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Prostate cancer and testosterone,
does the latter cause the former to grow?
Why don’t men under thirty get prostate cancer.At that age they have probably more testosterone than men older. Yet when we get older our chances of prostate cancer increase whilst our testosterone levels are dropping.
It really is time that our medics and researchers looked at a virus as a cause for prostate cancers.This article describes how some U.S. medics are using testosterone to enhanced men’s lives.
“Darling I know I am not a doctor, but I am sure that you are being treated incorrectly for prostatitis.
What is hypogonadism?
Testosterone is the male hormone which is mainly produced by the testis. Small quantities are made in other organs (eg adrenal gland), but in a man this contributes only a small amount of the total. Testosterone is a hormone which is released into the blood which will have effects on other parts of the body. When men have a lack of testosterone the condition is termed hypogonadism.
What are the symptoms of hypogonadism?
The symptoms of hypogonadism include loss of libido or reduced interest in sexual activity, erectile dysfunction or ED, reduced facial hair, loss of energy, falling asleep after meals, reduced muscle power and stamina, loss of height, and osteoporosis or brittle bones which may result in fractures of the spine or hips.
How is hypogonadism diagnosed?
The diagnosis is made on the basis of the clinical symptoms described above and confirmed with a blood test measuring the testosterone level.
What is the relationship between prostate cancer and testosterone?
It has been known since the 1940's that severe reductions of testosterone can cause shrinkage of prostate cancer that has spread to the bones, and therefore there has been a concern that raising testosterone levels might cause growth of any hidden prostate cancers. However, a recent study from Harvard has found no connection between higher testosterone levels and prostate cancer, nor did the study find evidence that testosterone treatment causes prostate cancer.
In fact, studies have demonstrated no difference in prostate cancer incidence among hypogonadal men using testosterone therapy compared to men in the general population.
Can I take testosterone if I have prostate cancer?
Historically, men have been told to avoid testosterone if they have prostate cancer just as women with breast cancer have been told to avoid using estrogens or the female hormone produced by the ovaries. However, if a man who has had a radical prostatectomy or radiation therapy and the PSA remains at the undetectable level after surgery or stable for 24-36 months after radiation, then he might be a candidate for testosterone replacement therapy if he is symptomatic for hypogonadism and he has a decreased testosterone level.
What precautions must I take if I use testosterone and I have a diagnosis of prostate cancer?
1.It is necessary for regular intervals for monitoring of PSA and exams.
2.If the PSA rises, then the testosterone must be discontinued.
NEGLECT OF NON INFECTIOUS PROSTATITIS, WHO GAINS WHO LOSES?
A PHYSICIAN COMMENTS ON THE DISEASE MOST MEDICS DO NOT TALK ABOUT.
(PELVIC PAIN SYNDROME)
Patient centred treatment is currently a buzz phrase. Of course good medicine always was patient centred.
Another view is that if you wish to understand why things happen the way they do you should look at absolutely everyone in the consulting room to see what they gain out of the consultation.
I am going to suggest that we look further than that and look at everyone from the ministry down to see who gains and who loses by the neglect of non-infectious prostatitis/pelvic pain syndrome.
That this condition is neglected is in my humble opinion clear. At risk of repeating myself we have :-
No article in the Lancet or BMJ for over 10 years-these are the leading generalist medical journals for the UK.
No articles in the English Language General Practitioner Journals.
No practical Department of Health advice for GP’s on how to diagnose and initially handle this common condition.
No knowledge of whether these inflammatory conditions respond to corticosteroids (available for treatment and research for over 60 years)
No accurate knowledge of the Natural History of the condition.
It is unknown whether the condition is associated with microscopic colitis or irritable bowel syndrome.
Do I need to continue?
Let us look at who gains or loses in turn by this neglect/denial. I will not be mentioning ethical or professional responsibility as these factors have been present for decades and you may judge what effect they have had.
The following are my personal opinions as a physician, not necessarily the opinions of the PHA.
Secretary of State for Health
Irrelevant-unreasonable to expect this person to know about individual conditions
Department of Health NHS
Gains –no need to expend resources on a Executive – trivial or non-existent condition.
