Posts Tagged ‘cancer’

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.

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Prostate Cancer

October 21, 2016

What do Jose Torres, John Kerry, and Jerry Lewis have in common?  They all have prostate cancer and have been successfully treated.  Nearly 250,000 men will be diagnosed with prostate cancer this year and nearly 30,000 men will die of prostate cancer.  This article will discuss the symptoms of prostate cancer and what can be done to diagnose the

The most common prostate problems are an enlarged prostate, prostatitis and prostate cancer.

Prostate cancer frequently has no symptoms and most men will have prostate cancer and not be aware of the diagnosis.  Symptoms that occur as a result of any prostate condition including benign enlargement of the prostate gland and prostate cancer include:

  • Frequent urination
  • Getting up at night to urinate
  • Pain with urination
  • Difficulty starting to urinate
  • Blood in the urine
  • Bone pain
  • Impotence or Erectile dysfunction (ED)

 

Risk factors associated with prostate cancer include:

The condition is rare in men under 40 years of age, but most cases are found in men aged 50 or older. At age 80+ nearly all men will have prostate cancer but will seldom succumb to the disease or they have prostate cancer but will not die from it. 

Genetic factor may contribute to prostate cancer risk. Men who have a father, brother, uncle or cousin with prostate cancer are 2 to 3 times more likely to get the condition as compared to men without prostate cancer in a close relative. 

African-American men also have an increased risk of having prostate cancer. It is suggested that African-American men start seeing a doctor for a digital rectal exam and a PSA test after age 40.

Studies have found that obese men have a greater risk of developing more advanced prostate cancer as well as a higher risk of metastasis and death from the condition.

Many studies have found a link between smoking and getting prostate cancer as well as an increased the risk of dying from the condition.

High fat diet has been shown to put men at high risk of prostate cancer. Some studies show that men who have diets high in red meat may raise a person’s chances of developing prostate cancer. 

Bottom Line:  Prostate cancer is the second most common cause of death in men due to cancer (lung cancer is number one), and is very treatable if the diagnosis is made early.  This can be accomplished with a rectal examination and a PSA test.  Speak to your doctor for more information.

 

Adding Spice To Your Sex Life- Cinnamon and Testosterone

July 9, 2016

 

It is normal for a man’s sex drive or libido to decline as he ages. The reason? The male hormone, testosterone, which is responsible for the libido starts to decline about 2-3% a year after age 30. This article will discuss a non-medical solution, cinnamon, that may have an impact on a man’s sex drive or libido.

Animal studies have demonstrated that cinnamon can reduce high blood sugar levels and improve insulin sensitivity and also the testosterone boosting and testicular health. Therefore, it’s very much possible that cinnamon can be used to increase testosterone levels in humans.

 Cinnamon is a spice that you may only associate with baking and desserts, but there are plenty of cinnamon benefits that make it a great spice to use everyday and as a dietary supplement.

When using cinnamon as a supplement be sure to use organic cinnamon and not the conventional variety you typically find in the spice aisle at the grocery store. Just like with vegetables, conventional spices can contain the same herbicides and pesticides when they are conventionally manufactured.

Benefits of cinnamon:

Improves Metabolism

Cinnamon often makes it onto the list of foods that you should be eating if you are trying to lose weight. Cinnamon has the ability to rev up the metabolism, which can help you lose weight more effectively.

By the way, daily exercise is also a natural way to get your metabolism going.

 
 

Reduces Cholesterol

Cinnamon has been shown to help lower the levels of LDL cholesterol in the body, often referred to as the bad cholesterol. This makes it a fantastic all-natural remedy for high cholesterol levels.

High cholesterol over long periods of time can lead to more serious heart problems such as stroke and heart attack.

Reduces Blood Sugar Levels

Cinnamon has been shown to help keep blood sugar levels where they should be, and is often recommended to diabetics to help naturally regulate blood glucose levels. You can use cinnamon even if you are not diabetic as a way to keep your blood sugar within healthy guidelines.

