Archive for the ‘cancer’ Category

Diet and Exercise May Reduce Risk of Cancer

March 23, 2017

There isn’t a day that goes by that the Internet or the print media isn’t bombarding readers with a new diet that prevents cancer.

Every day, there are headlines that bombard readers with various diets that purportedly prevent cancer: “The Diet That Stops Cancer” and “Eating Your Way Out of Cancer.” But what do the hard data really say about lifestyle choices preventing cancer?  Studies have shown that the combination of healthy eating, not smoking, and regular exercise can reduce the risk of heart disease by 80 percent and of stroke and some cancers by 70 percent.

Although no diet has received conclusive evidence of presenting cancer, there are lifestyle choices such as exercise that support conclusions that they can serve as deterrent of cancer.  Even the American Cancer society recommends avoid being overweight and includes being physically active for at least 30 minutes every day.  They also suggest eating a mostly plant-based diet; limiting red meats and avoiding processed meats; limiting alcoholic drinks (two glasses of wine a day for men and one glass for women); and to protect against cancer (Table 1). Other recommendations include avoid sugary drinks, limit consumption of processed foods and eat more vegetables, whole grains, and legumes such as beans.  Limit salt intake to 1.5 grams per day and limit consumption of salty foods, chips, pretzles, smoked or cured meats like salami, baloney, and beef jerky.

Other Cancer Prevention Recommendations

To prevent breast cancer, the ACS recommends at least 150 minutes of moderate-intensity physical activity per week, alcohol intake of one or fewer drinks per day, and maintaining a body mass index (BMI) less than 25 kg/m2. In a study of 2905 women at high-risk for breast cancer, adherence to these three recommendations reduced the risk for breast cancer by 44%.

Perhaps this shouldn’t be all that surprising, given that BMI itself is a risk factor for cancer. Too much body fat triggers insulin resistance, raising levels of insulin and growth factors that promote cancer. Fat also increases estrogen production, which can fuel some cancers, and fat secretes enzymes that promote inflammation.

Numerous medical studies have concluded that avoiding adult weight gain confers protection against certain types of cancer, particularly among nonusers of hormone replacement therapy (HRT). The study found that for each 5-kg increase in adult weight gain, the relative risk was increased 11% for postmenopausal breast cancer among no or low HRT users; 39% and 9% for postmenopausal endometrial cancer among HRT nonusers and users, respectively; and 13% for postmenopausal ovarian cancer among no or low HRT users. For each 5-kg increase in men, the risk for colon cancer increased by 9%. The relative risk for kidney cancer comparing highest and lowest level of adult weight gain was 1.42.

In addition to lowering the risk of cancer, eating a diet that is high in fruits and vegetables is associated with a lower risk for all-causes of death and lower risk of dying of cardiovascular causes such as heart disease or stroke.

Bottom line on diet and exercise and cancer prevention:  Weight gain, lack of exercise, and high alcohol intake are the key factors for leading a healthy lifestyle and decreasing the risk of cancer.

 

 

Advertisements

Diet and Exercise May Reduce Risk of Cancer

January 21, 2017

There isn’t a day that goes by that the Internet or the print media isn’t bombarding readers with a new diet that prevents cancer.

Every day, there are headlines that bombard readers with various diets that purportedly prevent cancer: “The Diet That Stops Cancer” and “Eating Your Way Out of Cancer.” But what do the hard data really say about lifestyle choices preventing cancer?  Studies have shown that the combination of healthy eating, not smoking, and regular exercise can reduce the risk of heart disease by 80 percent and of stroke and some cancers by 70 percent.

Although no diet has received conclusive evidence of presenting cancer, there are lifestyle choices such as exercise that support conclusions that they can serve as deterrent of cancer.  Even the American Cancer society recommends avoid being overweight and includes being physically active for at least 30 minutes every day.  They also suggest eating a mostly plant-based diet; limiting red meats and avoiding processed meats; limiting alcoholic drinks (two glasses of wine a day for men and one glass for women); and to protect against cancer (Table 1). Other recommendations include avoid sugary drinks, limit consumption of processed foods and eat more vegetables, whole grains, and legumes such as beans.  Limit salt intake to 1.5 grams per day and limit consumption of salty foods, chips, pretzles, smoked or cured meats like salami, baloney, and beef jerky.

