ABC of Mens Health Blog

Men treated for prostate cancer have high levels of psychological distress and many suffer ongoing sexual dysfunction and lower urinary tract symptoms, according to a survey of men in England designed to explore their supportive care needs.
Prostate cancer is the commonest solid cancer in men, accounting for one in every four cancers diagnosed in males in England in 2004. Fortunately, the survival rate for this cancer is improving, reflecting the slow growing nature of the disease and its successful treatment in many men. Nearly three-quarters (71%) of men are still alive five years after being diagnosed with prostate cancer.
A range of treatment options - include surgery, radiotherapy and hormonal treatments - are available for prostate cancer, with the choice being determined by a man’s age, the stage of his cancer and any other conditions that he has. Some of the treatments can have long-term effects on sexual and urological function.
The primary aim of treatment is to optimise cancer control, but some doctors also take into account a man’s urological and sexual function before treatment and the patient’s views on the balance of treatment efficacy against side-effects.
Relatively little is known about the support care needs - the requirements for care arising during illness and treatment to manage symptoms and side-effects - in men treated for prostate cancer. To find out more about how the disease and its treatment affects men, nursing researchers surveyed men with prostate cancer in six areas of England.
The researchers invited 1848 men who had been diagnosed with prostate cancer in the previous three to 24 months, from across six NHS Trusts (geographical regions in the National Health Service) to take part in the research study. Those who replied (820 men) were sent a postal questionnaire asking about their supportive care needs, prostate symptoms, quality of life, their cancer and its treatment; 741 were returned.
Three-quarters of the men taking part in the survey were 65 years old or over, Half (51%) had received hormonal therapy, one-quarter (25%) had radical prostatectomy and 28% had radiotherapy to the prostate. Just under half (46%) of the men said their cancer was in remission.
The survey revealed that the men had significant unmet supportive care needs. The areas of greatest need were related to psychological distress, sexuality-related problems and the management of enduring lowering urinary tract symptoms. The researchers noted: "High levels of psychological distress were reported, and those reporting psychological distress reported greater unmet supportive care needs."
Men who were uncertain of their remission status had higher levels of psychological need, while those not in remission were more likely to have needs for information.
Kaufen generishe cialis soft Nearly one-third (30%) of the men taking part in the survey reported moderate or extreme anxiety or depression. A similar number had difficulty with undertaking usual activities. Some or extreme pain was reported by 26% of the men and 22% had problems with mobility.
Virtually all (97%) of the men reported that they had experienced lower urinary tract symptoms, including frequency or needing to urinate during the night, during the month before the survey. Urinary symptoms were affected by treatment, remission status and time since last treatment. They were least severe in men who were in remission, in those who had undergone radical prostatectomy and/or in those who had completed their treatment 19-24 months before the survey.
Unmet needs related to sexuality were more common in younger men and in those who had undergone radical prostatectomy.
The researchers, led by Emma Ream, from the Florence Nightingale School of Nursing and Midwifery, King’s College London, UK, said: "The survey identified high levels of psychological distress within the sample, even though the majority had completed treatment over a year previously." They suggested that need for psychological care was particularly high in men not in remission or whose remission status was uncertain. "The need for systematic assessment and better management of psychological distress in men with prostate cancer was evident in this study," they concluded, adding that sexual dysfunction and lower urinary tract system symptoms also required greater attention by prostate services.
Reference
Supportive care needs of men living with prostate cancer in England: a survey.
Ream E, Quennell A, Fincham L. et al.
British Journal of Cancer advance online publication 2008, 1-7, doi:10.1038/sj.bjc.6604406
Cancer Research Summaries are overviews of important cancer research findings that have been reported in leading cancer publications. The Cancer Research Summaries are provided by the Cancer Media Service (CMS) in collaboration with Nature Clinical Practice Oncology.
"This summary is provided by the European School of Oncology’s Cancer Media Service"
Cancer Media Service
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Men’s Health News
Diabetes in men has a direct effect on fertility, a scientist told the 24th annual conference of the European Society of Human Reproduction and Embryology today (Wednesday 9 July).
Dr. Con Mallidis from Queen’s University, Belfast, UK, said that, despite the prevailing view that it had little effect on male reproductive function, the Belfast group had shown that diabetes caused DNA damage in sperm.
