Source: NBC News
Fewer U.S. men got prostate biopsies and surgery after new recommendations steered most men away from routine prostate cancer screening, researchers reported Wednesday.
Their findings add to a growing body of research that's adding to the debate about prostate cancer screening and often leaving men and their doctors more confused than informed. At issue is whether screening the general population of men for their second leading cause of cancer death does more harm than good.
The latest report, published in the Journal of the American Medical Association's JAMA Surgery, shows the new guidelines have indeed cut back on the number of procedures that men are undergoing.
"Practice has followed the guidelines," said Dr. Jim Hu, a urologic oncologist at NewYork-Presbyterian and Weill Cornell Medicine who helped lead the research team.
But Hu and his colleagues say they are worried that some men with dangerous cancers may be slipping through the cracks and argue that the highly controversial recommendations may have gone too far.
Hu's team was following up on 2012 guidelines from the U.S. Preventive Services Task Force (USPSTF) that recommended against using a blood test called a prostate-specific antigen (PSA) test to check most healthy men for prostate cancer.
Prostate cancer is very common, showing up in 240,000 U.S. men every year. It kills about 27,000 a year.
So the PSA test used to be a rite of passage for many men as they entered middle age. But the USPSTF said the test found very few men with prostate cancer who needed treatment, and caused men to be needlessly treated for slow-growing prostate tumors that never would have harmed them. Sometimes that treatment meant side effects, from impotence to incontinence.
It was an extremely controversial recommendation. USPSTF advisories guide health insurance reimbursement and often guide practice.
The American Cancer Society supports the USPSTF's approach to screening. But the American Urological Association doesn't.
The AUA doesn't recommend that men up to age 54 get routine PSA screening, but it says men aged 55 to 69 should consider it. Studies show that routine PSA testing saves about one life for every 1,000 men screened.
"This is a controversial issue. I think it's also politically charged," Hu told NBC News.
"I think the answer is education, and let patients decide what's best for them."
The battle is being fought out in the medical journals, with high-profile urologists and oncologists performing studies aimed at proving their points. For instance, in July, Dr. Edward Schaeffer, chair of urology at Northwestern University Feinberg School of Medicine, raised a ruckus with a study showing cases of aggressive prostate cancer were on the rise.
Hu said it is too soon to say whether some men with dangerous cancer may have missed out on treatment.
"Given that lead time associated with PSA screening is estimated at 5 to 7 years and the indolent nature of prostate cancer, a resultant increase in prostate cancer-specific mortality would likely remain undetectable for another decade," they wrote.
And it's possible some of the drop in biopsies could be due to better methods, such as the use of MRI scans, to see if the prostate looks like it has tumors on it.
The decrease in radical surgery could have come because of non-surgical methods to treat prostate cancer, such as radiation, as well as an approach called active surveillance, which delays treatment until the cancer shows signs of worsening.
"The greatest benefit of screening appears to be in men ages 55 to 69 years," the AUA says. "The AUA continues to support a man's right to be tested for prostate cancer -- and to have his insurance pay for it, if medically necessary."
Hu and colleagues looked at records from about 10 percent of practicing urologists for their study.
They found a nearly 29 percent drop in the number of biopsies done for prostate cancer since 2012. A biopsy is a small sample of tissue taken to be examined for evidence of cancer. They're usually done for prostate cancer if a man has some evidence of risk, such as an enlarged prostate, a lump or an irregular blood test called a PSA test.
And the number of radical prostatectomies dropped by 16 percent.
That suggests the USPSTF has achieved its goal of reducing the number of men treated for prostate cancer, Hu said. But he doesn't believe that is necessarily a good thing.
But Hu thinks the USPSTF recommendations went too far.
"I am not trying to paint them as the evil empire. I think they were well-intentioned," he said.
Hu also thinks a report that came out earlier this year suggesting that the recommendations have led to more men developing advanced cancers goes too far the other way.
Dr. Raj Pruthi, a urologist at The University of North Carolina at Chapel Hill who was not involved in the study, agreed.
"The trends of a reduction in screening, a decrease in diagnoses, and an increase in advanced disease create a natural concern that we may indeed have turned back the clock in the care of patients with prostate cancer," Pruthi wrote in a commentary on the study.
The USPSTF is reconsidering its guidelines on prostate cancer screening now, but has not said when revised guidelines will come out.
"My hope is they will reconsider the scope of the evidence," Hu said.
The “dad bod”, it seems, is in vogue. And now a new book claims that gaining weight after fatherhood makes men healthier, more attractive and more likely to live longer than their “skinny” counterparts.