Other Cancer Prevention Recommendations

To prevent breast cancer, the ACS recommends at least 150 minutes of moderate-intensity physical activity per week, alcohol intake of one or fewer drinks per day, and maintaining a body mass index (BMI) less than 25 kg/m2. In a study of 2905 women at high-risk for breast cancer, adherence to these three recommendations reduced the risk for breast cancer by 44%.

Perhaps this shouldn’t be all that surprising, given that BMI itself is a risk factor for cancer. Too much body fat triggers insulin resistance, raising levels of insulin and growth factors that promote cancer. Fat also increases estrogen production, which can fuel some cancers, and fat secretes enzymes that promote inflammation.

Numerous medical studies have concluded that avoiding adult weight gain confers protection against certain types of cancer, particularly among nonusers of hormone replacement therapy (HRT). The study found that for each 5-kg increase in adult weight gain, the relative risk was increased 11% for postmenopausal breast cancer among no or low HRT users; 39% and 9% for postmenopausal endometrial cancer among HRT nonusers and users, respectively; and 13% for postmenopausal ovarian cancer among no or low HRT users. For each 5-kg increase in men, the risk for colon cancer increased by 9%. The relative risk for kidney cancer comparing highest and lowest level of adult weight gain was 1.42.

In addition to lowering the risk of cancer, eating a diet that is high in fruits and vegetables is associated with a lower risk for all-causes of death and lower risk of dying of cardiovascular causes such as heart disease or stroke.

Bottom line on diet and exercise and cancer prevention:  Weight gain, lack of exercise, and high alcohol intake are the key factors for leading a healthy lifestyle and decreasing the risk of cancer.

The Skinny On Screening for Prostate Cancer

December 29, 2016

Prostate cancer is the second most common cancer among men (after skin cancer), according to the American Cancer Society. It is the second most common cause of death in following lung cancer and causes nearly 30,000 deaths annually in the United States.  The good news is that often prostate cancer can be treated successfully, especially when caught in its early stages.   More than 2 million men in America count themselves as prostate cancer survivors, according to the American Cancer Society.

At the present time screening for prostate cancer is controversial in the medical profession.  There are physicians who believe that testing all men for prostate cancer outweighs the benefit because it may find some very slow growing cancers in some men that could be left alone without any negative consequences. My personal opinion is that prostate cancer screening should be done but requires education and a decision made between doctor and patient.

My belief is that if prostate cancer is detected early, it has a favorable  prognosis. If men ask me what are the early signs of prostate cancer, the answer is that there are NO early signs of prostate cancer when it is confined to the prostate gland.  That is why men need to have an examination or the digital rectal examination and a PSA test.

Risk factors help determine who should be screened when

The protocol starts by evaluating men for their risk factors for developing prostate cancer. Risk factors include: age (after age 50 risk of prostate cancer rises rapidly); race (men of African-American and Caribbean descent are at higher risk); and family history (men who have a father, brother, or uncle with prostate cancer are at a higher risk of developing prostate cancer and should be screened on a regular basis) Men should be screened every year until they reach age 70 or 75. For most men who reach age 70 and all their screening tests are normal, the chances of their developing a cancer that would impact their well-being or their longevity is really low.

Managing the elevated PSA test

If your screening detects a possible cancer, your doctor will order a biopsy. This is done in the office under a local anesthesia and takes 10-15 minutes.  If the biopsy detects prostate cancer, then the next step is to determine the aggressiveness of the cancer or how likely it is to spread or grow.  For men with low-risk tumors that are not going to put their health or longevity at risk, I will often recommend surveillance, which means regular testing of the PSA and a follow up biopsy in 12-18 months.  As long as the PSA remains stable and there is no evidence of escalation of the cancer, then these men can be safely followed and only treated if the cancer appears to be growing or the PSA is steadily increasing.  Men with more aggressive tumors may need surgery and\or radiation. You and your doctor will make the best treatment decisions for you together.

Bottom Line:  Prostate cancer is a common cancer and can easily be diagnosed with prostate cancer screening.  Not all men need to be screened, but if you are between 50 and 70 years of age, speak to your doctor about the benefits of screening and make an informed decision if screening is right for you.

