Posts Tagged ‘digital rectal exam’

Prostate Cancer prevention-Diet and Exercise

September 19, 2015

I am often asked what can patients do to prevent prostate cancer. Prostate cancer is the most common cancer in men, and is the second leading cause of death from all cancers in the U.S. following lunch cancer, which is the most deadly cancer in men. In fact, half of men in their 80s have prostate cancer. While this may sound scary, the good news is that prostate cancer is usually slow growing and if caught early on, can be treated and stopped.

The truth is that prostate cancer is regarded as one of the most curable cancers, if caught early.

Signs of prostate cancer

Let me start that from the onset, early prostate cancer may have NO signs and NO symptoms.

If prostate cancer is advanced or spread beyond the prostate gland the signs may include:

  • Trouble urinating
  • Decreased force in the stream of urine
  • Blood in your urine or semen
  • Pain in your lower back, hips or thighs
  • Discomfort in the pelvic area
  • Erectile dysfunction
  • Elevated prostate-specific antigen test (PSA)

You may assume your urinary symptoms are a sign of a bladder infection or a kidney problem, but get it checked out. This can be especially true for younger men. While most cases of prostate cancer occur in men over 50, if you have difficulty starting a urine stream, have weak flow or have to go frequently, especially at night, get it checked out. It may not always be prostate cancer but does require an evaluation by a urologist.

Trouble urinating might simply indicate that your prostate is enlarged due to benign or non-cancerous causes. Having an enlarged prostate is not a sign of prostate cancer nor does it increase your risk of getting it.

Annual prostate screenings

Prostate cancer screenings work, especially for men ages 50 to 69. In recent years the formal recommendation for prostate screenings has changed. The U.S. Preventative Task Force on Health now says annual prostate screenings are not advised across the board, and are rather an item to be discussed and decided between a patient and doctor on an individual basis. If you have a family history, it’s a good idea to get checked regularly.

During a prostate screening, the doctor will test your PSA level, which is a simple blood test which measures a protein produced by your prostate gland. The higher the number, the greater chance you might have prostate cancer. (You should know that not all elevated PSAs point to cancer — some are caused by infections and even an enlarged prostate gland can elevate the PSA test.) Then, a physical exam is completed.

Preventing prostate cancer

Some risk factors for prostate cancer can’t be prevented, such as genetics and race. If you have a relative such as father, uncle, brother, or cousin with prostate cancer, then your risk is higher for prostate cancer. Also, African-American men have a higher incidence of prostate cancer and need to be screened at an earlier age.

While one in six men are diagnosed with prostate cancer at some time in their lives, that number increases to one in three for African Americans. Also, if you have a first degree relative who had prostate cancer — a dad or brother — your risk is doubled or tripled.

There are things you can do to prevent prostate cancer and cancer in general. Did you know that exercising three hours a week has been shown to greatly reduce your cancer risk overall? Eating well has similar results.

Live a healthy lifestyle: eat well, watch your weight and exercise frequently. By adopting a healthy lifestyle, you’ll decrease your risk for prostate cancer and other cancers as well.

 

Bottom Line: Prostate cancer is a common medical condition. Leading a health lifestyle with frequent exercise and a good diet can decrease your risk of developing 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.

Vasectomy And Prostate Cancer-What’s the Risk

July 10, 2014

I often receive calls about the relationship between prostate cancer and vasectomy. There have been many studies that have looked into this relationship and this blog will shed some light on the issue and help men make an informed decision on having a vasectomy, one of the best methods of permanent contraception.

Men who had a vasectomy had a significantly greater risk of developing aggressive, potentially fatal prostate cancer, according to data from a 50,000-patient cohort study.
A recent study in the Journal of Clinical Oncology stated that the overall association between vasectomy and prostate cancer was modest.

