Cancer Proof Your Prostate

For a walnut-sized organ, the prostate is the source of a lot of misery. Apparently, it has only two jobs: Producing the fluid in which semen travels and providing fertile ground for cancer cells–talk about your love-hate relationships.

This organ is the second most common cause of cancer in men (skin is the first), and one in six men will develop prostate cancer in his life. This year alone some 230,000 will get diagnosed with the disease. That’s more than lung, colon, and brain cancers combined. Some 30,000 will die.

Grim statistics, yes, but there are plenty of reasons to be optimistic. If caught and treated early, chances of survival are nearly 100%. And for the guys who find out the cancer has spread, the news is getting better. This past February, researchers at the University of California, San Francisco, announced they have a vaccine called Provenge that can treat severe forms of the disease.

It doesn’t prevent the disease; the vaccine combines a protein found in prostate cancer cells with a substance that stimulates the immune system. Doctors collect immune cells from the patient’s blood, mix them with the vaccine, and then inject the mixture in three doses over 2 months. The goal is to prompt the patient’s immune system to recognize the cancer cells for the intruders that they are.

In a study of 127 men with advanced prostate cancer, 34% of those who got the vaccine survived beyond 3 years; only 11% of the placebo group made it that far. And side effects were limited to a few days of cold-like symptoms, such as fevers and chills, says study author Eric Small, MD. Provenge is currently being fast-tracked through the FDA’s approval process and could be ready by 2006. If the vaccine continues to succeed against difficult cases–the men in the study had failed to respond to standard treatment–doctors will try it in patients with less advanced forms of the disease.

While it’s nice to know science is developing prostate solutions should you need them, the following advice can help reduce the likelihood you’ll suffer anything more than the indignity of a gloved finger. Putting this science into action (read: more sex, more wine) won’t confer immunity, but it will make your prostate one tough nut to crack.

Rev up your sex life
A happy man makes for a healthy man, especially when it comes to regular orgasms and your prostate. In a report from last year, National Cancer Institute researchers quizzed nearly 30,000 middle-aged men about their sex lives and discovered that those who averaged 21 ejaculations a month ran a 33% lower risk of prostate cancer than those who have four to seven ejaculations a month.

Researchers say it’s the ejaculation–not sex–that protects the prostate. In fact, a recent Australian study showed masturbating five or more times a week offered the same amount of prostate defense. “Seminal fluid contains substances that are carcinogenic,” says Graham Giles, PhD, the lead study author. “Regular ejaculation may help flush them out.”

If you’re not in a monogamous relationship, make sure that you and your partner are tested for sexually transmitted diseases. Human papillomavirus (HPV), cytomegalovirus (a type of herpes), and gonorrhea can infect the prostate, which ups your risk for prostate cancer.

Cancer Proof Your Prostate

Prostate cancer is the second-leading cancer killer of men. Globally 221,000 men die each year, and there are approximately 679,000 new cases diagnosed with 186,000 of those being in the U.S. As with most cancers, if detected in early stages prostate cancer is easily cured. Once spread beyond the prostrate it is usually treated with drugs that disrupt cancer fueling hormones.

Swedish researchers have just completed a study of 800 prostrate cancer patients which showed that nearly 24 percent of men who received only standard drug treatment had died after 10 years. Less than 12 percent of men who received both standard drugs and radiation treatment died in the same window of time. Those who survived more than 10 years saw a recurrence rate of 26 percent in those who had combination therapy, compared to 75 percent of those who had received only hormone therapy. The researchers said that the combination therapy should become the global standard of care.

The addition of radiation did not add too many side effects, according to the researchers. “The quality of life and adverse effect profile is acceptable. We therefore suggest that endocrine treatment plus radiotherapy should be the new standard of care for these patients,” Anders Widmark of Umea University in Sweden and colleagues wrote. The study was published in the journal Lancet Oncology.

The study focused on patients with “locally advanced” prostate tumors, those which have spread beyond the edge of the prostate gland, but have not invaded lymph nodes or other organs. According to Dr. Howard Sandler such tumors are difficult to completely remove with surgery and doctors usually treat such patients with other forms of therapy. Dr. Sandler is a spokesman for the American Society of Clinical Oncology and chair of Radiation Oncology at Cedars-Sinai Medical Center and was not involved in the study.

Dr. Sandler said that the additional radiation therapy is already standard in this country, but health agencies in Europe did not always provide radiation as well as drug treatment and that the radiation therapy that was performed in the study was somewhat simplistic, and modern radiation therapy with higher doses might magnify the benefits.

Dr. Chris Parker and Dr. Alex Tan of Britain’s Institute of Cancer Research in Sutton, Surrey wrote that, “The results should change current practice, making long-term hormonal therapy plus radical radiotherapy the standard of care for men with locally advanced prostate cancer." Experts predict the study will change the way prostate cancer patients are treated outside of the US.

John Neate, chief executive of The Prostate Cancer Charity said that the cancer specialists will have to digest all of the results before changes can occur in medical care, but the study represents real progress because it is about men, not mice or cells.