PSA Testing for Prostate Cancer-To Screen or Not to Screen That is the Question

September 28, 2016

Today, nothing is more confusing for men than the concept of screening for prostate cancer.  Prostate cancer is the second most common cancer in men, following lung cancer, and there are 250,000 men each year diagnosed with prostate cancer and causes nearly 30,000 deaths a year.  About one in seven men will be diagnosed with prostate cancer during his lifetime.

But some prostate cancers develop slowly, and, as the disease is more common in elderly men, most men with prostate cancer die with it and not from it. Thus, screening, diagnosis and treatment of the disease are controversial.

There is no consensus about prostate cancer screening as early diagnosis can be associated with very bothersome side effects such as erectile dysfunction and urinary incontinence.  Also screening has not been universally shown to increase survival or decrease the death rate from prostate cancer.  This article will discuss the pros and cons of PSA screening for men.

Men who opt for screening undergo a digital rectal exam and a blood draw to measure a chemical called PSA or prostate specific antigen. This level of PSA can be increased in men with prostate cancer. Other conditions may cause the increase in the PSA such as benign enlargement of the prostate gland and prostate infections.

The best way to detect an early potentially deadly case is to collect yearly PSA tests over three to five years so trends can be assessed.

I like most other urologists are concerned about over treatment of prostate cancer — in other words, being too aggressive in using surgery or radiation when a small amount of potentially slow-growing cancer is found on a biopsy.

The federal government has also become concerned about this issue. A large medical research trial called the Prostate Lung Colorectal and Ovarian (PLCO) Cancer Screening Study released results from 2009 showing no benefit from screening for prostate cancer when comparing a large group of unscreened men to a large group of aggressively screened men.

Researchers across the country are assessing the effects of the USPSTF recommendations on prostate cancer mortality since 2012. In a recent study from Northwestern University in Chicago, researchers found a significant increase in the cases of advanced prostate cancer already spread to other parts of the body from 2004 to 2013. As a result we could be missing serious cancers because of decreased screening.

Prostate cancer also has a hereditary predilection and men with a father, brother, cousin, or uncle should consider having screening around age 40.  This also applies to African-American men who have a greater risk of prostate cancer than Caucasian men and should also have testing after age 40.

My best advice is to ask your doctor\urologist about the decision to undergo prostate cancer screening.

Prostate Biopsy Negative? What’s Next?

November 21, 2015

There are over 1 million men who have a prostate biopsy each year.  Many of the biopsies are negative.  What can a man do who has an elevated PSA level and a negative biopsy to be certain that he doesn’t have prostate cancer and avoid having a second biopsy?

Lots of controversy surrounds the standard PSA (prostate-specific antigen) screening test for prostate cancer, which is unreliable and not specific for the disease. This uncertainty has prompted many men to ask, “Is there a better test for PSA?” Fortunately, there are options which, while they don’t replace the current PSA test, can provide significantly more reliable, actionable information.

The PSA test involves a blood draw and measuring the level of the blood protein, prostate specific antigen. Currently, men whose PSA test levels are between 4 ng/mL and 10 ng/mL typically are told they should consider getting a prostate biopsy. However, an elevated PSA can be caused by many different benign conditions such as benign enlargement of the prostate gland, a prostate infection or simply lifestyle habits, which means a biopsy would be an unnecessary invasive procedure.

Why we need more accurate testing?

Approximately 1.3 million prostate biopsies are performed annually, and less than one third of them reveal cancer. While that sounds like good news on one hand, on the other hand it means that two thirds of those biopsies may not have been necessary and/or these men have negative biopsy results but other clinical risk factors for prostate cancer such as a family member who has prostate cancer or being an African-American man who have a slightly greater risk for prostate cancer than a Caucasian man.

If you have been in this situation, you probably know how frustrating and confusing it can be. What should you do? Have a repeat biopsy or choose to have more tests? The uncertainty of having a hidden prostate cancer can lead men to get repeat biopsies, which can be associated with an increased risk of infection, hospitalization, emotional trauma, and significant costs.