The lead authors was quoted as saying, “I think we need to tell men that vasectomy has some risk with prostate cancer, may be linked, but we don’t know. It’s something they need to be aware of and monitored, but really, to me, this is not something that is such a strong association that we need to be changing the way we practice, either prostate cancer screening or vasectomy.”
Studies dating back to the early 1990s have yielded conflicting results about the association between vasectomy and prostate cancer. Some studies have shown as much as a twofold increase in the risk of prostate cancer after vasectomy, whereas others showed no association, the authors noted.

During follow-up through 2010, 6,023 participants had newly diagnosed prostate cancer, including 811 lethal cases. The data showed that 12,321 of the men had vasectomies. The primary outcomes were the relative risk (RR) of total, advanced, high-grade, and lethal prostate cancer, adjusted for a variety of possible confounders.

Vasectomy did not have a significant association with low-grade or localized prostate cancer.

The study adds information to the discussion and controversy surrounding vasectomy and prostate cancer but leaves many questions unanswered. Use of transurethral resection of the prostate, statins used to treat elevated cholesterol levels, selenium, and a number of other factors can influence prostate cancer risk.

The study added little information that goes beyond what previous studies had shown, said Gregory Zagaja, MD, of the University of Chicago. The study suffered from the same limitations of studies that came before it.

Multiple experts state that no consensus exists about potential biological explanations for reported associations between vasectomy and prostate cancer or whether the association is biologically plausible.

Bottom Line: There is a modest risk of prostate cancer in men who undergo a vasectomy. All men, whether or not they have had a vasectomy, need to have a regular PSA and digital rectal exam. For more information on this topic and the relationship between prostate cancer and vasectomy, speak to your doctor.

Saw Palmetto Effect On the PSA Level

September 29, 2013

Saw palmetto is a commonly used herbal supplement used to treat men with mild symptoms of the enlarged prostate gland or BPH (benign prostatic hyperplasia). Despite years of controversy regarding efficacy, saw palmetto remains the most common herbal treatment for men with lower urinary tract symptoms.
Extracted from the fruit of the saw palmetto dwarf tree, the extract exerts effects by diminishing 5-alpha-reductase activity and binding to androgen receptors in prostatic cells. Saw palmetto reduces prostatic dihydrotestosterone by 32%. As a result of this anti-androgen effect, concerns have been raised as to whether serum PSA values should be adjusted accordingly.

In a new study published in the Journal of Urology (2013;189:486-492), researchers evaluated serum PSA values in 369 patients randomized to receive saw palmetto or placebo.
These men were part of the CAMUS (Complementary and Alternative Medicine for Urological Symptoms) trial, a double-blinded, randomized controlled study designed to determine whether saw palmetto extract reduced the American Urological Association symptom score compared with placebo at 72 weeks.
Even with triple the recommended dose of saw palmetto, serum PSA remained unaffected compared with placebo. These data can help guide clinicians using PSA for the early detection of prostate cancer in those patients taking this common herbal remedy.

Bottom Line: Many men will use the herbal supplement, saw palmetto, for the treatment of their lower urinary tract symptoms of benign enlargement of the prostate gland. There is no affect on the PSA level but middle aged men taking saw palmetto should be tested with a PSA and no adjustment need to be made in the PSA level.

Screen Tests Are Not Just For Male Movies Stars

February 9, 2012

Getting the right screening test at the right time is one of the most important things a man can do for his health. Screenings find diseases early, before you have symptoms, when they’re easier to treat. Early colon cancer can be nipped in the bud. Finding diabetes early may help prevent complications such as vision loss and impotence. The tests you need are based on your age and your risk factors.

Prostate Cancer
Prostate cancer is the most common cancer found in American men after skin cancer. It tends to be a slow-growing cancer, but there are also aggressive, fast-growing types of prostate cancer. Screening tests can find the disease early, sometimes before symptoms develop, when treatments are most effective.
Screenings for healthy men may include both a digital rectal exam (DRE) and a prostate specific antigen (PSA) blood test. The American Cancer Society advises men to talk with a doctor about the risks and limitations of PSA screening as well as its possible benefits. Discussions should begin at:
• 50 for average-risk men
• 45 for men at high risk. This includes African-Americans.
• 40 for men with a strong family history of prostate cancer
The American Urological Association recommends a first-time PSA test at age 40, with follow-ups per doctor’s orders.

