Archive for February, 2015

PSA Testing For Prostate Cancer-New Recommendations For 2015

February 16, 2015

In 2012 the United States Task Force released guidelines for PSA testing for prostate cancer that stated that no man should be tested for prostate cancer with a PSA test since there was far too many man who were over-diagnosed and who had treatment and complications from the treatment and that the cancer was so slow growing that few men would die of their prostate cancers.

Two physicians’ groups are now recommending informed decision-making when it comes to screening for prostate cancer. This is in line with American Cancer Society guidelines for early detection of prostate cancer.

The American Urological Association (AUA), the leading organization representing urologists, is recommending more moderate use of prostate cancer screening tests.

In its new guidelines, the AUA recommends that men ages 55 to 69 discuss the benefits and harms of prostate cancer screening with their doctors before deciding whether to be screened. It recommends against screening for men younger than 55 who are at average risk, as well as for men 70 and older.

The American College of Physicians (ACP) released a similar guidance statement in April 2013. The ACP says men between the ages of 50 and 69 should discuss the limited benefits and substantial harms of the prostate-specific antigen (PSA) test with their doctor before undergoing screening for prostate cancer. The guideline says only men between the ages of 50 and 69 who express a clear preference for screening should have the PSA test.

These new recommendations are closer to those of the American Cancer Society and several other groups issued in recent years. The American Cancer Society recommends that men discuss the possible risks and benefits of prostate cancer screening with their doctor before deciding whether to be screened. The discussion about screening should take place starting at age 50 for men who are at average risk of prostate cancer and expect to live at least 10 more years. It should take place at age 40-45 for men who are at higher risk, this includes African-American men and men who have a father or brother diagnosed with prostate cancer.

The discussion with the doctor should include an explanation to men of the uncertainty of the PSA test, potential harms from the prostate biopsy and treatments such as surgery and radiation, and potential benefits of PSA screening. Use of this test should be a decision made by the individual patient in collaboration with his healthcare provider.

Some limitations of screening

Screening looks for disease in people who have no symptoms. The main goal of prostate cancer screening is to reduce deaths due to prostate cancer. But the studies showed that the number of men who avoided dying of prostate cancer because of screening after 10 to 14 years was very small.

And screening isn’t perfect. Sometimes screening misses cancer, and sometimes it finds something suspicious that turns out to be harmless. The PSA test often produces false-positive results. For example men with an enlarged prostate gland or men with an infection of the prostate gland can have an elevated PSA level. Also, there aren’t reliable tests yet to tell the difference between prostate cancer that’s going to grow so slowly it will never cause a man any problems, and dangerous or aggressive prostate cancer that will grow quickly. Treatments for prostate cancer can have urinary, bowel, and sexual side effects that may seriously affect a man’s quality of life.

Bottom Line: The PSA is not a perfect test. It is inexpensive and it is non-invasive. It is useful as a baseline test and can help a man decide if he should proceed to a biopsy or to have treatment for his cancer. A thorough discussion between the man and his doctor is the best recommendation that I can provide for all men who are concerned about prostate cancer.

Elevated PSA Linked to Shiftwork

February 16, 2015

Men who work night shifts or rotating shifts are more likely to have elevated PSA levels than men who do not.
In an analysis of data from the National Health and Nutrition Examination Survey (2005-2010), Erin E. Flynn-Evans, PhD, of Brigham and Women’s Hospital in Boston, and colleagues found shiftworkers had a 2.6 times increased risk of an elevated PSA (4.0 ng/mL or higher) compared with non-shiftworkers after adjusting for confounders.
The researchers, who published their findings online ahead of print in the Journal of the National Cancer Institute, concluded that sleep or circadian disruption is associated with elevated PSA, indicating that shiftworking men likely have an increased risk of developing prostate cancer.
A previous prospective cohort study of Japanese rotating-shift workers demonstrated that, compared with day workers, rotating-shift workers had a significant threefold increased risk of prostate cancer after adjusting for age, family history of prostate cancer, and other potential confounders, according to a report in the American Journal of Epidemiology (2006;164;549-555).

Take Home Message: If you are caring for a middle age man who does shift work, it is a good idea to encourage him to get a PSA and a digital rectal exam annually.