Fortunately, some progress is being made in the realm of better testing for prostate cancer and in determining whether a prostate biopsy is necessary. In this blog I will discuss the PCA3 test that may be helpful and prevent additional biopsies and additional psychological anxiety.

PCA3 Test

PCA3 is an acronym for Prostate CAncer gene 3. Prostate cells have PCA3 genes that are responsible for making this prostate cancer-specific protein. Prostate cancer cells produce higher levels of PCA3 than do healthy cells, and when the level of PCA3 protein is high, it leaks into the urine, where it can be measured. Unlike the PSA test, PCA3 is not affected by benign prostatic hyperplasia (enlarged prostate) or other noncancerous prostate conditions such as prostatitis.

To take the PCA3 test, you must first have a digital rectal examination (DRE), which stimulates the PCA3 to enter the urine. Then you must immediately provide a urine sample. Typically, it takes 1 to 2 weeks to obtain the results of the PCA3 test. For diagnostic purposes, the higher the PCA3 score, the more likely a man has prostate cancer. When the PCA3 score is used to help with treatment, the higher the score, the more aggressive the prostate cancer is likely to be.

The Food and Drug Administration approved the PCA3 test in 2012. Physicians can use the PCA3 score, in addition to DRE and PSA test, to help them make treatment decisions. For example, knowing a man’s PCA3 score can be helpful when:

  • Men have a family history of prostate cancer
  • Men have a positive biopsy, because their PCA3 score can provide additional information about how aggressive the cancer may be and therefore, be helpful in determining which treatment approach is best
  • Men have an elevated PSA or a suspicious DRE and are considering a prostate biopsy
  • Men have a negative result on their biopsy but the doctor is still uncertain about the presence of cancer
  • Men have a positive result on their biopsy and they and their doctor want to better understand how aggressive the cancer is
  • Men who have early, nonaggressive prostate cancer and have chosen active surveillance want to monitor any possible cancer progression

How effective is the PCA3 score in detecting prostate cancer? This question was addressed in a study involving 859 men who were scheduled to undergo a prostate biopsy. The authors found that use of the PCA3 test improved over-detection of low-grade prostate cancer and under-detection of high-grade cancer. Cost of the PCA3 test is about $450. The test is paid by most insurance companies including Medicare.

Bottom Line:  Prostate cancer is the most common cancer in men and the second most common cause of death in men.  The PSA test is a good screening test for men between the ages of 50 and 70.  However, there are false positive results with consequences of unnecessary prostate biopsies or may result in unnecessary repeat prostate biopsies.  The PCA3 test is helpful in identifying prostate cancer or helpful in reassuring a man that he doesn’t have prostate cancer and can avoid a repeat biopsy.  For more information, speak to your urologist.

WHAT’S KEEPING YOU AND YOUR ERECTIONS DOWN?

August 7, 2015

Millions of American men suffer from ED or erectile dysfunction. For young men having difficulty achieving an erection, here are some common causes:
Stress : Among men in their teens, 20s and 30s, most cases of ED are linked to psychological issues. Anxiety and stress are a major factors especially if these are factors right before sex. Many young men who are inexperienced feel pressure to perform the best sexually and also have concerns about size. This stress can lead to performance anxiety. This buildup of stress can cause an influx of adrenaline or epinephrine which can inhibit an erection.
Too much bike riding : Now, just to be clear, if you’re an avid biker, it doesn’t mean you’re going to develop ED. But if you experience numbness as you ride within the first few miles or after biking marathons you may be causing long-term damage. Below the prostate (and what directly rests on the bicycle seat) are the nerves responsible for bringing blood the penis, which is what happens during an erection. Try getting fitted for a better seat if you’re experiencing this.
Medicines : Cold medications like Sudafed contain pseudoephedrine, which acts as epinephrine in the body and decreases the ability to achieve an erection. It increases your body’s natural fight or flight reaction and makes your body think you’re scared of something. The effects of the drug aren’t permanent.
Partying : Drinking and recreational drug use may also serve as a proponent of ED. Alcohol is a depressant and relaxes you but can cause the inability to perform. Cocaine for example, will lower your testosterone levels.
Cancer treatments : If young men have been diagnosed with testicular cancer or another cancer and are being treated with chemotherapy and radiation may lower testosterone levels which affect blood flow to the penis. Radiation can also directly damage the lining of the blood vessels or cause nerve damage.
Diabetes and high blood pressure are other causes of ED because diabetes impacts the body’s ability to produce nitric oxide. Another major factor is being obese or overweight. Anything that’s bad for your heart is bad for your penis. Blood vessels are tiny in the penis and if they’re clogged the blood won’t flow there. Eating right and exercising makes everything work better.

