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For Men Prostate Problems are Almost Inevitable

A gentleman said, “Doc, how come you have not written about prostate problems lately?” He was right. Sometimes I feel I have written about a subject recently but when I look back at my list on the computer, I find time does go by fast. So, here is some information about prostate problems.

On a personal note, I am proud to say that this is my 400th column. I appreciate all the feed back and encouragement I receive from readers from all walks of life. Not only I enjoy writing but I learn a lot myself when I do all the research for my articles. I have learnt to take care of my health better thanks to these columns.

Ok, let us get back to our subject.

“Prostatic disease eventually affects almost all men; benign prostatic hypertrophy or hyperplasia (BPH) is an inevitable part of aging,” says an article in the Canadian Medical Association Journal (CMAJ June 19, 2007).

Do we need to worry about prostatic hypertrophy or hyperplasia which in simple terms means prostatic enlargement? Sure, we have to worry. Who knows, it could be malignant. Although prostatic enlargement eventually affects almost all aging men, not all men suffer from prostatic cancer. The lifetime risk of diagnosis of prostatic cancer is 18 per cent and death from prostatic cancer is three per cent.

Enlarged prostate gland has several effects. These include difficulty with voiding urine and blood PSA levels may go up. Other complications are urinary retention, urinary bleeding, bladder stones, recurrent urinary tract infections and renal failure. These effects become progressively worse requiring frequent medical attention and rising PSA requires multiple tests to rule out prostate cancer.

About 20 years ago, the standard treatment for benign enlargement of prostate gland was surgery. Now, patients with mild symptoms do not need any treatment. Patients with moderate symptoms are treated with medications. These medications have shown to improve the flow of urine and improve the quality of life. Do these medications prevent complications of BPH? Studies have shown that this is possible.

The two major classes of drugs used to treat BPH are: a) alpha-blockers like doxazosin relax smooth muscle fibers of the bladder neck and prostate gland to reduce prostatic obstruction, b) five- – reductase inhibitors like finasteride decrease levels of testosterone in the prostatic gland itself but do not affect the systemic testosterone level. This leads to reduction of the prostate gland by 20-30 per cent.

With -blockers, patients experience relief of symptom within two weeks of starting the medication, compared with several months with finasteride. Researchers have found that doxazosin and finasteride slowed down the growth of BPH compared with placebo; the combination therapy was significantly more effective than either drug alone.

The CMAJ article says that the Medical Therapy of Prostatic Symptoms study showed that:
-BPH is a progressive disease
-progression can be prevented by medical therapy
-patients at risk for progression can be readily identified by PSA level, prostatic volume and symptom severity
-and the combination of finasteride and doxazosin is more effective than either alone in preventing progression, particularly in high-risk groups.

Are there any side-effects to these medications?

The article says that clinically significant side effects, mainly postural hypotension (low blood pressure), were infrequent and they led to cessation of therapy in 18–27 per cent of the men involved in the study. Side effects that occurred were minor and related mainly to sexual function.

Patients treated with finasteride had significant benefit with improvement in urinary symptoms. There was also an added advantage in that the finasteride-treated patients saw reduction in the overall risk of prostate cancer by 25 per cent – a rate almost unheard of in the field of cancer prevention, says the CMAJ article. The authors of the article say, “Because PSA levels are reduced in men with BPH who are taking finasteride, rising PSA findings are more likely to be caused by prostate cancer. Taking this drug may therefore provide a diagnostic advantage as well.”

The article poses the question: Should selected patients now be offered finasteride to lower their risk of developing prostate cancer and BPH progression?

“The answer, based on these trials, is unequivocally yes,” conclude the authors of the CMAJ article.

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Does Coffee Improve Sexual Performance?

Sex has been part of our lives since Adam and Eve decided to have a cup of coffee…ok I am just kidding. Anyway, Adam and Eve did what they had to do without the necessity of having coffee or having a smoke. They just needed and an apple. Now you won’t find an apple in anybody’s bedroom or a hotel room. Instead, you find a small coffee maker.

