A Free Course on Undertanding Prostate Treatments
A common prostate cancer therapy should not be used in men whose cancer has not spread beyond the prostate, according to a new study led by researchers at Henry Ford Hospital.
The findings are particularly important for men with longer life expectancies because the therapy exposes them to more adverse side effects, and it is associated with increased risk of death and deprives men of the opportunity for a cure by other methods.
The research study has been published online in European Urology. The focus of the new study is androgen deprivation therapy (ADT), in which an injectable or implanted medication is used to disrupt the body’s ability to make testosterone. ADT is known to have significant side effects such as heart disease, diabetes, increased weight gain and impotence; however a growing body of evidence suggests ADT may in fact lead to earlier death.
Too many are getting unnecessary prostate treatment, UCLA study says
A UCLA study of U.S. men over 66 with slow-growing prostate cancer found that nearly half of those who are not expected to live long enough to benefit from surgery or radiation are nevertheless getting it, despite national guidelines to the contrary.
Because prostate cancer typically grows slowly, some men may never need treatment for it. That’s especially true for those with a life expectancy of less than ten years, due to other illness or advanced age.
The beginnings of prostate problems
BPH (benign prostatic hyperplasia) is a term used for an enlargement of the prostate gland which may or may not be associated with problems of urination. This occurs with such frequency that it may be considered physiological—”normal,” in the common language—aspect of aging among men. Beginning at about the age of 45 years, there is progressive increase in the incidence of BPH with each passing decade. Nearly half of all men in their mid-fifties have some enlargement of the gland. Nearly 80 percent of men over the age of 80 years have some degree of hyperplasia.
Many mechanisms have been proposed to explain the development of BPH. In the older medical literature, BPH was sometimes considered to be a tumor, a view that is seen as obsolete by all modern pathologists. Other older theories attributed prostate enlargement to inflammation and consequences of poor circulation. Pathology textbooks generally dismiss those ideas these days, though I do not how anyone can say inflammation does not cause the enlargement of the gland since the inflammatory process causes swelling and enlargement in all tissues. The analysis of the aggregate evidence, however, clearly supports the hormonal theory of BPH. Specifically, with increasing age there is a continuing drop in the testosterone (and other male androgenic influences) and relatively increasing estrogenic influences with resulting estrogenic dominance over male hormones. There is also evidence to suggest that the outer portion of the gland is testosterone-dependent while the inner portion (which causes more obstructive symptoms) is estrogen-dependent (Franks).
As for symptoms caused by BPH, since the prostate gland encircles the bladder neck and the urethra, not surprisingly obstruction to the outflow of urine of varying degrees occurs with BPH. Specifically, one or more of the following symptoms may be experienced by individual patients:
- Initial delay in beginning of urination;
- Weakening of the urinary stream;
- Thinning of the urinary stream;
- A sense of incomplete voiding;
- Double urination (a second urination occurring within minutes of the first one);
- Dribbling of urine; and
- Split urinary stream; and
- Urinary retention (inability to urinate).
The diagnosis of prostatic enlargement usually does not pose any difficulties. The increase in the size of the gland can usually be determined by one or more of the following methods:
- Digital rectal examination (DRE);
- Prostate ultrasound;
- MRI examination of the prostate gland;
- Direct visualization of the enlarged middle lobe of the prostate gland infringing on the urinary outlet with cystoscopy, a procedure in which the inside of the urinary bladder is examined by a urologist with a special instrument called uretheroscope.
Relationship Between BPH and Sexual Dysfunction
As discussed earlier, I consider the prostate gland as an essential sex organ. All disorders of this gland should be expected to cause a variety of sexual dysfunctions. The issue of the impact of benign prostatic hyperplasia on sexual function was recently discussed in the January 28, 2006 issue of Clinical Therapies by researchers at Brown University. They reported the following data concerning incidences of erectile dysfunction (ED) and ejaculatory dysfunction (EjD):
Incidence of Erectile dysfunction (ED)
- Surgery, 10%
- Minimally invasive therapies, 1%-3%;
- Pharmacologic monotherapy or combination therapy, 3%-10%
Incidence of ejaculatory dysfunction (ED)
- Surgery, 65%;
- Minimally invasive therapies, 4%-16%;
- Pharmacologic monotherapy or combination therapy, 0%-10%).
Among pharmacologic therapies for BPH, the frequency of EjD appears to be greater with Flowmax (tamsulosin, 10%) than with other alpha(1)-blockers (0%-1%) or the 5-alpha-reductase inhibitor finasteride (4%), based on data from a single-arm meta-analysis conducted by the American Urologic Association (AUA).