The author, Richard Bribiescas, professor of anthropology and deputy provost at Yale University, claims that this is likely due in part to the decreasing testosterone levels seen in older men. He writes:
[One] effect of lower testosterone levels is loss of muscle mass and increases in fat mass. This change in body composition not only causes men to shop for more comfortable trousers but also facilitates increased survivorship and, hypothetically, a hormonal milieu that would more effectively promote and support paternal investment.
But is there actually any solid science behind the idea that lower levels of testosterone – and a bit of a tummy – can make men healthier?
There exists a complex relationship between our bodycomposition, the relative amounts of fat and muscle that we have, and how we age. While accurately measuring biological ageing is actually quite difficult, studies have nevertheless shown that having too much body fat can prematurely age us and that maintaining our levels of muscle mass could have the opposite effect. It is certainly true that frailty, a syndrome in which older adults carry an increased risk of poor health outcomes is increased in people who carry too much body fat.
Testosterone and ageing
But what about testosterone? Testosterone is a steroid hormone that in men is produced by the testes. Alongside governing male sexual characteristics, it also controls body composition, with lower levels – which naturally occur as we age –being associated with less muscle and more fat. It is this very change in body composition that these new claims of vitality are based upon.
Beyond this, there is actually some evidence that testosterone is involved in the ageing process. The most profound evidence that testosterone can affect how we age comes from studies of people who have none: eunuchs or castrati. These men, who have had their testicles removed, outlive their non-castrated counterparts by as much as 20 years, suggesting that the levels of this hormone may have a profound effect on the ageing process.
The precise reasons for this impressive effect are not very clear, but suggested mechanisms have included an increased ability to fight off infection and a reduced risk of developing prostate cancer, although the latter is a controversial link. It is unlikely the effect is related to cardiovascular health as low testosterone levels are also associated with cardiovascular risk factors and testosterone replacement therapy (TrT) has been shown to improve angina pectoris.
How low can you go?
While having low testosterone levels might aid eunuchs in living longer, in the rest of the male population low testosterone is associated with a range of symptoms including poor cognitive function, decreased mobility, reduced sexual function, and lower energy levels, not a list of qualities that many potential partners would find attractive.
But can replacing testosterone levels that have diminished with age improve these issues? Certainly, TrT has been shown to have beneficial effects on bone health, body composition and memory and testosterone has even been called “the best anti-ageing drug”. Taken collectively, this evidence suggests that although an absence of testosterone over the lifespan may be beneficial, the reduced levels seen in middle-aged and older men might not be such a great thing.
Body mass index (BMI) and longevity
One area of interest that this new book has highlighted is the observation that being overweight might be good for you, at least in terms of how long you live. Traditional opinion is that those of us who are overweight – that is, have a BMI of 25 - 29.9 – are unhealthy. But recent evidence suggests that people in this category might actually live longer than people who have a healthy, underweight or obese BMI, although conflicting evidence does exist.
This controversial finding suggests that there may be a benefit in being slightly overweight. So while this might not support the book’s claim that middle-aged men with “dad bods” are more attractive, it is possible that pudgy dads might live a little bit longer than their more slender counterparts. Just don’t give up on that healthy lifestyle.
Source: Urology Times
An international group of physician and scientific experts, including several urologists, recently approved nine resolutions that offer physicians and patients what they say is evidence-based clarity on the topic of male hypogonadism and its management.
"The medical and scientific communities are still largely unaware of the major negative impact of testosterone deficiency on general health. The media-driven focus on unproven risks has obscured the known health risks of untreated testosterone deficiency: obesity, reduced bone mineral density, and increased mortality,” panel member Abdulmaged Traish, MBA, PhD, of Boston University Medical Center, Boston said in a press release.
The nine resolutions, published in Mayo Clinic Proceedings (2016; 91:881-96), begin with defining testosterone deficiency (TD) as a “well-established, clinically significant medical condition that negatively affects male sexuality, reproduction, general health and quality of life.” The others include:
- Symptoms and signs of TD occur as a result of low levels of testosterone and may benefit from treatment regardless of whether there is an identified underlying origin.
- There is no scientific basis for any age-specific recommendations against the use of testosterone therapy in adult males.
- The evidence does not support increased risks of cardiovascular events or prostate cancer with testosterone therapy.
- The evidence supports a major research initiative to explore possible benefits of testosterone therapy for cardiometabolic disease, including diabetes.
Ben Stiller opened up for the first time about being diagnosed with prostate cancer at 48. He visited the Stern Show on Tuesday morning and told Howard how he and his doctor were able to detect and treat the disease. Come to any one of our Epoch Health locations to get tested today!
Study Sees No Link Between Testosterone Therapy and Blood Clots Finding was based on data from more than 30,000 American men, 40 and older.