How much should I weigh?” It’s a common question, and an important one. Surprisingly, though, it’s actually the wrong question. For health, the issue is not just how much you weigh, but how much of your fat is located in your abdomen, reports the January 2009 issue of Harvard Men’s Health Watch.

Abdominal fat comes in two different forms. Some of it is located in the fatty tissue just beneath the skin. This subcutaneous fat behaves like the fat elsewhere in the body; it’s no friend to health, but it’s no special threat either. Fat inside the abdomen is another story. This visceral fat, which is located around the internal organs, can damage your health.

Scientists originally thought visceral fat was dangerous because it was linked to elevated stress hormones, which raise blood pressure, blood sugar levels, and cardiac risk. A newer explanation relies on the concept of lipotoxicity. Unlike subcutaneous fat, visceral fat cells release their metabolic products directly into the blood, so free fatty acids from visceral fat accumulate in the liver and other organs. This impairs the body’s regulation of insulin, blood sugar, and cholesterol and leads to heart problems. A third hypothesis starts with the complex role of fat cells. In addition to hoarding excess energy, fat cells produce a large number of proteins that contribute to metabolic abnormalities, inflammation, and heart disease. These three explanations are not mutually exclusive; all may help account for the hazards of visceral fat.

One way to evaluate body fat is to measure height and weight, then calculate body mass index (BMI). This is now the standard way to diagnose obesity. Another simple method uses the ratio of the waist and hip measurements. But many experts are turning to an even simpler technique: waist circumference. Because it involves one measurement instead of two, it’s more accurate and reproducible. And new research suggests that this simple measurement is the best way to tell who is at risk for the serious consequences of obesity.

So, what do you do about abdominal obesity? Harvard Men’s Health Watch suggests that you remember the basics. The only way to reduce visceral fat is to lose weight_and the only way to lose weight is to burn up more calories with exercise than you take in from food.

Also in this issue:

• Ten health resolutions
• Fatherhood and prostate cancer risk
• Pharyngitis
• Winter depression

Harvard Men’s Health Watch is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $24 per year.

Forty percent of men with prostate cancer may not even know they have it, according to a new research study by the Prostate Cancer Foundation of Chicago.

The study revealed the standard office biopsy procedure often isn’t enough to properly detect prostate cancer. This new research will be published in an upcoming issue of Urology, a national medical journal.

Researchers used an advanced biopsy technique called stereotactic transperineal prostate biopsy (STPB). This was performed on patients with persistent elevated prostate specific antigen (PSA) levels who previously had at least one negative office biopsy. All patients had received transrectal prostate biopsies (TRPB), administered by a urologist.

“Men who have negative transrectal biopsies and continue to have elevated PSA levels should consider STPB because 40% will harbor malignancy,” says Michelle Braccioforte, director of research and education for the Prostate Cancer Foundation of Chicago. “Our level of confidence is greatly enhanced with regards to the presence or absence of cancer, and more specifically, the exact location of the cancer within the prostate.”

STPB is performed by taking a median of 40 samples of the prostate through the perineum while the patient is under general anesthesia. Performed as an outpatient procedure, it allows more comprehensive sampling, compared to the transrectal method, which takes fewer samples through the rectum. In addition, by taking more samples during STPB, the exact location of the cancer can be pinpointed.

Between April 2004 and January 2008, 747 patients with high PSA levels were studied. All patients had been tested using TRPB at least once and all results had been negative. All patients received the STPB. Biopsy results identified the presence of cancer in 291 (39%) of the patients.

One in six men in the U.S. will be diagnosed with prostate cancer, the most common form of cancer among men. For those with elevated or rising PSA levels, this is a sign that further testing should be administered to rule out prostate cancer.

The Prostate Cancer Foundation of Chicago, located in Westmont, IL, is a not-for-profit organization that conducts ongoing research intended to improve the diagnosis and treatment of prostate cancer. For more information, visit http://www.chicagoprostatefoundation.org/ to download or call Michelle at 630.654.2515.

Male Circumcision Can Help Protect Against HPV And HIV, Studies Show

Circumcision can protect men and their female sex partners from contracting human papillomavirus, as well as help to protect men from contracting HIV, according to three studies published in the Journal of Infectious Diseases, Reuters reports. The first study — conducted by Bertran Auvert of the University of Versailles in Frances and colleagues in South Africa — examined more than 1,200 men visiting a South African clinic. The study found that less than 15% of men who were circumcised had HPV, compared with 22% of uncircumcised men. The authors wrote, “This finding explains why women with circumcised partners are at a lower risk of cervical cancer than other women.” A second study examining men in the U.S. had less definitive results but produced some evidence that circumcision might protect men from HPV, Reuters reports. The study, which was conducted by Carrie Nielson and colleagues at Oregon Health & Science University, found that circumcised men were about half as likely as uncircumcised men to have HPV. The third study, which was conducted by Lee Warner and colleagues at CDC, examined HIV among African-American men living in Baltimore. According to the study, 22% of uncircumcised men were at high risk of contracting HIV, compared with 10% of circumcised men. Previous studies in Africa had found that circumcision reduces a man’s risk of contracting HIV, but U.S. studies were less clear, Reuters reports (Fox, Reuters, 12/18).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

2008 The Advisory Board Company.