1. STOP SMOKING

Heart problems aren’t the only issue keeping men down. Erectile dysfunction is commonly caused by stress, medications, partying, cancer treatments, or even bike riding.

Smoking can cause blood vessels to narrow, which can have a detrimental effect on blood flow to sex organs. Similarly, smoking diminishes your stamina, limiting the amount of rigorous activity one can handle – which unfortunately can leave your partner wanting more.
2. WORK IT OUT
Notwithstanding my earlier comments about biking, moderate regular exercise has been shown to help improve blood flow to the sexual organs. Exercises focused on thighs, buttocks and pelvis are especially good for genital circulation. In addition, exercise boosts self-image and confidence. Anything that improves self-esteem will in turn improve libido.
3. LOSE WEIGHT
Study out of Duke, found that up to 30% of obese people seeking help controlling their weight indicate problems with sex drive, desire, performance, or all three. This is because being overweight can reduce blood flow and lower testosterone levels. High cholesterol as well as type 2 diabetes, both associated with being overweight, impact sexual performance. Both can cause penile arteries to shut down when arteries get clogged with fat deposits. Erectile dysfunction leads to decreased sexual desire and libido.
4. GINGKO BILOBA
Herbal remedies like tea or supplements derived from ginkgo biloba can have a positive effect on sexual desire and even orgasm. This age-old remedy is known to improve circulation, yet again enhancing sex.
5. TRY SOME LIBIDO-BOOSTING FOODS
Certain foods, like those high in zinc (think oysters!) can increase sperm production and testosterone- the hormone in men responsible for sex drive. Also, foods high in essential fatty acids like flaxseeds, sardines, and nuts help to increase testosterone production and increase libido.

This article was written by Dr. Samadi a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery, and an expert in robotic prostate surgery in New York City.

Myths and Misinformation On Prostate Cancer

June 10, 2015

Prostate cancer is the second most common cancer in men, following lung cancer, with 250,000 new cases discovered each year. There are many areas of confusion about prostate cancer. Let me debunk a few of these myths.

Myth 1: Prostate cancer surgery will end your sex life and cause urine leakage.
Fact: Your surgeon may be able to spare the nerves that help trigger erections. Then you will probably be able to have an erection strong enough for sex again. But it may be a while. Recovery can take from 4 to 24 months, maybe longer. Younger men usually recover sooner.
If you still have trouble, ask your doctor about treatments for erectile dysfunction. Cialis, Levitra, and Viagra are common medications that can help. Your doctor will tell you if these are right for you.

Other prostate cancer treatments, such as radiation and hormone therapy, also can affect your sex life. Urine leakage may occur after surgery, but it’s usually temporary. Within a year, about 95% of men have as much bladder control as they did before surgery.

Myth 2: Only elderly men are at risk of prostate cancer.
Fact: Prostate cancer is rare for men under 40. If you are concerned, ask your doctor if you need to get tested earlier. Age isn’t the only factor. Others risk factors include:
Family history. If your father or brother had prostate cancer, your own risk doubles or triples. The more relatives you have with the disease, the greater your chances of getting it.
Race. If you are African-American, your risk of prostate cancer is higher than men of other races. Scientists do not yet know why.
You may want to discuss your risks with your doctor so you can decide together when you should be tested for prostate cancer with a screening PSA test and a digital rectal examination.

Myth 3: All prostate cancers must be treated.
Fact: You and your doctor may decide not to treat your prostate cancer. Reasons include:
Your cancer is at an early stage and is growing very slowly.
You are elderly or have other illnesses. Treatment for prostate cancer may not prolong your life and may complicate care for other health problems.
In such cases “active surveillance” may be an option to consider. This means that your doctor will regularly check you and order tests to make sure your cancer does not worsen. If your situation changes, you may decide to start treatment.