More FAQs From My Patients

February 16, 2015

I have a high cholesterol level. Is there anything I can do to lower the cholesterol level besides medications, i.e., statins?
Yes, there are cholesterol lowering foods that are effective and have absolutely no side effects. These include:
Soluble fiber of 25gms each day is helpful and good for the colon as well. Good sources of soluble fiber include legumes such as peas and beans; cereal grains such as oats and barley and vegetables and fruits such as carrots, apples, and dried plums (prunes).
Nuts to the rescue. Although nuts are high in fat, the fats are predominantly monounsaturated and polyunsaturated, which are known to decrease LDL cholesterol levels or bad cholesterol. By eating a daily helping of nuts — about 2.4 ounces — results in an average 5% reduction in total cholesterol concentration. Nuts that will help lower LDL cholesterol levels include almonds, walnuts, peanuts, pecans, macadamias and pistachios.
Plant sterols and stanols, plant compounds that are structurally similar to cholesterol, partially block the absorption of cholesterol from the small intestine. They lower levels of LDL cholesterol without adversely affecting high-density lipoprotein (HDL or “good”) cholesterol levels. Plant sterols and stanols, plant compounds that are structurally similar to cholesterol, partially block the absorption of cholesterol from the small intestine. They lower levels of LDL cholesterol without adversely affecting high-density lipoprotein (HDL or “good”) cholesterol levels.
So you can begin by decreasing your consumption of red meat, butter, and high cholesterol containing seafood such as crayfish (heaven forbid!) shrimp and lobster and try these other non-medical options. If these do not work, then talk to your doctor about medication.

I am thinking of having a vasectomy. Is there any risk of erectile dysfunction or impotence?
No, you have nothing to worry about. A vasectomy ONLY prevents the sperm from entering into the ejaculate or seminal fluid. It does not affect the testosterone level or the ability to engage in sexual intimacy. If your erections are good before the vasectomy, they will remain just like they were prior to the vasectomy. So it is safe to proceed with the “prime cut”!

I am a man 78 years of age. Do I need to have a PSA test for prostate cancer?
No, the American Cancer Society and the American Urological Association do not recommend screening for prostate cancer with the PSA test in men more than 75 years. Cancer screening tests — including the prostate-specific antigen (PSA) test to look for signs of prostate cancer — can be a good idea in younger men between 50-75 but not in men over age 75. A normal PSA test, combined with a digital rectal exam, can help reassure you that it’s unlikely you have prostate cancer. But getting a PSA test for prostate cancer is not be necessary for men 75 and older.

I am 40 years of age and ate some red beets. My urine turned red. Is that normal after consuming red beets?
Usually red urine after red beet consumption is a result of a pigment, betalain, in the red beets and is nothing to worry about. However, if the red persists more than 24 hours after consuming the beets, then it is important to see your physician and have a urine examination. When the red color persists, this is referred to as hematuria. Hematuria is a clinical term referring to the presence of blood, specifically red blood cells, in the urine. Whether this blood is visible only under a microscope or present in quantities sufficient to be seen with the naked eye, hematuria is a sign that something is causing abnormal bleeding in the patient’s genitourinary tract. For more information on hematuria, please go to my website: http://neilbaum.com/articles/hematuria-blood-in-the-urine

New Long Acting Injection For Low Testosterone Levels in Men

February 16, 2015

Many of you may have heard about a new long acting form of injectable testosterone that is available in the US. Known as Aveed is an oily injections that contain 1000mg of testosterone undecanoate. This new preparation allows the man with low T to drastically reduce the number of injections to approximately four per year.
Previously the only other option for long lasting testosterone delivery was the implant, Testopel. This is a procedure where local anesthetic is generally applied to an area of skin, usually on the abdomen or buttock, where the pellets are placed. A number of small pellets are then placed under the skin. These are expected to last four to six months.

Some men who are not using implants are using the injectable forms of testosterone known as testosterone cypionate. These injections are generally injected into the upper arm or buttocks every ten days to three weeks depending on your current dosage and testosterone levels.

As with all medications however, there are side-effects. Many of you would be aware of the patient leaflet supplied with all vials of testosterone that indicate possible side-effects. Some of the common side effects include diarrhea, leg pain, dizziness/headache, breathing problems, acne, itching, and breast-pain and breast enlargement. Some of the other effects known to occur in this preparation included weight gain, muscle cramps, nervousness, hostility, depression, sleep apnea, water retention, skin conditions and balding.