The increase in the numbers of diabetics diagnosed at a young age has coincided with worldwide concerns over male fertility, he told the conference. "But this is not simply a coincidence," he said. "We have shown for the first time that diabetes adversely influences male fertility at a molecular level."
The scientists studied semen samples from men with diabetes who were receiving insulin therapy. Kaufen levitra pillen mastercard On initial routine microscopic examination the semen samples appeared normal, apart from a slight decrease in volume.
"But when we looked for DNA damage, we saw a very different picture," said Dr. Mallidis, adding that this is not part of a routine semen analysis. "Sperm RNA was significantly altered, and many of the changes we observed are in RNA transcripts involved in DNA repair. And comparison with a database of men of proven fertility confirmed our findings. Diabetics have a significant decrease in their ability to repair sperm DNA, and once this is damaged it cannot be restored."
Transcription is the synthesis of RNA under the direction of DNA, and is the first step towards gene expression, where the information from the gene becomes a product such as a protein translating the genetic information into a cellular function. If there are errors in transcription, there will also be errors in the function of the gene. "We were particularly interested to see a fourteen-fold decrease in the expression of a protein called ornithine decarboxylase, which is responsible for the production of spermine and spermidine, compounds responsible for cell growth that help stabilise the structure of DNA. We also found that spermatogenesis 20, a factor unique to the testis and whose function remains unknown, was greatly increased. Taken together, these factors indicate clearly that having diabetes has a direct influence on the health of semen."
Sperm DNA quality is known to be associated with decreased embryo quality, low embryo implantation rates, higher miscarriage rates, and some serious childhood diseases, in particular some childhood cancers. Over the years possible causes for sperm DNA fragmentation have been suggested but to date the exact mechanism for the damage remains unknown, say the scientists.
"We found a class of compounds known as advanced glycation end products (AGEs) in the male reproductive tract. These are formed as the result of glycation (the addition of sugar)," said Dr. Mallidis, "and accumulate during normal ageing. They are dependent on life style - diet, smoking etc - and in many diabetic complications are centrally implicated in DNA damage. We believe that they play a similar role in the male reproductive system."
The scientists intend to follow up their work by trying to determine how AGEs cause and contribute to DNA damage. They believe that they may have uncovered a new role for AGEs, and that their influence goes far beyond diabetes and its complications.
"We must now try to develop strategies to protect sperm, and to diminish the accumulation of AGEs," said Dr. Mallidis. Such strategies could involve changes in diet, disrupting a step in the formation of AGEs, or increasing the body’s protection against AGEs, possibly through the use of dietary supplements.
"Finally, there is spermatogenesis 20. What does it do, how does it do it, under what circumstances and why? Why is it so greatly increased in diabetics? We need to find answers to all these questions," said Dr. Mallidis.

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UroToday.com - Dr. Kevin McVary (Chicago) presented the AUA lecture. The incidence of ED increases to over 60% by age 60. He showed data that ED increases with increasing severity of LUTS, independent of age. Across all age groups, increasing LUTS correlated with worse ED even after adjusting for other factors such as diabetes mellitus. This suggests a common pathophysiology or causal relationship between ED and LUTS.
In the MTOPS data, sexual function domains were stratified against AUA symptom indices and all sexual function domains correlated with LUTS. kaufen levitra Ohne Rezept Prostate volume also correlated with ED as increasing size and worsening ED were linked. Several theories may explain these findings. Nitros oxide (NO) can be reduced by smoking, diabetes, etc. and result in prostatic hyperplasia that contributes to LUTS. In a canine prostate model, exposure to NO results in increased relaxation of smooth muscle, consistent with the hypothesis. Dr. McVary’s research has shown decreased NO as men age. The enzyme PDE-5 in the prostate and bladder is increased and may contribute to ED. Experimental models of PDE-5 inhibitors result in increased smooth muscle relaxation.
He spoke about using the PDE-5 inhibitor concept to treat LUTS. A placebo run-in phase is important in LUTS trials. Sildenafil was tested in a combined ED/LUTS trial, and LUTS scores improved by over 6 points. Both obstructive and irritative scores improved. He cited Dr. Steif’s vardinafil study that also demonstrated an improvement in LUTS. Despite symptom improvement, Dr. McVary did not find any improvement in urinary flow rate.