Testicular Cancer
This uncommon cancer develops in a man’s testicles, the reproductive glands that produce sperm. Most cases occur between ages 20 and 54. The American Cancer Society recommends that all men have a testicular exam when they see a doctor for a routine physical. Men at higher risk (a family history or an undescended testicle) should talk with a doctor about additional screening. I suggest that most men learn how to do a self-examination. You can gently feeling for hard lumps, smooth bumps, or changes in size or shape of the testes. If you find an abnormality, contact your doctor. For more information on testis self-examination, please go to my website: http://www.neilbaum.com/testes-self-examination-tse.html

Colorectal Cancer
Colorectal cancer is the second most common cause of death from cancer. Men have a slightly higher risk of developing it than women. The majority of colon cancers slowly develop from colon polyps: growths on the inner surface of the colon. After cancer develops it can invade or spread to other parts of the body. The way to prevent colon cancer is to find and remove colon polyps before they turn cancerous.
Screening begins at age 50 in average-risk adults. A colonoscopy is a common test for detecting polyps and colorectal cancer. A doctor views the entire colon using a flexible tube and a camera. Polyps can be removed at the time of the test. A similar alternative is a flexible sigmoidoscopy that examines only the lower part of the colon. Some patients opt for a virtual colonoscopy — a CT scan — or double contrast barium enema — a special X-ray — although if polyps are detected, an actual colonoscopy is needed to remove them.

Skin Cancer
The most dangerous form of skin cancer is melanoma (shown here). It begins in specialized cells called melanocytes that produce skin color. Older men are twice as likely to develop melanoma as women of the same age. Men are also 2-3 times more likely to get non-melanoma basal cell and squamous cell skin cancers than women are. Your risk increases as lifetime exposure to sun and/or tanning beds accumulates; sunburns accelerate risk.
The American Cancer Society and the American Academy of Dermatology recommend regular skin self-exams to check for any changes in marks on your skin including shape, color, and size. A skin exam by a dermatologist or other health professional should be part of a routine cancer checkup. Treatments for skin cancer are more effective and less disfiguring when it’s found early.

High Blood Pressure (Hypertension)
Your risk for high blood pressure increases with age. It’s also related to your weight and lifestyle. High blood pressure can lead to severe complications without any prior symptoms, including an aneurysm — dangerous ballooning of an artery. But it can be treated. When it is, you may reduce your risk for heart disease, stroke, and kidney failure. The bottom line: Know your blood pressure. If it’s high, work with your doctor to manage it.
Blood pressure readings give two numbers. The first (systolic) is the pressure in your arteries when the heart beats. The second (diastolic) is the pressure between beats. Normal blood pressure is less than 120/80. High blood pressure is 140/90 or higher, and in between those two is prehypertension — a major milestone on the road to high blood pressure. How often blood pressure should be checked depends on how high it is and what other risk factors you have.

Cholesterol Levels
A high level of LDL cholesterol in the blood causes sticky plaque to build up in the walls of your arteries (seen here in orange). This increases your risk of heart disease. Atherosclerosis — hardening and narrowing of the arteries — can progress without symptoms for many years. Over time it can lead to heart attack and stroke. Lifestyle changes and medications can reduce this “bad” cholesterol and lower your risk of cardiovascular disease.
The fasting blood lipid panel is a blood test that tells you your levels of total cholesterol, LDL “bad” cholesterol, HDL “good” cholesterol, and triglycerides (blood fat). The results tell you and your doctor a lot about what you need to do to reduce your risk of heart disease, stroke, and diabetes. Men 20 years and older should have a new panel done at least every five years. Starting at 35, men need regular cholesterol testing.