Strategic Health Authority
Gains –no need to expend resources on a non-existent condition
Primary Care Trust
Neutral –no need to expend resources on expensive treatments or research but must fund chronic pain/depression treatment
Loses- must manage a patient who may be depressed and in chronic pain-frequently without a management protocol or useful consultant advice
Gains-No need to research, seek funds for, or treat a conditionthat they were trained to think of as trivial orpsychological –a few screening tests are required to exclude rarities and then it is entirely legitimate to discharge the patient
Major loser- in severe pain may lose job and/or marriage. Likely to become depressed. Often still disbelieved by some professionals. “There is a pain but it is not in the prostate”. “
No one can blame you for removing an irritant from clinic” to quote previous generations of urologists.
THE Advisory Committee on Clinical Excellence Awards has power to change behaviour as it recommends awards for exceptional contribution …over and above that which would normallybe expected in a job
Do you think the behaviour of the relevant specialists justifies Clinical Excellence Awards?
Can you see a pressure to improve management of chronic prostatitis/pelvic pain syndrome?
It would not be fair simply to criticise the current generation of urologists who have been given a terrible basis for their practice by their seniors who ignored or denied the condition.
Anecdotes have no part to play in scientific discussion but do explain human behaviour on occasions.
When I write these articles I think of a young professional who had just been given a permanent position when he developed prostatitis.
He had a TURP which made him worse, had his seminal vesicles removed which made him even worse.He became depressed and retired to bed (always a mistake) he was taking large amounts of codeine.
He developed a clot in the leg (DVT) it broke off to his lungs (Pulmonary Embolus)- he died.
I did not see his death certificate but I doubt it mentioned prostatitis in a significant role.
One last question for everyone from the secretary of state down
“Is chronic non-infectious prostatitis best treated by a surgeon or would someone from a different background handle it better?”
Comment by the PHA.
Of course we could always look to alternative methods of treatment. Blowing our own trumpet we have many readers who have got their lives back by taking Quercetin and Beta sitosterol.These powerful anti-inflammatory products work wonders on the pain that prostatitis causes.For more information on costs etc see…
EACH year some 30 million American men undergo testing for prostate-specific antigen, an enzyme made by the prostate. Approved by the Food and Drug Administration in 1994, the P.S.A. test is the most commonly used tool for detecting prostate cancer.
The test’s popularity has led to a hugely expensive public health disaster. It’s an issue I am painfully familiar with — I discovered P.S.A. in 1970. As Congress searches for ways to cut costs in our health care system, a significant savings could come from changing the way the antigen is used to screen for prostate cancer.
Americans spend an enormous amount testing for prostate cancer. The annual bill for P.S.A. screening is at least $3 billion, with much of it paid for by Medicare and the Veterans Administration.
Prostate cancer may get a lot of press, but consider the numbers: American men have a 16 percent lifetime chance of receiving a diagnosis of prostate cancer, but only a 3 percent chance of dying from it. That’s because the majority of prostate cancers grow slowly. In other words, men lucky enough to reach old age are much more likely to die with prostate cancer than to die of it.
Even then, the test is hardly more effective than a coin toss. As I’ve been trying to make clear for many years now, P.S.A. testing can’t detect prostate cancer and, more important, it can’t distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t.
Instead, the test simply reveals how much of the prostate antigen a man has in his blood. Infections, over-the-counter drugs like ibuprofen, and benign swelling of the prostate can all elevate a man’s P.S.A. levels, but none of these factors signals cancer. Men with low readings might still harbor dangerous cancers, while those with high readings might be completely healthy.
In approving the procedure, the Food and Drug Administration relied heavily on a study that showed testing could detect 3.8 percent of prostate cancers, which was a better rate than the standard method, a digital rectal exam.
Still, 3.8 percent is a small number. Nevertheless, especially in the early days of screening, men with a reading over four nanograms per milliliter were sent for painful prostate biopsies. If the biopsy showed any signs of cancer, the patient was almost always pushed into surgery, intensive radiation or other damaging treatments.
The medical community is slowly turning against P.S.A. screening. Last year, The New England Journal of Medicine published results from the two largest studies of the screening procedure, one in Europe and one in the United States. The results from the American study show that over a period of 7 to 10 years, screening did not reduce the death rate in men 55 and over.
The European study showed a small decline in death rates, but also found that 48 men would need to be treated to save one life. That’s 47 men who, in all likelihood, can no longer function sexually or stay out of the bathroom for long.