This, of course, does not mean that these symptoms will occur in all individuals who use the preparation. It is, however, always wise to consider the options available to you. It is most important to inform your doctor of any medical issues or concerns you may have so that the most suitable preparation can be chosen for you.

Bottom Line: Low T affects millions of American men. A new treatment option is the long acting injection of Aveed with a length of action of 10-12 weeks. For more information ask your doctor.

Valentine’s Day Present From Dr. Baum-How To Improve Your Erections

February 14, 2015

Valentine’s Day is a perfect day to speak about sexual intimacy. Lots of men have trouble or difficulty getting an erection. Here’s five suggestions that don’t require any medication you might consider. Happy V.D. and I’m not referring to a sexually transmitted disease! ☺

Erectile dysfunction (ED) can occur for many reasons. Sometimes it is as simple as the side effect of a particular medication. But for roughly 75% of men, the cause is more complex. ED may result from vascular disease, neurological disease, diabetes, or prostate-related treatments or surgeries.

Whether you currently suffer from ED or are hoping to sidestep this condition, try these tips for better health and a better sex life.
Start walking. According to one Harvard study, just 30 minutes of walking a day was linked with a 41% drop in risk for ED. Other research suggests that moderate exercise can help restore sexual performance in obese middle-aged men with ED.
Eat right. In the Massachusetts Male Aging Study, eating a diet rich in fruit, vegetables, whole grains, and fish — with fewer red and processed meats and refined grains — decreased the likelihood of ED. Another tip: a chronic deficiency in vitamin B12 may contribute to erectile dysfunction. A daily multivitamin and fortified foods are the best bets for those who absorb B12 poorly, including many older adults.
Pay attention to your vascular health. High blood pressure, high blood sugar, high cholesterol, and high triglycerides can all damage the arteries in the heart (causing heart attack), in the brain (causing stroke), and leading to the penis (causing ED). Low levels of HDL (good) cholesterol and an expanding waistline also contribute. Check with your doctor to find out whether your vascular system — and thus your heart, brain, and penis — is in good shape or needs a tune-up through lifestyle changes and, if necessary, medications.
Size matters, so get slim and stay slim. A trim waistline is one good defense – a man with a 42-inch waist is 50% more likely to have ED than one with a 32-inch waist. Getting to a healthy weight and staying there is another good strategy for avoiding or fixing ED. Obesity raises risks for vascular disease and diabetes, two major causes of ED. And excess fat interferes with several hormones that may be part of the problem as well.
Move a muscle — but we’re not talking about your biceps. A strong pelvic floor enhances rigidity during erections and helps keep blood from leaving the penis by pressing on a key vein. In a British trial, three months of twice-daily sets of Kegel exercises (which strengthen these muscles), combined with biofeedback and advice on lifestyle changes — quitting smoking, losing weight, limiting alcohol — worked far better than just advice on lifestyle changes.

Bottom Line: Good health means satisfying sexual intimacy. There’s a lot you can do yourself to keep you active in the sack! Happy Valentine’s Day.

Taken from Harvard HealthBeat, February 14, 2015

Non Medical Solutions for Erectile Dysfunction

February 10, 2015

Men suffering from sexual dysfunction can be successful at reversing their problem, by focusing on lifestyle factors and not just relying on medication.

In a new paper published in the Journal of Sexual Medicine, researchers highlight the incidence of erectile dysfunction and lack of sexual desire among men aged 35-80 years.
Over a five-year period, 31% of the 810 men involved in the study developed some form of erectile dysfunction.

Sexual relations are not only an important part of people’s well-being. From a clinical point of view, the inability of some men to perform sexually can also be linked to a range of other health problems, many of which can be debilitating or potentially fatal.

The major risk factors for this are typically physical conditions such as high blood pressure, diabetes and side effects from commonly used medications. Other risk factors include being overweight or obese, a higher level of alcohol intake, having sleeping difficulties or obstructive sleep apnea, and age.

Many of these risk factors affecting men are modifiable thus offering men an opportunity to do something about their condition. Even when medication to help with erectile function is required, it is likely to be considerably more effective if lifestyle factors are also addressed.

Erectile dysfunction can be a very serious issue because it’s a marker of underlying cardiovascular disease, and it often occurs before heart conditions become apparent. Therefore, men should consider improving their weight and overall nutrition, exercise more, drink less alcohol and have a better night’s sleep, as well as address risk factors such as diabetes, high blood pressure and cholesterol.
This is not only likely to improve their sexual ability, but will be improve their cardiovascular health and reduce the risk of developing diabetes if they don’t already have it.