MONDAY, July 20, 2015 (HealthDay News) -- Testosterone therapy doesn't appear to increase the risk of blood clots in veins, a new study contends.
The most common forms of this problem -- called venous thromboembolism (VTE) -- are deep vein thrombosis (a clot in the leg) and pulmonary embolism (a clot in the lungs). VTE is the third most common type of cardiovascular problem, after heart attack and stroke, the researchers said.
There is conflicting information about the link between testosterone therapy and the risk of VTE. As a result, many men with low testosterone and their doctors are reluctant to start testosterone therapy, the study investigators said.
"In 2014, the [U.S.] Federal Drug Administration required manufacturers to add a warning about potential risks of VTE to the label of all approved testosterone products," study author Jacques Baillargeon, a professor of epidemiology at the University of Texas Medical Branch at Galveston, said in a university news release.
"The warning, however, is based primarily on post-marketing drug surveillance and case reports. To date, there have been no published comparative, large-scale studies examining the association of testosterone therapy and the risk of VTE," he noted.
Baillargeon and his colleagues looked at data from more than 30,000 American men, aged 40 and older. The researchers found that having a prescription for testosterone therapy was not associated with an increased risk of VTE.
The researchers also studied various forms of testosterone therapy, including topical creams, transdermal patches and intramuscular injections. No increased risk of VTE was found with any of these forms, the researchers said.
But due to the study's design, it's not possible to say definitively that there's no VTE risk associated with testosterone therapy.
Baillargeon said he recognized the need for more study. "It's also important to note that further research needs to be conducted to rigorously assess the long-term risks of testosterone therapy," he said.
The study was published July 20 in the journal Mayo Clinic Proceedings.
The U.S. National Library of Medicine has more about testosterone therapy.
SOURCE: University of Texas Medical Branch at Galveston, news release, July 20, 2015
Although Epoch Health touts that it can treat symptoms related to low testosterone in men, it maintains it’s nothing like the low-T retail outlets that are gaining scrutiny from some members of the medical community.
Epoch Health of Little Rock is “just not testosterone therapy,” said E. Scot Davis, the CEO of Arkansas Urology. Epoch Health is a subsidiary of Arkansas Urology.
If men complain about gaining weight, being tired or having a low sex drive, they will be given a free screening to determine what’s going on, he said.
“It may not necessarily be low testosterone,” he said. “If they’re truly low-T, we’ll treat them. If they aren’t, then we’re going to get them to an appropriate doctor that they need to see. That’s what really makes us different.”
Epoch has opened four locations in Arkansas since December 2013. Davis said more clinics in the state are under discussion, but he declined to say where they might be located. There are also Epoch locations in Missouri, Arizona and Alaska. Epoch partners with urologists in those states, and it retains 5-10 percent ownership in the clinics.
Meanwhile, the increased use of testosterone treatments is raising alarm bells for some doctors.
“The idea that large numbers of men should be treated with testosterone is not supported by the science. It’s very risky,” said Dr. Steven Nissen, the chairman of the department of cardiovascular medicine at the Cleveland Clinic in Ohio. “These kinds of entrepreneurial operations, frankly, are not in the best interest of patients.”
Nissen wasn’t talking specifically about Epoch.
Testosterone therapy is approved to treat a “very rare condition” of men who don’t make testosterone, he said, but “it’s now being used as sort of a general tonic for men.”
“This is American medicine at its worst,” Nissen said.
He also said there are concerns about the cardiovascular safety of the testosterone treatments.
“There are no definitive safety studies,” Nissen said. “The studies that we do have are pointing in the wrong direction, suggesting an increase of heart attack and stroke.”
In March, the U.S. Food & Drug Administration cautioned that prescription testosterone products are approved only for men who have low testosterone levels caused by certain medical conditions “due to disorders of the testicles, pituitary gland, or brain that cause a condition called hypogonadism,” the FDA said on its website. “However, FDA has become aware that testosterone is being used extensively in attempts to relieve symptoms in men who have low testosterone for no apparent reason other than aging.”
Davis agreed that a number of men who are being treated for low-T shouldn’t be. But at Epoch, he said, patients there are screened and “probably half” don’t get the testosterone.
He also said that there are a number of studies to show that testosterone treatment is not risky.
Davis said Epoch conducts proper testing and monitoring of its patients. The clinics that are receiving the bad reputations are the ones that don’t, he said.
Dr. Adam Cole, the national medical director for Epoch, says in a video posted on the Epoch website that he looks at testosterone as “not a treatment but more of a tool that a patient can use in order to help turn their life around.”
He also boasted about the benefits of testosterone treatments, including sleeping better and a reduction in body fat. “As we progress through this,” Cole says in the video, “they’ll lose 10-12 percent body fat. They’ll gain 10-15 percent more muscle mass.”