Antibacterial Properties

Cinnamon acts as an antibacterial agent in the body, and with that because of that it is very helpful in treating a myriad of problems. This is why it is often recommended for an upset stomach, because it can help clear harmful bacteria from the digestive system.

Cancer Fighter

Cinnamon has been shown to be effective cancer fighting foods, and there are many reasons for this, but the chief among them is cinnamon’s antibacterial property.

More studies are needed before cinnamon can fully be given the green light and regarded as a cancer-fighting agent.

Heart Disease Prevention

Because of cinnamon’s ability to lower cholesterol levels and improve blood circulation throughout the body, it can be used to help prevent heart disease.

Anti-Inflammatory

The anti-inflammatory nature of cinnamon means that you can use it to help with a number of conditions caused by inflammation.

Helps Balance Hormones

Cinnamon can help balance hormones in women, making it a great all-natural remedy to try before turning to medication like estrogen replacement therapy. Cinnamon acts to lower the amount of testosterone produced by women, while increasing the amount of progesterone.

Helps Brain Function

The aroma of cinnamon has long been thought of as being a brain booster, and modern science is backing that up. Reason enough to start opt for cinnamon scented candles, or cinnamon essential oils for aromatherapy.  Cinnamon can help your brain work better and keep you more alert, just by smelling it.  Rather than use energy drinks or other artificial ways to make yourself zeroed in, you can use the scent of cinnamon to give you that extra mental edge needed during a typical workday.

Clears the Digestive Tract

Cinnamon can help clear out your digestive tract, which will help your body absorb the nutrients from the foods you eat more easily. This also means you’ll have fewer stomach problems including indigestion, diarrhea, and constipation.

Increases Circulation

Cinnamon has a warming effect on the body, and can help improve blood flow throughout. There are plenty of diseases and conditions, like sexual functioning, that are caused by poor circulation, so taking steps to improve that circulation can be very beneficial indeed. Improved blood flow in the body can help improve the sex drives of both men and women, as it helps blood flow to the reproductive organs. For men this means stronger erections and for women it means increased sensitivity of the clitoris and labia.

Improves Your Mood

You can use cinnamon as a sort of aromatherapy to help improve your mood. That’s because for this benefit of cinnamon you simply need to smell it. The aroma of cinnamon acts to shift you to a better mood.

Many things can occur throughout the day to put us in an off mood, so it’s important to have a collection of steps you can take to try and shake you out of a funk and get you back to feeling good.

Alzheimer’s Prevention

One of the more surprising cinnamon benefits is its ability to help prevent Alzheimer’s. Research is promising in regards to cinnamon’s effect on the brain, enough so that it would be smart to start taking it as a supplement if you feel you are at risk for Alzheimer’s.

Bottom Line: Most men and women today want to maintain and restore their ability to be sexually intimate with their partner. Yes, there are pills and medications that can be effective. However, there are natural options, like cinnamon, that are available to nearly everyone and at low or minimal cost that may improve their ability to be sexually active. Also there are numerous other benefits of cinnamon that make it a worthwhile option. It’s hard to think of a spice like cinnamon as being anything more than a flavoring agent, but which is currently being studied for its beneficial effects including sexual intimacy and performance.

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.

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.

PSA Test For Diagnosis of Prostate Cancer-The Test That Just Might Save Your Life

March 12, 2015

The value of prostate-specific antigen (PSA) screening for prostate cancer is the subject of much debate today. Results from a large long-term European study provide important insight. The study was published in Lancet, which is a prestigious European medical journal.

Over 13 years, men who were offered PSA screening had a 21 percent lower risk of dying of prostate cancer than their counterparts who weren’t offered screening. Stated another way, PSA screening prevented one death for every 27 cases of prostate cancer it detected.

In spite of these results, there is no one-size-fits-all screening strategy. All men and their doctors should weigh the benefits and risks of screening based on the man’s individual circumstances and preferences.

Bottom Line: These findings provide confirmation that prostate cancer-related deaths are lower in men who are screened. I recommend annual PSA testing until age 75 and discontinue testing as prostate cancer is a slow growing malignancy and older men will often die WITH prostate cancer rather than FROM it.