Bottom Line: Lifestyle changes can significantly improve a man’s overall health as well as his erections. So get moving, watch your diet, and make every effort to control your blood glucose and blood pressure.

The Enlarged Prostate Gland-What You Need To Know

February 10, 2015

The enlarged prostate gland affects 13 million American men and affects their quality of life. This blog will discuss the symptoms of the enlarged prostate gland and treatment options that you might consider if you have urinary tract symptoms.

One in every six men above the age of 50 suffers from prostate problems. Prostate is the walnut-shaped gland between urinary bladder and urinary passage. Enlarged prostate is a common problem as men become older. Also, fifty per cent of men over the age of 50 show signs of prostate enlargement. By the age of 70, about 80 per cent of men have enlarged prostates. And while this problem is becoming very common, often men do not identify it as a crisis and approach doctors for help and just believe it is a normal part of the aging process. As a result then, there is an increased risk of kidney failure and prostate cancer.
Men suffering from prostate problems are often not willing to discuss their problems till it reaches a stage where they can’t take the pain and suffering any longer. Early symptoms of the burning sensation, frequent and urgent need to urinate and also pain in the lower abdomen and back are not taken seriously.
The early symptoms can be treated with medicines. Often men do not come in at early stages either because they fail to identify the problem or are not willing to discuss the problems. It is only when they suffer from getting up multiple times each night and frequent urinary tract infections do they visit the doctors.

The level of Prostate-Specific Antigen (PSA) is a blood test done frequently. This test is done to identify the risk of cancer. If the PSA levels are under 4 it is normal and is merely a sign of enlarged prostate. If it is more than four then there is a risk of prostate cancer. Surgery to remove the prostate is not recommended till there are severe complications or there is a high risk of cancer. The first line of treatment is medicines and often patients respond well to it. However, these medications are often associated the sexual side effects such as retrograde ejaculation or dry ejaculation where the semen\sperm goes back into the bladder at the time of orgasm or erectile dysfunction. Minimally invasive surgery can also be done through microwave or laser where high-energy is used to remove prostate tissues. The other procedure or transurethral resection of the prostate (TURP) is to cut the prostate tissues into small pieces through a tube inserted into the penis and remove them from the body. This latter technique requires a general anaesthesia, a catheter for several days after the procedure, and a hospital stay. Nearly all of the men who have the TURP will have sexual side effects following surgery.

The problem of prostate enlargement is common in men and is largely due to the natural aging process. It is not due to any genetic predisposition nor is it related to lifestyle.

Now there is a new treatment option that does not require medication, hospital admission or a catheter after surgery. This is the UroLift which can be accomplished in the doctor’s office or in the one-day stay area of hospital. The UroLift consists of an implant that pins open the prostate gland and makes urination easier and reduces the urinary symptoms. This procedure is covered by most insurance companies and Medicare.

Bottom Line: The enlarged prostate gland affects millions of American men. Help is available. Speak to your doctor to find a solution if you have symptoms of frequent urination, urgency of urination, painful urination, or getting up at night to urinate.

A Walk A Day, and Not An Apple, Keeps the Doctor Away

February 10, 2015

The baby boomers have arrived in large numbers. They are taking responsibility for their health and are eager to stay well and out of the doctor’s office. This blog will discuss the importance of exercise, even walking, to make you healthy and well. This blog will emphasize exercise and not weight loss as the road to good health and longevity.

A brisk 20 minute walk each day could be enough to reduce your risk of early death. A study of over 334,000 European men and women found that twice as many deaths may be attributable to lack of physical activity compared with the number of deaths attributable to obesity, but that just a modest increase in physical activity could have significant health benefits.
Physical inactivity has been consistently associated with an increased risk of early death, as well as being associated with a greater risk of diseases such as heart disease and cancer. Although it may also contribute to an increased body mass index (BMI) and obesity, the association with early death is independent of an individual’s BMI.
To measure the link between physical inactivity and premature death, and its interaction with obesity, researchers analyzed data from 334,161 men and women across Europe participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study. Over an average of 12 years, the researchers measured height, weight and waist circumference, and used self-assessment to measure levels of physical activity. The results are published today in the American Journal of Clinical Nutrition.