Myth 4: A high PSA score means you have prostate cancer.

Fact: Not necessarily. Your PSA could be high due to an enlarged prostate or inflammation in your prostate. The PSA score helps the doctor decide if you need more tests to check for prostate cancer. Also, your doctor is interested in your PSA score over time. Is it increasing, which could be a sign of a problem? Or, did it decrease after cancer treatment, which is great.

Myth 5: If you get prostate cancer, you will die of the disease.
Fact: You’re likely live to an old age or die of some other cause. That doesn’t mean checking for prostate cancer is not important. Most men with prostate cancer die with the cancer and not from it.

Bottom Line: I hope this article puts the perspective of prostate cancer back in its proper perspective. The diagnosis is common and help is available for most men with prostate cancer.

Owner Maintenance Suggestions For Men

May 2, 2015

June is Male Health Awareness Month. These are a few tests that are unique for men I suggest that they have these tests on a regular basis in order to maintain good health.

TESTICULAR SELF-EXAM

Testicular cancer is a young person’s disease. Please pay close attention to this section if you are between the ages of 15 and 40.

There’s a lot of media coverage for women getting regular mammograms and doing breast self-exams. Men need to examine their testicles as well.

Once a month, after you take your shower, roll each testicle around between your thumb and first two fingers. Look for any bumps, changes, hardness, heaviness, or an enlargement of the entire testicle. Also be on the lookout for changes in the skin of the scrotum. If you detect any of those changes, see a urologist and get it checked out.

PROSTATE CHECKUPS

It is unusual to find prostate cancer in men under the age of 50, but many men will have a diagnosis of prostate cancer by the time they are 70. For a lot of those men who are first diagnosed with prostate cancer after the age of 70, the cancer will grow very slowly and may not require treatment. The doctor will monitor the cancer with regular PSA and digital rectal exams to make sure it stays contained. Many men can live a healthy life with the diagnosis, but for some it can grow very quickly, spread beyond the prostate, and be life threatening. Nearly one-fifth of all men in the United States will eventually receive a diagnosis of prostate cancer, and many more may have prostate cancer because it goes undetected in men who show no symptoms. 3% of men with prostate cancer will die from the disease.

DRE: Digital Rectal Exam

The prostate gland can be physically checked to see if there might be cause for concern about cancer even when the patient has no symptoms. The Digital Rectal Exam is inexpensive, indicator of bumps or abnormal areas on the prostate gland, and you receive the results right after the examination. I suggest a DRE with every year between the ages of 50 and 80. The doctor can tell if your prostate is unusually large. This will tell you if the prostate is pressing against the bladder and causing frequent urination. Because of the mild discomfort of the DRE, it’s sometimes difficult to have men have the exam.

PSA Test

I know there is controversy over the PSA test, which is a blood test that measures the level of a protein produced by the cells of the prostate gland when there is cancer—and sometimes when there is no cancer. In other words, the PSA Test sometimes has “false positives.” But by giving you both tests annually or every other year, your doctor can get a good idea of the likelihood that you might have a problem, and then you can discuss how serious the problem might be and what you can do about it.

Prevention of prostate cancer

I am also asked what can men do to prevent prostate cancer or if they have prostate cancer is there a diet that helps control prostate cancer. Evidence shows that the risk of prostate cancer is reduced by a diet that is lower in red meat, fat, and dairy products and higher in fruits and vegetables—especially broccoli, cauliflower, cabbage, Brussels sprouts, bok choy and kale (all the cruciferous vegetables)—plus tomatoes. Such a diet, along with limiting alcohol consumption, maintaining an exercise program, and keeping body weight down, is associated with a lower risk of prostate cancer and other cancers as well.

Bottom Line: Men need to be involved in their healthcare. These few tests and suggestions are just a few suggestions that all men can and should do.

Urinary Incontinence – Don’t Depend on Depends!

March 12, 2015

Urinary incontinence affects millions of American men and women. Help is available. You don’t have to suffer in silence.