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.

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.

Treating Prostate Cancer With Hormone Therapy

September 28, 2014

For men with advanced prostate cancer, hormone therapy is a treatment option. The goal is to reduce levels of male hormones, called androgens or testosterone, in the body, or to prevent them from reaching prostate cancer cells. Using drugs to decrease the testosterone is one of the most common methods of treating advanced prostate cancer.

The main androgens are testosterone and dihydrotestosterone (DHT). Most of the body’s androgens come from the testicles, but the adrenal glands also make a small amount. Androgens stimulate prostate cancer cells to grow. Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time. However, hormone therapy alone does not cure prostate cancer and eventually, it stops helping.

Hormone therapy may be used:

  • If you are not able to have surgery or radiation or can’t be cured by these treatments because the cancer has already spread beyond the prostate gland
  • If your cancer remains or comes back after treatment with surgery or radiation therapy
  • Along with radiation therapy as initial treatment if you are at higher risk of the cancer coming back after treatment (based on a high Gleason score, high PSA level, and/or growth of the cancer outside the prostate)
  • Before radiation to try to shrink the cancer to make treatment more effective

Several types of hormone therapy can be used to treat prostate cancer. Some lower the levels of testosterone or other androgens (male hormones). Others block the action of those hormones.

Treatments to lower androgen levels

Orchiectomy (surgical castration)

Even though this is a type of surgery, its main effect is as a form of hormone therapy. In this operation, the surgeon removes the testicles, where most of the androgens (testosterone and DHT) are made. With this source removed, most prostate cancers stop growing or shrink for a time.

This is done as a simple outpatient procedure. It is probably the least expensive and simplest way to reduce androgen levels in the body. But unlike some of the other methods of lowering androgen levels, it is permanent, and many men have trouble accepting the removal of their testicles.

Some men having the procedure are concerned about how it will look afterward. If wanted, artificial silicone sacs can be inserted into the scrotum. These look much like testicles.

Luteinizing hormone-releasing hormone (LHRH) drugs

These drugs lower the amount of testosterone made by the testicles. Treatment with these drugs is sometimes called chemical castration because they lower androgen levels just as well as orchiectomy.

Even though LHRH analogs (also called LHRH agonists) cost more than orchiectomy and require more frequent doctor visits, most men choose this method. These drugs allow the testicles to remain in place, but the testicles will shrink over time, and they may even become too small to feel.

LHRH analogs are injected or placed as small implants under the skin. Depending on the drug used, they are given anywhere from once a month up to once a year. The LHRH analogs available in the United States include leuprolide (Lupron®, Eligard®), goserelin (Zoladex®), triptorelin (Trelstar®), and histrelin (Vantas®).

When LHRH analogs are first given, testosterone levels go up briefly before falling to very low levels. This effect is called flare and results from the complex way in which LHRH analogs work. Men whose cancer has spread to the bones may have bone pain. If the cancer has spread to the spine, even a short-term increase in tumor growth as a result of the flare could compress the spinal cord and cause pain or paralysis. Flare can be avoided by giving drugs called anti-androgens for a few weeks when starting treatment with LHRH analogs. (Anti-androgens are discussed further on.)

Degarelix (Firmagon®)

Degarelix is an LHRH antagonist. LHRH antagonists work like LHRH agonists, but they reduce testosterone levels more quickly and do not cause tumor flare like the LHRH agonists do.

This drug is used to treat advanced prostate cancer. It is given as a monthly injection under the skin and quickly reduces testosterone levels. With degarelix no anti-androgens are necessary. The most common side effects are problems at the injection site (minimal pain, redness, and swelling) and increased levels of liver enzymes on lab tests. Other side effects are discussed in detail below.

Abiraterone (Zytiga®)

Drugs such as LHRH agonists can stop the testicles from making androgens, but other cells in the body, including prostate cancer cells themselves, can still make small amounts, which may fuel cancer growth. Abiraterone blocks an enzyme called CYP17, which helps stop these cells from making certain hormones, including androgens.