Coffee is known to do many things. But does it improve sexual performance?

In 1990, a paper was published in the Archives of Internal Medicine looking at sexual function in people over the age of 60 in Washtenaw County, Michigan. Their study showed that estimated proportions of individuals who were sexually active were 73.8 per cent for married men and 55.8 per cent for married women.

Among unmarried men and women the proportions were 31.1 per cent and 5.3 per cent, respectively. The levels of sexual activity decreased significantly with age in both genders. The estimated proportion of married men with erectile impotence was 35.3 per cent. The authors found that consumption of at least one cup of coffee per day was significantly associated with a higher prevalence of sexual activity in women and with a higher potency rate in men.

Ok, one cup of coffee would do the trick? Then why take the blue pill? I doubt whether coffee will ever replace your Viagra, Cialis, or Levitra. But coffee should keep you awake for awhile during sexual performance if you are in a habit of dosing off before the foreplay is over.

Scientists from Southwestern University found caffeine increased the female libido in experiments on rats. The Pharmacology, Biochemistry and Behaviour journal study said the effect was caused by it stimulating the part of the brain regulating arousal. But researchers said a similar effect was only likely to be repeated in humans who do not drink coffee regularly. Well, that study does not help much.

According to a report in the Globe and Mail (February 6, 2009), psychologists at Durham University in Britain questioned 200 people about their daily caffeine intake and whether they had ever had a hallucinatory experience.

The researchers found that hard-core coffee drinkers (those who consume an average of seven cups daily) were three times more likely to report seeing things that weren’t there, hearing voices and feeling as if they were floating above their bodies. I wonder who would like to make love to a person who has had seven cups of coffee. It would be a different kind of experience….levitational love making.

Caffeine is a mild stimulant which acts on the central nervous system and some other organs of the body. It temporarily improves concentration, alertness, reasoning, intellectual effort and vigilance. A prerequisite before love making? The stimulant effects of a small amount (say one cup of coffee) take effect after 15 – 45 minutes and last normally for about four hours.

Caffeine is readily absorbed into the bloodstream and does not accumulate in the body, being rapidly metabolized and excreted. It is interesting to know that the effects of caffeine do not last so long in smokers – nicotine doubles the speed at which caffeine is broken down in the body. Alcohol has a similar effect.

In summary, caffeine is a mild stimulant which may help with your sexual performance but do not make love to a person who has had seven or more cups of coffee. If you do then you will be singing …Love is in the air….

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Watch Out for the Blood Sucking Female Mosquitoes

For the past several summers we have been worrying about West Nile virus. This virus was first isolated in 1937 from the blood of a patient on the West Nile province of Uganda. Not too far from where I was born. The man had fever. Initially, the outbreaks of the disease were few. But over the years the numbers have increased.

In North America, the virus was first detected in 1999. It was in New York. From there it was exported to Ontario and rest of Canada. Most cases of West Nile virus are mild and self-resolving. But one per cent of cases get infection in the nervous system.

Culex tarsalis is the blood sucking female mosquito that spreads the virus. As the summer comes and the temperature soars, the West Nile virus activity increases. Alberta Health and Wellness undertook a study of West Nile virus prevalence through June 2007. The report is posted on its website.

According to this report, Alberta experienced its first locally acquired clinical cases of West Nile virus (275 confirmed human cases) in the summer of 2003. Since then, clinical (e.g., symptomatic) infections have been detected every year, though the numbers have fluctuated.

From 2004 to 2006, there were very few clinical cases with a combined total of 51. In 2007 there was an increase in the number of infections with 320 cases and the first two deaths associated with the virus in the province. During the 2008 West Nile virus season, only one clinical infection was detected in Alberta and it is thought to be travel-related, says the Alberta Health report.

It is important to remember that for every clinical infection of West Nile virus there are many more undetected infections in humans, since majority of the infections have no symptoms and are never detected.

West Nile virus is carried by birds. Mosquitoes get infected by feeding on the blood of these birds. Infected mosquitoes then transmit the virus to humans when they bite us.