Preserving Prostate Health
For the prostate gland, regular and active sexual activity is one the best approaches for preserving prostate health.
Beyond sexual activity I offer the following guidelines for nutritional and herbal (phytofactor) measures for prostate health.
- Green tea is my top choice based on available historical, experimental, and clinical data.
- Pomegranate taken in small amounts (one piece (or three to four ounces) three times a week. A UCLA study showed that 8 ounces of the juice contain 1.5 mmol of total polyphenols, and lengthen the doubling time of prostate cancer cells in animal model (slowed the rate of cancer cell growth) from 15 months to 37 months.
- Blueberries in season, four to six ounces in season.
- Fermented soybean products as replacement for wheat products, when possible;
- Lycopene from tomatoes and other food items.
- Nutritional / herbal formula to be taken four to five times a week (See table below for the composition of the formula sued at the institute.
Composition for the Prostate Gland Formula In use At the Institute
African pygeum extract 100 mg
Saw palmetto 150 mg
L-alanine 25 mg
L-glycine 200 mg
L-glutamic acid 300 mg
Zinc 40 mg
Manganese 10 mg
Pantetheine 20 mg
Lactoferrin 2 mg
Other elements which may be considered include: quercitin, trimethylglycine, grapeseed extract, lycopene, and nettles.
Treatment Options for BPH
All of the elements presented in the preceding section for prostate health are directly applicable to the treatment of BPH. However, only about one-half of individuals with well-developed BPH can expect to control their symptoms and shrink their enlarged glands with those measures. The following are my guidelines for individuals who fail to respond well to natural measures:
- Transurethral resection of the prostate (TURP)
- Transurethral microwave thermotherapy (TUMT), also called prostate hyperthermia)
- Open prostatectomy for massively enlarged glands
- Alcohol injections and laser therapies are uncommon and not fully evaluated options.
- Prolonged catheterization (fraught with the danger of recurrent urinary tract infections and so not recommended)
The procedure for prostate hyperthermia(TUMT) may appear to be less invasive than the TURP prcedure but is not necessarily the case. The week in which I finished the draft of this segment, I saw two men with BPH. One had hyperthermia procedure and had to wear a catheter for two weeks. The second man underwent a TURP procedure and left the hospital on the second day without a catheter. The wound healing after both types of procedures proceeds at the same rate. Thus, I consider both TUMT and TURP procedures good options. My choice will depend upon the level of expertise and procedural skill of the operating surgeon.
Lowering PSA by blocking an enzyme called 5-alpha reductase, which converts testosterone into a more potent androgenic hormone called dihydrotestosterone, abbreviation. Avodart lowers PSA by blocking both type 1 and type 2 of the enzyme 5-alpha reductase. Usual dose 0.5 mg for BPH, 5 mg for lowering PSA. Caused death of both androgen-dependent (LNCaP) and androgen-independent (PC-3) cell lines. Proscar lowers PSA by blocking only type 2 of the enzyme 5-alpha reductase.
. Alpha-blockers (Flowmax)
. 5-alpha-reductase inhibitors (Avodart, Proscar)
. Alfuzosin, doxazosin, terazosin, tamsulosin, dutasteride, and finasteride
. Combined therapy with alpha-blockers and 5-alpha-reductase inhibitors
For the general interest of reader, I include here some text giving the position taken by the British Journal of Urology (Int) on the matter. In its May 2006 issue, the journal published a position paper authored by researchers at the Department of Health Policy and Administration, School of Public Health, and Division of Urology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina. It included the following text:
What is the ‘best’ treatment depends on the value that an individual and society place on costs and consequences. alpha-Blockers are less expensive than the alternatives, and are effective at relieving patient-reported symptoms. Unfortunately, they have little effect on clinical outcomes and have the highest BPH progression rate. Other treatments have lower disease progression and better clinical outcomes, but are more expensive and entail more invasive treatments, and/or more uncertainty.
CONCLUSIONS: Treatment decisions are made using a variety of information, including the cost and consequences of treatment. The best treatment depends on the patient’s preference and the outcome considered most important. alpha-Blockers are very effective at treating urinary symptoms but do not improve clinical outcomes, including disease progression, relative to other treatments. TURP remains the ‘gold standard’ for surgical procedures. The desire to avoid TURP or the 2 weeks of catheterization associated with TUMT might affect a patient’s treatment decision when symptoms are severe. Therefore, more information about patient preferences and risk aversion is needed to inform treatment decision-making for BPH.
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