He also spoke about atherosclerosis induced chronic ischemia causing bladder and penile fibrosis and contributing to both voiding and erectile symptoms. Another theory is that increased autonomic activity correlates to ED and LUTS. He presented data in patients to support this correlation. A causal relationship was not demonstrated. Increased sympathetic tone from obesity, physical inactivity and other causes lead to effects on erectile function and LUTS.
Presented by: Kevin McVary, MD, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy
Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS
UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.
To access the latest urology news releases from UroToday, go to:
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Copyright © 2008 - UroToday
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Men’s Health News
Men with serious injuries, such as traumatic brain injury or spinal cord injury, must deal with a range of emotions.
If these men have strong traditional masculine ideas and abuse alcohol, it becomes even more difficult to help them heal and come to terms with their emotions and situations. A University of Missouri psychology researcher studied these challenging factors to find better ways to understand and treat men who fit this mold, such as the injured soldiers coming back from Iraq and Afghanistan.
"It is really a triple whammy," said Glenn Good, professor of educational, school and counseling psychology in the MU College of Education. "Counselors face many challenges when it comes to helping men deal with emotions surrounding serious injuries. Newly injured men often face adjustments in the level of personal assistance they require, and this may result in struggles with some aspect of the traditional masculine role, such as a ‘go it alone’ mentality. When three factors - injury, traditional male role and alcohol abuse - occur together, the rehabilitation process may be a challenge. In this study, we examined the combination of all three factors with the aim of better understanding how to treat men with several challenges."
Good and his colleagues found that a young man with a serious injury would often report a greater pursuit of status, higher drive for dominance and increased risk taking. However, they were more open to accepting assistance. Older men in the study tended to hold to the masculine attitude that they could do everything on their own and did not need any help, presenting a greater challenge.
"Unfortunately, we are going to have a country full of men like this coming back from Iraq and Afghanistan," Good said. "Soldiers have been trained to be hyper-masculine and, after a serious injury, could easily turn to alcohol use to deal with their new challenges. We have to confront this problem and create interventions that address all of these issues and not just one behavior or problem at a time. Our systems of care for people with spinal cord injuries, veterans and non-veterans, must address these issues proactively and with adequate resources to face these multiple challenges."
Good found alcohol use was common regardless of age. In the study, binge drinking was defined as five or more drinks per occasion.
"Some men are drinking instead of seeking appropriate help, but some have been heavy drinkers all along," Good said. "The binge drinking is problematic. kaufen cialis soft Ohne Rezept Some may drink to suppress their bad feelings about being injured and their perceived loss of masculinity. They may think they are being strong by not seeking help when in fact turning to alcohol could be even more detrimental."

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Men’s Health News
Using a breakthrough technology, researchers led by a Weill Cornell Medical College scientist have pinpointed the hormone estrogen as a key player in about half of all prostate cancers.
Estrogen-linked signaling helps drive a discrete and aggressive form of the disease caused by a chromosomal translocation, which in turn results in the fusion of two genes.
"Fifty percent of prostate cancers harbor a common recurrent gene fusion, and we believe that this confers a more aggressive nature to these tumors," explains study senior author Dr. Mark A. Rubin, professor of pathology and laboratory medicine, and vice chair for experimental pathology at Weill Cornell Medical College. Dr. Rubin is also attending pathologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
"Interfering with this gene fusion — or its downstream molecular pathways — will be crucial in the search for drugs that fight the disease. Based on our new data, we now believe that inhibiting estrogen may be one way of doing so," he says.
The findings are published in the May 27 online edition of the Journal of the National Cancer Institute. Dr. Rubin conducted the study while at the Brigham and Women’s Hospital and in collaboration with Dr. Todd Golub and other members of the Broad Institute of MIT and Harvard, in Cambridge, Mass. His team is now continuing this line of research at Weill Cornell.
Dr. Rubin, along with researchers at the University of Michigan, first discovered and described the common fusions between the TMPRSS2 and ETS family member genes subset of prostate cancer in the journal Science in 2005. "The discovery showed that these malignancies occur after an androgen (male hormone)-dependent gene fuses with an oncogene — a type of gene that causes cancer," he explains.
Experts have long understood that male hormones help spur prostate cancer — in fact, androgen-deprivation therapy is a first-line treatment against the disease. And yet the disease can progress despite androgen reduction, suggesting that other pathways might be at work.
"So, we wanted to learn more — what is the genetic and molecular ‘fingerprint’ of this aggressive subset of prostate tumor?" Dr. Rubin says.