All mosquitoes need water to develop from their immature stages to adulthood. The life cycle takes less than 10 days to complete if the surrounding temperature is favorable. Once the adult mosquito is ready to fly then it looks for something to eat.

Nectar from flowers provides energy to both male and female mosquitoes. While male mosquitoes feed exclusively on nectar, the female mosquito needs blood to produce her eggs. The source of blood can be animals (including people) and birds.

It is important to control the breeding sites around your home by preventing stagnation of water (flower pots, gardening cans, wheelbarrows, puddles, tire swings, bird baths and eavestroughs) even in small quantities. Boats and gardening containers can be stored upside down.

During mosquito season you should limit your outdoor activities. Minimize exposure of your skin by wearing long pants, shirts with long sleeves, socks and shoes when outdoors. Loose clothings will keep mosquitoes away from the skin. Use insect repellents like DEET. Read the directions carefully before using DEET-based repellents especially on children, infants and yourself.

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Sun Worshipers Should Take Steps to Avoid Melanoma

Melanoma is one of the three common skin cancers which is caused mainly by exposure to sunrays. The other two are basal cell carcinoma and squamous cell carcinoma.

For Canadian males, the rate for melanoma has tripled since the late 1960s. For Canadian females, the rates have varied over the years but still show a gradual increase.

Melanoma is the most serious form of skin cancer. If diagnosed and removed early then the cure rate can be excellent. Once the cancer advances and spreads to other parts of the body, it is hard to treat and can be deadly. The death rate from melanoma continues to rise about two percent annually.

Skin is the largest organ of our body and has many important functions to protect us from environment. Skin is constantly exposed to sun, wind, industrial elements and other causes of external and internal injury.

Melanoma arises from cells called melanocytes. These cells contain melanin (melas = black) – a principal pigment responsible for the color of human skin, hair, and eyes. Melanin also acts as a filter to decrease the harmful effects of ultraviolet rays to the dermis.

When the skin is exposed to ultraviolet radiation, there is immediate increase in the number of melanocytes and production of melanin pigment. This results in tanning. The amount of melanin produced is genetically determined. That is why some people burn easily without tanning.

The risk of skin cancer is increased in individuals who spend too much time outdoors; children who have had episodic sunburn, and if there is a family or personal history of skin cancer (especially melanoma). Males are affected more than females.

There are two important things to remember about prevention of skin cancer: cover up and stay out of the sun.

We need to remember that skin tanned by ultraviolet radiation is damaged skin which predisposes to cancer. We need to avoid sunburn and generally reduce exposure to ultraviolet radiation by staying out of the midday sun, wearing protective clothing, seeking shade, and applying sunscreen.

We should have moles or sun burnt skin surgically removed if they show signs of change or non-healing. Bleeding, chronic irritation, change in color or size should warn us to have these moles removed.

Despite having a good understanding of the relation between overexposure to the sun and skin cancer, 81per cent of North Americans still think they look good after being in the sun. Just like the smokers. They know smoking kills but they still smoke.

Does melanoma occur in children? Yes, approximately two per cent of melanomas occur in patients under the age of 20 years, and about 0.4 per cent of melanomas occur in pre-pubertal children.

Prevention of skin cancer is very important. This should start in childhood. More than 90 percent of skin cancers occur on sun-exposed areas of the body. So, protect yourselves from the damaging effects of sun and tanning beds.

Artificial tanning machines are also dangerous. Recently, the World Health Organization (WHO) said the increased popularity of artificial tanning machines is one of the main reasons for a rapid increase in incidence of skin cancer, particularly among young women in Europe and North America.

WHO suggested Governments should pass laws on the responsible use of sun beds, banning their use for all people under 18.

So make an investment in sunscreen, wide brimmed hat, sunglasses which filter ultraviolet rays and stay away from the sun between 10 a.m. and 3 p.m. Enjoy the summer, get enough vitamin D for the winter but be sun smart.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!