Type 2 Diabetes
One-third of Americans with diabetes don’t know they have it. Uncontrolled diabetes can lead to heart disease and stroke, kidney disease, blindness from damage to the blood vessels of the retina (shown here), nerve damage, and impotence. This doesn’t have to happen. Especially when found early, diabetes can be controlled and complications can be avoided with diet, exercise, weight loss, and medications.
A fasting plasma glucose test is most often used to screen for diabetes. More and more doctors are turning to the A1C test, which tells how well your body has controlled blood sugar over time. Healthy adults should have the test every three years starting at age 45. If you have a higher risk, including high cholesterol or blood pressure, you may start testing earlier and more frequently.

Human Immunodeficiency Virus (HIV)
HIV is the virus that causes AIDS. It’s in the blood and other body secretions of infected individuals, even when there are no symptoms. It spreads from one person to another when these secretions come in contact with the vagina, anal area, mouth, eyes, or a break in the skin. There is still no cure or vaccine. Modern treatments can keep HIV infection from becoming AIDS, but these medications can have serious side effects.
HIV-infected individuals can remain symptom-free for many years. The only way to know they are infected is with a series of blood tests. The first test is called ELISA or EIA. It looks for antibodies to HIV in the blood. It’s possible not to be infected and still show positive on the test. So a second test called a Western blot assay is done for confirmation. If you were recently infected, you could still have a negative test result. Repeat testing is recommended. If you think you may have been exposed to HIV, ask your doctor about the tests.
Most newly infected individuals test positive by two months after infection. But up to 5% are still negative after six months. Safe sex — abstinence or always using latex barriers such as a condom or a dental dam — is necessary to avoid getting HIV and other sexually transmitted infections. If you have HIV and are pregnant, talk with your doctor about what needs to be done to reduce the risk of HIV infection in your unborn child. Drug users should not share needles.

Glaucoma
This group of eye diseases gradually damages the optic nerve and may lead to blindness — and significant, irreversible vision loss can occur before people with glaucoma notice any symptoms. Screening tests look for abnormally high pressure within the eye, to catch and treat the condition before damage to the optic nerve.
Glaucoma Screening
Eye tests for glaucoma are based on age and personal risk:
• Under 40: Every 2-4 years
• 40-54: Every 1-3 years
• 55-64: Every 1-2 years
• 65 up: Every 6-12 months
Talk with a doctor about earlier, more frequent glaucoma screening, if you fall in a high-risk group: African-Americans, those with a family history of glaucoma, previous eye injury, or use of steroid medications.

Bottom Line: There’s a saying New Orleans that if ain’t broke, don’t fix it. Well that doesn’t apply to maintaining your car and it certainly doesn’t apply to your health and well-being. Men need to have screening tests in order to detect disease states early when they are treatable and curable.

The French Have Done It Again- Dogs Can Use Their Noses to Sniff Out Prostate Cancer

June 10, 2010
Dogs can be trained to detect prostate cancer by smelling urine samples and signaling the presence of certain volatile organic compounds produced by cancer cells, according to French researchers.

Jean-Nicolas Cornu, MD, of Tenon Hospital in Paris, and colleagues obtained fresh urine samples that had been frozen for preservation from 66 men referred to a urologist because they had an elevated PSA level or abnormal findings on digital rectal examination. Of the 66 men, 33 had prostate cancer and 33 did not, as determined by prostate biopsy.

The dogs used in the study were trained in three phases. In the first phase, which lasted five months, dogs were trained to recognize cancer urine. In the second phase, which lasted 11 months, dogs were trained to discriminate cancer urine from control urine. In the final phase, dogs were presented with five urine samples and prompted to select the one sample that was cancer urine.

Dogs correctly classified 63 of 66 samples.  These results suggest that volitle organic compounds  produced by cancer cells can be detected in urine samples.
So if you come to a French doctor’s office and you find a dog in the exam room, don’t be alarmed.  The dog may just be one of the doctor’s helpers used to diagnose your illness!  For my office, I’m going to “go standard” and suggest for all men over the age of 50 that they have an annual PSA blood test and a digital rectal exam.  It’s the American way!

To your good health.  Dr. Baum