: Some research has suggested that a diet rich in red meat or high-fat dairy products increases the risk of prostate cancer. Studies have also shown that men who took folate supplements and men who took vitamin E supplements alone have an increased risk of prostate cancer.
• Sleep disorders: There is some evidence that men who suffer from sleep disorders have an increased risk of developing prostate cancer. One study demonstrated this risk to be between 1.6 and 2.1 times greater and that the risk increased with the severity of sleep impairment.

If prostate cancer is suspected, your doctor will likely order a PSA test, which, along with a digital rectal exam, will help clarify your prostate cancer symptoms. But an elevated PSA result only means the process of dealing with your condition has just begun. If this initial screening goes beyond normal PSA levels, additional tools up to and including biopsy will be under consideration.

Originally published in March 2016 and updated.

The post What Is Prostate Cancer? appeared first on University Health News.

For example, if you have diabetes, managing your blood glucose levels is not only critical for your overall health, but may help prevent worsening of your ED. If you have cardiovascular disease, treatment for your abnormal cholesterol levels or heart function may impact your erectile dysfunction symptoms.

If you are suffering from erectile dysfunction, it is important to discuss it with your healthcare provider so that the underlying cause can be identified and treated.

Lifestyle Modifications for Erectile Dysfunction

There are some measures you can take in your daily life to lessen or eliminate erectile dysfunction causes and to treat and prevent it.

• Exercise: Physical activity is good for your overall health but can also impact ED by helping to treat underlying causes. Exercise can reduce stress, improve blood flow, help regulate blood glucose levels, and improve your heart function all of which can help treat ED.
• Reduce your alcohol intake: Alcohol consumption, particularly excessive alcohol consumption, is linked with ED. Limiting your intake can help restore normal erectile function.
• Avoid recreational drugs: Drugs such as marijuana, cocaine, and heroin can all cause ED.
• Address psychological issues: Getting treatment for medical conditions such as depression or anxiety can play a big role in ED treatment for people suffering from them. Similarly, seeking counseling for relationship problems or taking measures to reduce stress in your life may also be helpful if those problems are contributing to your ED.
• Erectile dysfunction exercises: Pelvic floor muscle exercises, sometimes called Kegel exercises, have been shown to help treat ED. In fact, one study in the UK demonstrated that 40 percent of men with ED regained normal erectile function after beginning a pelvic floor muscle exercise regimen. An additional 33 percent saw significant improvement in their ED with the exercises. Most of these exercises involve engaging the muscles that help you stop urinating or that prevent you from having a bowel movement despite having an urge.

Oral Medications for Erectile Dysfunction

Medical treatment for ED was revolutionized in 1998 with the FDA’s approval of the first phosphodiesterase type 5 (PDE-5) inhibitor, sildenafil (Viagra). PDE-5 inhibitors work by preventing the breakdown of cyclic guanosine monophosphate, a key part of the erection-producing nitrous oxide-CGMP pathway.

When a man becomes sexually aroused, this pathway is activated which facilitates blood flow into the penis that is necessary for an erection. PDE-5 inhibitors essentially enhance this pathway but do require sexual arousal to be effective; in other words, they do not work in the absence of sexual arousal or stimulation. There are currently four PDE-5 inhibitors FDA-approved for ED:

• Sildenafil ()
• Tadalafil (Cialis)
• Vardenafil (Staxyn, )
• Avanafil (Stendra)

Because Sildenafil has been available longer than any of the other PDE-5 inhibitors, its efficacy has been studied the most. Studies have reported that anywhere from 36 to 76 percent of men who took sildanefil have been able to achieve an erection at least once. All of these medications, however, have side effects, some of which are a consequence of their enhancement of the nitrous oxide-CGMP pathway that causes blood vessel relaxation. The most common of these are headache (16 percent), flushing (10 percent), and nausea (7 percent).

All of these medications are prescription only and should be monitored by your doctor as they can interfere with other medications including nitrate drugs such as nitroglycerin and can cause significant problems in men with blood pressure problems, liver disease, or kidney failure. Doctors caution against the use of so-called “herbal Viagra,” which are supplements containing ingredients that mimic the effects of PDE-5 inhibitors but which are not regulated by the FDA and which may cause serious problems in men, particularly those with contraindications for PDE-5 inhibitors.

Testosterone may be given orally to men whose ED is linked to low testosterone levels. Testosterone can also be administered through intramuscular injections or through transdermal patches.

Non-oral Medications for Erectile Dysfunction

Alprostadil is a medication sometimes used for ED as an injection into the penis (Caverject Impulse or Edex) or as a suppository (Muse) inserted into the urethra, the tube through which urine and semen are emitted. Aprostadil contains prostaglandin E1, a chemical that dilates blood vessels. The primary side effects of aprostadil are minor bleeding and the formation of fibrous tissue in the penis where it is administered.