Abiraterone can be used in men with advanced castrate-resistant prostate cancer (cancer that is still growing despite low testosterone levels from LHRH agonists, LHRH antagonists, or orchiectomy). Abiraterone has been shown to shrink or slow the growth of some of these tumors and help some of these men live longer.

This drug is a pill and the most common dose is 4 pills every day. Since this drug doesn’t stop the testicles from making testosterone, men who haven’t had an orchiectomy need to continue with treatment to stop the testicles from making testosterone (LHRH agonist or antagonist therapy). Because abiraterone lowers the level of other hormones in the body, prednisone (a cortisone-like drug) needs to be taken during treatment as well to avoid the side effects caused by lower levels of these other hormones.

Bottom Line:  Nearly 250,000 cases of prostate cancer are identified each year.  Nearly 40,000 men die from prostate cancer, second most common cause of death due to dancer after lung cancer.  For men who have elevated PSA levels after treatment, hormonal therapy is a consideration.

Questions I Am Frequently “Axed”

May 12, 2014

I often discuss common medical conditions with patients and questions come up on multiple occasions. I have recorded these questions and will answer them periodically on this blog site. If you have any questions you like me to answer, please let me hear from you, nbaum@neilbaum.com.

I am 31 years old and have just had a baby. When can I resume sexual intimacy with my husband?
Whether you give birth vaginally or by C-section, your body will need time to heal. Many health care providers recommend waiting four to six weeks before having sex. This allows time for the cervix to close, postpartum bleeding to stop, and any tears or repaired lacerations to heal.
The other important timeline is your own. Some women feel ready to resume sex within a few weeks of giving birth, while others need a few months — or even longer. Factors such as fatigue, stress and fear of pain all can take a toll on your sex drive. If you have any questions contact your obstetrician.

I have loss of urine when I cough or sneeze or do any kind of exercise. My doctor said I have stress incontinence and he recommended a vaginal sling using mesh material. Is this safe?

Surgery to decrease or prevent urine leakage can be done through the vagina or abdomen. The urethra or bladder neck is supported with either stitches alone or with tissue surgically removed from other parts of the body such as the abdominal wall or leg (fascial sling), with tissue from another person (donor tissue) or with material such as surgical mesh (mesh sling).

Surgical mesh in the form of a “sling” (sometimes called “tape”) is permanently implanted to support the urethra or bladder neck in order to correct SUI. This is commonly referred to as a “sling procedure.”

The use of surgical mesh slings to treat SUI provides a less invasive approach than non-mesh repairs, which require a larger incision in the abdominal wall. The multi-incision sling procedure can be performed using three incisions, in two ways: with one vaginal incision and two lower abdominal incisions, called retropubic; or with one vaginal incision and two groin/thigh incisions, called transobturator. There is also a “mini-sling” procedure that utilizes a shorter piece of surgical mesh, which may be done with only one incision.

Complications of this type of procedure are rare but may occur. The most common complications include bleeding and infection, erosion or infection of the graft material (possibly requiring further surgery), injury to nearby structures, pain, inability to urinate (retention of urine), recurrent or worsening incontinence, new or worse vaginal prolapse, urgency or urge type-incontinence.

I am 65 years old man and had my prostate gland removed for prostate cancer three years ago. My PSA test is rising after several years being at an undetectable level. Is there anything else I can do?

First, I would get the test repeated. Although mistakes are rare, you need to confirm the results with a second test. Next a test has to be done to see if there has been any spread or recurrence of the cancer at the location of the surgical removal of the prostate gland. There are several tests that can be useful for this purpose including a bone scan to see if there has been any spread to the bones.

For men with less than five years life expectancy or with other medical conditions that may affect their longevity, then no treatment is needed and watchful waiting is an option.

For men with spread to other organs or to lymph nodes, hormone therapy is a consideration. This usually consists of medication to decrease the testosterone level which almost always results in loss of libido and erectile dysfunction.

Finally, if there is localized disease in the pelvis, radiation therapy is an option after surgery has failed to cure the disease.

The bottom line is that a rising PSA after surgery is usually treatable.

To Your Good Health,
Dr. Neil Baum