Health News Blog provides coverage of current health news.

posted by admin on Mar 30

Prostatitis is a broad name for a disease that can be either acute (intense, but for a finite interval), or chronic (of indefinite duration). It is either bacterial (caused by bacteria) or not bacterial. (Some doctors refer to bacterial prostatitis as “infectious.” This simply refers to an infection caused by bacteria; it does not mean you can “catch” it or give it to someone else.)

The disease is common in men but extremely rare among boys before puberty. How common is it? Statistics are hard to come by, but a National Health Center for Health Statistics study between 1977 and 1978 found 76 annual doctor’s office visits per 1,000 men for genitourinary tract problems. Of these visits, about 19 were for prostatitis.

Prostatitis is an umbrella diagnosis that spreads to encompass three conditions—acute and chronic bacterial, and nonbacterial, prostatitis—although a fourth ailment, called prostatodynia, is often lumped into this category.

Both acute and chronic bacterial prostatitis are associated with urinary tract infections (UTIs), positive cultures that pinpoint the bacteria’s location to the prostate, and an abundance of inflammatory cells in prostatic secretions. Acute bacterial prostatitis comes on suddenly, accompanied by fever and symptoms that demand prompt treatment (see below). Chronic bacterial prostatitis typically manifests itself by repeated urinary tract infections; these keep returning when the culprit—a persistent form of bacteria—defies the antibacterial drugs intended to kill it. The bacteria usually go away for a while after antibiotics, but then they come back. The hallmark of chronic bacterial prostatitis is that, when the infection returns, it’s caused by the same type of bacteria that caused the previous infection. One reason bacterial prostatitis is so closely linked to urinary tract infections is that they often are caused by the same nasty bacteria— most commonly, by varieties of E. coli. (These bacteria also cause urinary tract infections in women.) Also, the bacteria generally are enteric—the kind commonly found in the intestines. In most cases, just one variety of bacteria is involved, but some infections involve two or more types.

In nonbacterial prostatitis, there is a similar excess of inflammatory cells in the prostatic secretions, but no history of urinary tract infections, and negative cultures. Still another ailment, prostatodyniu (which means “painful prostate”) is a good mimic, often manifesting itself by the same symptoms, but patients have no history of urinary tract infections, and they have negative cultures and normal prostatic secretions.

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posted by admin on Mar 30

In a recent Department of Veterans Affairs study involving 556 men at several medical centers, researchers systematically compared men who underwent TUR to men with moderate to severe BPH symptoms who opted for watchful waiting. The average age of patients was 66; the study lasted three years.

In this study, the TUR patients were the clear winners in terms of symptom improvement and quality of life. They had “significantly fewer treatment failures, fewer crossovers to alternative treatment, and less bother from urinary symptoms,” the researchers noted. (Some men in the watchful waiting group eventually decided to have a TUR to relieve symptoms.) Men in the TUR group also had a greater improvement in their symptom scores, urinary flow, and quality of life. (Interestingly, spouses or “significant others” were also asked to evaluate their mates’ quality of life, and their reports confirmed the patients’ own assessments.)

The researchers concluded that TUR was safe, that it did not cause incontinence and impotence, and that it was associated with very few short- or long-term complications in men who didn’t have any serious health problems; reoperation rates were also low. Based on these findings, they determined that TUR was superior to watchful waiting in reducing symptoms and improving quality of life in men with moderate to severe BPH. However, they also noted that watchful waiting didn’t cause significant harm to anyone—and therefore, that for men with tolerable symptoms a conservative approach is certainly reasonable.

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posted by admin on Mar 30

Benjamin Franklin reportedly suffered from it; so did Thomas Jefferson. So will most men, if they live long enough. This almost inevitable condition, called benign prostatic hyperplasia (BPH), is the enlargement of the prostate.

BPH is not prostate cancer, and having it doesn’t mean a man is more likely to get prostate cancer. Unlike prostate cancer, which grows outward and invades surrounding tissue, the cell growth in benign enlargement is inward, involving the prostate’s innermost core. The key word here is benign. (In this case, hyperplasia means an increase in the number of cells in the prostate, which causes it to become enlarged.) By itself, an enlarged prostate causes no symptoms and does no harm. If it weren’t for the fact that the prostate encircles the urethra (the tube that carries urine from the bladder through the prostate to the penis), BPH might never require treatment. It takes years to develop; in fact, most men don’t realize they have BPH until the prostate begins to tighten around the urethra and hinder urine flow.