If you notice a few drops of urine dribbling out when you laugh, cough or even sneeze, you may need to consult a general practitioner as these could be symptoms of urinary incontinence, or loss of voluntary control over one’s urination. In some cases there may be a total loss of urine from the urinary bladder while in other cases there could be partial leakage too. Most commonly seen in elderly males and females, this is a condition that could cause great embarrassment and mental agony. As the person loses control over his or her urination, it drips into his inner clothes without his knowledge and this causes stains, bad smells as well as embarrassment to the person in question. This problem can prevent the person from socializing as he\she is always preoccupied with the thought that the urine might leak out and others may come to know about his or her condition. As this is a problem that often affects the elderly, it could cause severe mental agony and sometimes elderly persons may even develop depression because of it.

Causes of incontinence

Some cases of incontinence are temporary and often, these instances are caused by an external or lifestyle factor. Drinking alcohol, caffeinated beverages, or too much of any fluid can cause a temporary loss of bladder control. Some medications — such as blood pressure drugs, muscle relaxants, sedatives, and some heart medicines — may also lead to a short spell of incontinence. A urinary tract infection may also lead to instances of incontinence.

Other causes of incontinence include:
Aging: As you age, your bladder muscles becomes weaker and incontinence becomes more likely. Any issues with your blood vessels will make this situation worse.
Vaginal delivery or surgery in the pelvis: Any damage caused to your pelvic floor muscles can lead to incontinence, since these muscles support your bladder. In some cases, they can be damaged or weakened by surgery—usually during a procedure to remove the uterus—or during childbirth.
Enlarged prostate: In nearly all men, the prostate gland enlarges with age. It is common for men to experience some incontinence as a result.
Cancer and stones: Prostate cancer in men, or bladder cancer in men or women can cause incontinence. In some cases, the cancer’s treatment will cause incontinence as a side-effect. A tumor, whether malignant or benign, can also cause incontinence by blocking the usual flow of urine. Kidney or bladder stones can also have the same effect, say experts.

Evaluation of the man or woman with incontinence
The condition is determined after a person records regular urine leakages. Diagnosis of urinary incontinence may involve a physical exam, an ultrasound, urodynamic testing and tests including cystoscopy, urinalysis and a bladder stress test. Sometimes, I may ask the person to keep a bladder diary.

Prevention
Although it is not always possible to prevent UI, one can lower its risk by practicing Kegel exercises, especially during pregnancy, following a healthy high-fiber diet, maintaining a healthy weight and avoiding caffeine and acidic foods.

Treatment of this condition
Most cases of urinary incontinence can be treated with lifestyle changes and bladder training exercises but medication and other coping strategies like use of diapers (that can absorb the excess urine) are also used if the problem is due to urgency or mixed incontinence. There are a few effective ways to put an end to your battle with incontinence, such as –

• Drink fluids in moderation
• Empty the bladder completely
• Lose weight
• Avoid drinking tea and coffee
• Stop drinking alcohol
• Treat digestive problems
• Read labels on medications
• Apart from these, there is a therapy to improve the symptoms of frequency, nocturia, urgency, and urge incontinence.
Treatment options also include anticholinergics, antispasmodic agents, and tricyclic antidepressants (Tofranil). Pharmacologic therapy for stress incontinence and an overactive bladder may be most effective when combined with a pelvic exercise regimen.

Some surgical procedures like tape or sling procedures, bladder suspension, urethral bulking agents, artificial urinary sphincter in men with incontinence after prostate surgery and other surgical procedures are available as treatment.

Bottom Line: Men and women who suffer from incontinence don’t have to suffer in silence and wear diapers. Help is available. See your doctor to discuss an evaluation and treatment options.

Advance To Every Cancer Patient

January 24, 2015

Cancer and cardiovascular disease are the most common medical causes of death in America. Tremendous advances have been in the treatment of cancer and there is often more than one treatment option for any disease. This is certainly true for prostate cancer where there are multiple treatments such as surgery, radiation, chemotherapy, and even no treatment at all but watchful waiting.

Here are my suggestions for each patient who has cancer:

1. Get a second opinion. Each patient needs to be aware of all the treatment options and to feel confident and informed about the options available. For example, a urologist who performs surgery is not likely to recommend radiation therapy when radiation therapy may be the better option for the patient. A second opinion is a chance to gain ore knowledge and insight into the accuracy of the diagnosis. Also if a pathologist looking at a biopsy or surgical specimen makes the diagnosis, I suggest that another pathologist provide a second opinion to confirm the diagnosis.