Numerous early screening proponents, including Thomas Stamey, a well-known StanfordUniversity urologist, have come out against routine testing; last month, the American Cancer Society urged more caution in using the test. The AmericanCollege of Preventive Medicine also concluded that there was insufficient evidence to recommend routine screening.
So why is it still used? Because drug companies continue peddling the tests and advocacy groups push “prostate cancer awareness” by encouraging men to get screened. Shamefully, the American Urological Association still recommends screening, while the National Cancer Institute is vague on the issue, stating that the evidence is unclear.
The federal panel empowered to evaluate cancer screening tests, the Preventive Services Task Force, recently recommended against P.S.A. screening for men aged 75 or older. But the group has still not made a recommendation either way for younger men.
The Preventative Services Task Force approaches a potential client with some advice.
Prostate-specific antigen testing does have a place. After treatment for prostate cancer, for instance, a rapidly rising score indicates a return of the disease. And men with a family history of prostate cancer should probably get tested regularly. If their score starts skyrocketing, it could mean cancer.
But these uses are limited. Testing should absolutely not be deployed to screen the entire population of men over the age of 50, the outcome pushed by those who stand to profit.
I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments.
Written By: Richard J. Ablin is a research professor of immunobiology and pathology at the University of Arizona College of Medicine and the president of the Robert Benjamin Ablin Foundation for Cancer Research.
Sad isn’t it ? The PHA have been pointing out the downside of PSA testing almost since we began back in 1993/4.I shudder to think of the thousands of men who have had the pain of biopsies, not to mention any following side effects, over that period of time.
I just don’t like thinking about the unnecessary operations for detected prostate cancers that today would be described as pussy cats and have no action taken to treat them.PD.
PSA Takes More Criticism.
Prostate test creator labels it a 'public health disaster'
THE creator of the blood test used to detect prostate cancer has admitted it has become a ''hugely expensive public health disaster'' and should be abandoned.
Richard Ablin, who developed the prostate-specific antigen test 40 years ago, used by about 1 billion of men a year, yesterday agreed it had been proven inaccurate and was ''hardly more effective than a coin toss''.
''PSA testing can't detect prostate cancer, and more important, it can't distinguish between the two types of prostate cancer - the one that will kill you and the one that won't,'' Dr Ablin wrote in a column in the The New York Times.
But many doctors fear his comments will frighten men and put them off getting tested for a condition that kills thousands a year.
''The PSA test does save lives and it does pick up cancers in their early stages,'' the director of Sydney's, Australian, St Vincent's Prostate Cancer Clinic, Phillip Stricker, said.
''It hasn't been the blockbuster we thought it might be.”
He agreed that the test had wrongly been given to older men with late-stage cancers and limited life spans, pushing up costs, and often picked up cancers that did not need treatment, but said ''if used intelligently'' it was still worthwhile.
We, the PHA, have always said if you have one test which is high do not under any circumstances make decisions on further testing, such as a biopsy, without having a second PSA test to confirm the first. You should also take action to ensure you do not engage in sport activity which pounds the pubic area, such as mountain bike riding and refrain from any ejaculation for several days prior to your second test.Now it appears you should ensure you do not take any pain killers for a week before the test.
………..do not engage in a sport activity which pounds the pubic area,
Dr Ablin said simple over-the-counter pain medications such as ibuprofen could elevate prostate antigen levels, giving a false indication of cancer. Men with low readings could be harbouring dangerous cancers and those with high readings could be completely healthy.
Dr Albin said the test should ''absolutely not be deployed'' as a mass screening tool.This counters the calls over the years for screening of all males over forty.
''I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of PSA screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments.''
Two studies published in the New England Journal of Medicine last year found the test was inaccurate and costly.
An American survey of 77,000 men concluded there was no decrease in the death rate in those who had yearly tests compared with those who were not offered testing. In the European trial, involving 182,000 men, it was found the death rate did decline slightly, but 48 men would need to be treated to save one life.
''We now have a situation where there is overdiagnosis and overtreatment,'' the chief executive of the Cancer Council Australia, Ian Olver, said.
Modern medicine may be great at re attaching severed limbs but it really fouls up with many other medical so called ‘progress’. PD.
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