Like wrinkles and gray hair, BPH seems to come with the territory of aging. One exception to this rule seems to be men in Asia; however, BPH—as well as prostate cancer, both of which were once rare in China and Japan—is becoming increasingly common in the Far East. Some scientists believe this is related to increased “Westernization” of the traditional diet, which is low in fat and animal protein.

In this country, studies have found that the incidence of BPH increases every year after age 40; it’s present in 50 percent of men aged 51 to 60, and 80 percent of men who reach age 80. Twenty-five percent of these men—more than 350 thousand a year in this country alone—eventually will require surgery (some of them more than once) to relieve the urinary obstruction BPH causes, making BPH the most common cause of surgery in American men over age 55. The yearly cost of BPH surgery in the United States is well over $3 billion. Clearly, BPH is a significant medical problem in this country, and the numbers will only increase as our lifespans continue to lengthen.

But if BPH is almost a certainty for most men, its annoying symptoms don’t have to be. Never before have so many good treatment options—medical and surgical—been available for BPH, and never before have so many men sought, and found, relief from their symptoms.

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posted by admin on Mar 30

Should a man with stage T3, T4, or N+ (C or D1) cancer—but no symptoms— begin hormone therapy? Many doctors believe he should, the sooner the better. “Treat the tumor while a greater percentage of cells are responsive to hormones, and the patient should do better,” says one oncologist.

That is certainly one option, but we doubt that ultimately it will make a difference in prolonging life. Hormone therapy never cures; at best, it palliates cancer. An excellent example of this is a study done by the Veterans Administration Cooperative Urological Research Group, in which 1,764 men received either a placebo, surgical castration, 5 milligrams of DES a day, or the DES plus surgical castration. When prostate cancer began to progress in the men on the placebos—this happened to 70 percent of the men with stage T3 or T4 (C), and to all of the men with stage N+ and M+ (D) cancer—they began hormone therapy. The study, though not originally intended for this purpose, turned into a comparison of early hormone therapy versus delayed treatment. There was no difference in survival between the men who started hormone therapy late and the men who had been on it all along.

So what this means is that whether we treat a man with castration immediately—as soon as the diagnosis of advanced disease is made—or we wait until he has symptoms and then perform the castration, the survival is exactly the same. There is no evidence that any kind of hormone therapy works better earlier than later, when a man begins experiencing symptoms such as urinary obstruction or bone pain. We don’t believe that any man who is asymptomatic—feeling no symptoms—is going to feel any better once he has been deprived of his normal hormones. To repeat a point: The cancer cells that ultimately prove fatal in prostate cancer are the hormone-insensitive cells. They keep right on growing, unfazed by hormone therapy. To these cells, whether hormone therapy comes earlier or later does not matter.

For an asymptomatic man, early hormonal therapy means going from feeling fine and “normal” to experiencing hot flashes, loss of libido and the ability to have an erection, weight gain, changes in muscle mass, skin and hair growth and the subtle changes in personality that accompany the loss of male hormones. The long-term effects of hormone therapy can include osteoporosis— loss of bone density, which leaves bones more brittle and easy to break.

What’s the point of going through this early, when ultimately it’s not going to work any better than if a man waits to start hormone therapy until he develops symptoms of advanced disease?

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posted by admin on Mar 30

Evaluating the complications of interstitial brachytherapy is confusing for doctors as well as patients—mainly because there are many studies out there whose results and criteria vary widely. Some reasons for this are that different surgeons have different techniques and, frankly, levels of expertise; that some doctors implant seeds in patients who would be ruled out for this treatment by other doctors; and that some doctors leading various studies may not specify, may lump in different categories, or may not even be aware of all the complications their patients have had. Any time you see gaping holes in percentages

(like, “From s’percent to 85 percent of men had . . .”), it’s probably safe to assume that truly accurate results are hard to come by

Having said this, we can also say that there are some complications you can expect from implantation of radioactive seeds. They include the following.

The incidence of death from any of the procedures is extremely low. There is a huge fluctuation in the incidence of late (not immediately after surgery) complications—ranging from zero to 72 percent—depending on which study one chooses to quote; the most common range is from 10 percent to 25 percent.

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