2. Find the right doctors. Nearly 20% of patients who receive a diagnosis of cancer have the disease in an advanced stage where the cancer has spread to other organs or other areas of the body. These patients with cancer that has spread, as well as all newly diagnosed patients, should get advice from physicians experienced in treating the specific type of cancer. You want to be sure that you are in the right hands.

3. Know what questions to ask. There are 10 questions compiled by the Cancer Treatment Centers of America (www.cancercenter.com/secondopinion) that would be helpful for newly diagnosed cancer patients to bring to their visit with the doctor. These are:

1 What types of diagnostic testing do you perform? An accurate diagnosis is critical because it is the basis upon which your treatment plan will be determined. For example, PET/CT scans help determine the precise location of cancer in the body to accurately plan treatment. Tumor molecular profiling identifies a tumor’s unique blueprint to choose targeted chemotherapy drugs. It’s important to have access to advanced diagnostic tests, as well as physicians who are experienced in performing them.
2 What does my diagnostic testing tell me? The information you should receive from diagnostic tests includes: where the cancer originated, the size of the tumor, the stage of cancer and whether or not it has spread to the lymph nodes or other parts of the body.
3 What treatment options are available? What do you recommend and why? Many types of cancer have a variety of treatment options available. Your doctor should be able to explain the potential benefits of each to help you understand your options, even if he or she doesn’t perform a specific treatment.
4 What happens if a treatment approach doesn’t work for me? At any point, you should feel comfortable asking your doctor about the status of your treatment. When choosing a care team, you may want to consider doctors willing to try new therapies, depending on your response. Look for professionals who will tailor treatments to your specific diagnosis, and who are willing to pursue other options if your treatment isn’t progressing as expected.
5 What are the side effects of treatment, and how often do your patients experience them? No two people will have the exact same response to cancer treatment, and side effects may vary depending on what type of treatment you choose. Ask your doctor what side effects you might experience, so that you can plan ahead and choose with all of the information you need.
6 How will you help me manage side effects? Integrative therapies can help prevent or manage side effects, so you stay strong and avoid treatment interruptions. Some therapies that can support your wellness during cancer treatment include: nutrition therapy, naturopathic medicine, mind-body medicine, acupuncture, oncology rehabilitation, spiritual support and pain management. Ask your doctor if any of these are available at your hospital, and how they can be incorporated into your treatment plan.
7 How many patients have you treated with my type and stage of cancer, and how successful have you been? Ask how much experience your doctor has treating your type and stage of cancer and whether he/she is a board-certified specialist. You may also want to ask about his/her facility’s treatment results so you can see how successful they have been in treating your cancer type.
8 Who will be involved in my care, how often will they meet and who is my main point of contact? An integrated care team including a surgical, medical, and/or radiation oncologist; dietitian; naturopathic oncology provider; clinical nurse and medical advocate (often a nurse care manager) can ensure you get support for your entire well-being during treatment. If you don’t already have a team like this in place, talk to your doctor about assembling a multidisciplinary team.
9 Where will all my treatments, appointments, tests, etc., take place? When looking for a treatment facility, consider the coordination and convenience of your treatment. Having appointments and procedures in one location can make treatment less stressful for you, and it may allow you to start treatment sooner.
10 How will you help me balance my cancer care with the demands of my normal life? Your cancer treatment should adapt to your individual needs, and family and professional obligations. Talk to your doctor about your personal needs, so that all aspects of your life are considered when choosing a treatment plan.

4. Stay strong. You will often experience significant side effects dealing with your treatment or the disease. I recommend that you consult with a nutritionist to be sure that you are receiving the right combination of calories, vitamins, and nourishment in order to be in the best physical shape to fight the disease. I also suggest a regular program of exercise that enhances your heart, lungs, and muscles to keep you in the best body-mind condition.

Bottom Line: The cancer diagnosis is often shocking and requires each patient to muster all of his\her energies to engage and fight cancer. These are a few suggestions that will help you prepared to carry the biggest fight of your life.