TThe authors estimate that doing exercise equivalent to just a 20 minute brisk walk each day — burning between 90 and 110 kcal (‘calories’) — would take an individual from the inactive to moderately inactive group and reduce their risk of premature death by between 16-30%. The impact was greatest amongst normal weight individuals, but even those with higher BMI or with obesity saw a benefit.
Using the most recent available data on deaths in Europe the researchers estimate that 337,000 of the 9.2 million deaths amongst European men and women were attributable to obesity (classed as a BMI greater than 30): however, double this number of deaths (676,000) could be attributed to physical inactivity.

Bottom Line: So what is the message? This is a simple message: just a small amount of physical activity each day could have substantial health benefits for people who are physically inactive. Although we found that just 20 minutes would make a difference. Physical activity has many proven health benefits and should be an important part of our daily life.

Story Source:

Journal Reference:
1. Ulf Ekelund, Heather A Ward, Teresa Norat, Jian’an Luan, Anne M May, Elisabete Weiderpass, Stephen S Sharp, Kim Overvad, Jane Nautrup Østergaard, Anne Tjønneland, Nina Føns Johnsen, Sylvie Mesrine, Agnès Fournier, Guy Fagherazzi, Antonia Trichopoulou, Pagona Lagiou, Dimitrios Trichopoulos, Kuanrong Li, Rudolf Kaaks, Pietro Ferrari, Idlir Licaj, Mazda Jenab, Manuela Bergmann, Heiner Boeing, Domenico Palli, Sabina Sieri, Salvatore Panico, Rosario Tumino, Paolo Vineis, Petra H Peeters, Evelyn Monnikhof, H Bas Bueno-de-Mesquita, J Ramón Quirós, Antonio Agudo, María-José Sánchez, José María Huerta, Eva Ardanaz, Larraitz Arriola, Bo Hedblad, Elisabet Wirfält, Malin Sund, Mattias Johansson, Timothy J Key, Ruth C Travis, Kay-Tee Khaw, Søren Brage, Nicholas J Wareham, and Elio Riboli. Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC). Am J Clin Nutr, January 14, 2015 DOI: 10.3945/ajcn.114.100065

Over the Counter Cold Medicnes May Wreck Havoc With Your Prostate Gland.

February 10, 2015

Nearly 14 million American men have symptoms related to an enlarged prostate gland. Nearly 50% of men over age 50 will have symptoms. OTC cold medications such as diphenhydramine (Benadryl), brompheniramine (Dimetapp), and loratadine (Claritin), pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE) may worsen your prostate symptoms.

The prostate gland is a walnut sized organ at the base of bladder and surrounds the urethra or the tube in the penis that transports urine from the bladder to the outside of the body. For reasons not entirely known, the prostate gland enlarges after age 50 and compresses the urethra making urination difficult and rarely impossible. Often men who have enlargement of the prostate gland have the cold or the flu and will take cold medications containing antihistamines and decongestants, which can worsen prostate symptoms.

It’s very important that men with enlarged prostate avoid cold medicines with pseudoephedrine or phenylephrine. Those are ingredients in decongestants and they constrict the prostatic and cause more compression on the urethra thus aggravating men’s urinary symptoms. Antihistamines aren’t quite as bad, because they work more on the bladder muscle, but they can decrease bladder contractility thus making it difficult for men to empty their bladder of urine.

Enlargement of the prostate is more common in older men, because as men age their prostate continues to grow. Nearly 80 percent of men age 50 and older will be diagnosed with some degree of the disease. Sometimes men need to get up every hour at night. I recommend against waiting too long to visit a doctor for this problem as urinary retention can occur and can cause kidney damage and other serious issues.

If a man is already having a little difficulty and his stream is already slow, and then you (make it worse) it by adding one of these OTC cold medicines, it’s the recipe for causing retention.

Cold remedies that are inhaled, such as a nasal corticosteroid, will not have the same side effects as an oral agent. Mentholated ointments are a safer alternative to decongestants.
If men notice problems with urination after taking certain medicines, they may need to weigh the risks and benefits of the OTC medications.

Bottom Line: I urge men to carefully read over-the-counter drug labels. You have to be aware of what a medication’s potential side-effects are. Unfortunately, the package insert for most medications is quite lengthy. Men need to have a relationship with a primary care doctor or a urologist, doctor who specializes in treatments of the enlarged prostate gland.