Answering that question required the analysis of 455 prostate cancer samples from trials in Sweden and the United States that were conducted as far back as the mid-1970s.
"These samples were placed in fixative and not frozen, so we needed new methods of retrieving the genetic information," Dr. Rubin says. To do so, his team led by co-lead authors Dr. Sunita Setlur and Dr. Kirsten Mertz developed an innovative technology for effectively "reading" the gene transcription profiles hidden in the samples.
"That led us to perform the largest gene-expression microarray analysis yet conducted in prostate cancer research, amassing information on more than 6,000 genes," Dr. Rubin says. "This allowed us to obtain a robust, 87-gene expression ’signature’ that distinguishes fusion-positive TMPRSS2-ERG cancers from other prostate malignancies."
A close analysis of the signature yielded a surprise: that estrogen-dependent molecular pathways appear to play a crucial role in regulating (and encouraging) this aggressive subset of prostate cancer.
While estrogen is typically thought of as a "female" hormone, men produce it as well.
"Now, we show for the first time that this natural estrogen can stimulate the production of the cancer-linked TMPRSS2-ERG transcript, via the estrogen receptor (ER)-alpha and ER-beta. These receptors are found on the surface of some prostate cancer cells," Dr. Rubin explains.
The finding could have implications for prostate cancer research, including drug development. According to Dr. Rubin, "We now believe that agents that dampen estrogen activity (ER-beta antagonists) could inhibit fusion-positive prostate cancers. Alternatively, any intervention that boosts estrogen activity (ER-alpha) might also give a boost to these aggressive malignancies."
Research into just why fusion-positive prostate cancers are so aggressive — and potential molecular drug targets to help curb that aggression — will continue under Dr. Rubin’s direction at Weill Cornell, in collaboration with members of his group and with computational biologist Dr. Francesca Demichelis.
"The technological achievement of using fixed samples that were up to 30 years old is significant," Dr. Rubin says. "In the future, we hope to explore banked tissues from clinical trials to help understand why they failed. This should lead to insight for designing the next trial."
This work was funded by the U.S. National Institutes of Health, a Prostate SPORE grant at the Dana-Farber/Harvard Cancer Center, Swiss Foundation for Medical-Biological Grants SSMBS, U.S. Department of Defense and the Prostate Cancer Foundation.
Co-researchers include study co-lead authors Dr. Kaufen cialis soft pillen mastercard Sunita Setlur and Dr. Kirsten Mertz of Brigham and Women’s Hospital and Harvard Medical School, Boston; Dr. Yujin Hoshida and Dr. Todd Golub of the Broad Institute and the Dana-Farber Cancer Institute, Boston; Dr. Francesca Demichelis of Weill Cornell Medical College and Harvard Medical School, Boston; Dr. Mathieu Lupien of the Dana-Farber Cancer Institute; Dr. Sven Perner and Jeff Tang of Weill Cornell Medical College; Andrea Sboner of Yale University, New Haven; Dr. Yudi Pawitan and Dr. Katja Fall of the Karolinska Institutet, Stockholm, Sweden; Dr. Ove Andren, Dr. Jan-Erik Johansson and Dr. Swen-Olof Andersson, of Orebro University Hospital, Orebro, Sweden; Laura A. Johnson of Brigham and Women’s Hospital, Boston; Dr. Hans-Olov Adami, of Karolinska Institutet, Sweden, and Harvard School of Public Health, Boston; Dr. Stefano Calza, of the Karolinska Institutet, Sweden, and the University of Brescia, Italy; Dr. Arul M. Chinnaiyan, Dr. Daniel Rhodes and Scott Tomlins, of the University of Michigan Medical School, Ann Arbor; Dr. Lorelei Mucci and Dr. Meir Stampfer of Harvard Medical School, Harvard School of Public Health and Brigham and Women’s Hospital, Boston; Dr. Philip Kantoff of Dana-Farber Cancer Institute and Harvard Medical School; Dr. Eberhard Varenhorst, of University Hospital Linkoping, Sweden; and Dr. Myles Brown of the Dana-Farber Cancer Institute.
Dr. Mark A. Rubin, Dr. Francesca Demichelis, Dr. Sven Perner, Dr. Arul M. Chinnaiyan and Scott Tomlins are co-inventors on a patent filed by the University of Michigan and the Brigham and Women’s Hospital, covering the diagnostic and therapeutic fields for ETS fusions in prostate cancer.

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