Erectile Dysfunction Equipment or Devices

Some men may find relief of their ED with the use of a penis pump, also called a vacuum erection device, or from penile implants. Penis pumps work by placing a tube over the penis. Such devices help pull blood into the penis by means of an attached pump that creates a vacuum effect in the tube. Your healthcare provider can help you determine whether this is an appropriate option for you and can guide you to the model that might help you most.

The main components of penile implants are surgically inserted inflatable or non-inflatable rods. Inflatable implants account for 80 percent of implants used and involve inserting a pump into the scrotum and the inflatable rods into the shaft of the penis. Non-inflatable rods are semi-rigid rods devices inserted into the penis that can allow the penis to be directed up or down. Implants are typically only used for men who have failed other non-surgical treatment options.

Originally published May 2016.

The post Erectile Dysfunction Causes and Cures appeared first on University Health News.

Radical prostatectomy is the term used to describe surgical removal of the prostate and nearby tissue. There are two main surgical approaches used in radical prostatectomy: the open approach and the laparoscopic approach.

Open Approach to Radical Prostatectomy

The two open approaches used for removing the prostate gland involve making large incisions in either the lower abdomen or perineal region (the area between the scrotum and anus) while the patient is under general anesthesia.

These procedures are being performed less frequently because the recovery time, length of hospital stay, and blood loss associated with them are greater than for the newer laparoscopic approaches. This open approach to radical prostatectomy remains the preferred option, however, for men with very large prostates.

• Radical Retropubic Prostatectomy: In this procedure, the surgeon makes an incision from just below the navel to just above the pubic bone. He or she will remove the prostate as well as nearby lymph nodes to see if the cancer has spread to the lymph nodes. In some instances, a pathologist will examine the lymph nodes immediately to determine the presence or absence of cancer involvement as the surgeon may opt not to proceed with removal of the prostate if the cancer is more advanced than it was originally thought to be. In many instances, though, it will take several days to obtain the pathology report for the lymph nodes. A nerve-sparing technique, developed in an attempt to spare the nerves controlling bladder and erectile function, can be used in this type of prostatectomy to try to minimize the side effects of urinary incontinence and erectile dysfunction (ED).
• Radical Perineal Prostatectomy: This surgery involves removing the prostate through an incision between the scrotum and anus. Because lymph nodes cannot be biopsied and the nerve-sparing technique cannot be employed in this type of prostatectomy, it is typically only performed in men for whom a retropubic approach is contraindicated.

Laparoscopic Approach to Radical Prostatectomy

Beginning in 1999, surgeons in the U.S. began performing radical prostatectomies from a laparoscopic approach. This involves making several small incisions in the lower abdomen and using special surgical instruments including a laparoscope, a long thin instrument with a camera and light on the tip. Smaller incisions and less manipulation of nearby tissue result in a generally easier recovery than in an open approach, although their cancer cure rates are essentially identical.

There are two types of laparoscopic radical prostatectomies (LRP):

• Traditional Laparoscopic Radical Prostatectomy: Traditional LRP involves the surgeon directly manipulating the laparoscope and other surgical instruments to remove the prostate and lymph nodes. The nerve-sparing technique can be performed in LRP.
• Robotic-Assisted Laparoscopic Radical Prostatectomy: This procedure is a recent development in radical prostatectomy surgery. Using a robotic interface, the surgeon controls robotic arms that perform the surgery through the small incisions instead of the surgeon directly maneuvering the surgical tools.

Side Effects from Radical Prostatectomy

Despite the differences in recovery time, hospital length of stay, and blood loss between an open and laparoscopic approach to radical prostatectomy, the incidence of side effects appears to be the same for both. The most common side effects of radical prostatectomy impacting a man’s quality of life are:

• Urinary incontinence: Inability to control urinary flow can occur because of trauma or damage to the nerves involved in urination. The most common type of incontinence suffered by men after radical prostatectomy is stress incontinence in which men leak urine during activities that put “stress” on the muscular sphincter that keeps urine in the bladder. These activities can range from sneezing or coughing to exercising. Other men experience urge incontinence in which the need to urinate is sudden and urgent, or overflow incontinence in which they have difficulty emptying their bladder and may leak urine without having the sensation of needing to urinate. The good news is that incontinence issues typically resolve with less than 5 percent of men experiencing any permanent problems.
• Erectile dysfunction: The majority of men who undergo a radical prostatectomy experience some difficulty in achieving an erection after their surgery, which is thought to be mediated by injury to the nerves involved in erectile function. In many men, erectile function gradually returns to pre-operative status, especially in those who had a nerve-sparing approach performed, although it may take as long as two years. The use of medications, particularly phosphodiesterase-5 inhibitors (PDE-5), can significantly help many men regain erectile function following prostate surgery.

The post Prostate Cancer Therapies: Surgical Options appeared first on University Health News.