Epoch’s Davis declined to say what the cost for treatment is, but Epoch’s website says a patient without insurance can prepay $220 for a month of service.
Nissen said that testosterone clinics “are for-profit operations designed to lure men in and charge them and keep them in the system.”
He said once the men come in for the treatments, they have to keep coming back for more treatments.
That’s not Epoch’s goal, Cole said: “Hopefully, you don’t have to be on this therapy for the rest of your life.”
Cole said in an interview with Arkansas Business that the goal of Epoch is to get men healthy and do it as safely as possible.
“If we just wanted to make money, we would do the shot box,” he said. “Our motto really has been from the beginning, you do what’s right for the patient and everything else will take care of itself.”Published by Arkansas Business on Monday, May 18, 2015
(May 19, 2015) More than two years ago, the U.S. Food and Drug Administration (FDA) expanded the approved use of Botox (onabotulinumtoxinA) to treat adults with overactive bladder, and the drug’s use for urinary incontinence was approved by the FDA almost five years ago.
That’s right. Botox isn’t only used to rid the face of wrinkles. Botox can also be injected into the bladder to relax it, providing an increase in its storage capacity and a decrease in urinary incontinence. We have seen the positive effects of the proper use of Botox to improve overactive bladder symptoms and urinary incontinence.
Overactive bladder is a type of bladder-control problem that affects more than 33 million Americans of all ages. It occurs when the bladder contracts more often than necessary, even when the bladder is not full.
Symptoms of an overactive bladder can include an urgent, uncontrollable need to urinate; an involuntary loss of urine; frequent urination (typically eight more times in a 24-hour period); and waking up to urinate at night two or more times.
Though overactive bladder is a common medical condition, many patients may feel ashamed or embarrassed to discuss it. However, it is important to communicate with your doctor about your overactive bladder so it can be properly treated.
Urinary incontinence, or uncontrolled urine loss, is more common than most people think. In fact, more than 17 million Americans have urinary incontinence. But urinary incontinence is not a normal process of aging and can occur in patients of all ages.
Under normal conditions, the bladder stores urine until it is voluntarily released. This involves a complex interaction between the brain, spinal cord and bladder. Anything that interferes with this interaction can make a person incontinent.
Incontinence is not life threatening, but it does have negative social implications. You may lose your self-esteem and experience depression, anxiety and feelings of helplessness. Your fear of urine loss may become an obsession. You may lose your sense of sexuality. You may distance yourself from friends and loved ones or limit social interaction outside the home.
The good news is that incontinence can typically be corrected or improved to the point that it no longer interferes with daily activities.
Clinical studies show that Botox relieves symptoms. Randomized, controlled trials show complete continence in patients treated with Botox in as many as 55 percent of cases. The medicine is an effective treatment for overactive bladder and results in a significant improvement in the quality of life of patients.
Dr. Edwin Diaz is certified by the American Board of Urology and is a member of the American Urological Association, American Association of Clinical Urologists, Endourological Society, Arkansas Medical Society, Arkansas Urologic Society and Pulaski County Medical Society. He practices medicine at Arkansas Urology in North Little Rock.
A Little Rock native and Arkansas Baptist graduate, Dr. Taylor Moore completed his residency at the University of Arkansas for Medical Sciences, is a member of the American Urologic Association and the American Medical Association, and recently presented an abstract for the American Urologic Association’s South Central Section. He practices medicine at Arkansas Urology clinics in Little Rock and Heber Springs.
A newly published review suggests that age-related testosterone deficiency treatment with intramuscular injections of testosterone replacement therapy (TRT) offers health benefits and lower cardiovascular risk compared to testosterone replacement by patch or gel.
While TRT can result in increased muscle mass and strength, decreased fat mass, and increased bone mineral density, the therapy has known risks. These include the development of polycythemia, decreases in high-density lipoprotein cholesterol, breast tenderness and enlargement, and prostate issues.
The authors point out, however, that TRT does not increase prostate cancer risk. And whether TRT hurts, helps, or has no effect on cardiovascular risk remains controversial in the literature.
The University of Florida, Gainesville, researchers who conducted this latest review were among the authors of a previously published study suggesting that oral TRT increases cardiovascular risk, but no significant cardiovascular effects were noted with injected or transdermal TRT (BMC Med 2014; 12:211).
For the current study, which was published online in the American Journal of Physiology – Endocrinology and Metabolism (April 21, 2015), study authors Stephen E. Borst, PhD, and Joshua F. Yarrow, PhD, reviewed literature indicating “that intramuscular injected TRT produces greater musculoskeletal benefits and lower cardiovascular risk compared to transdermal TRT… We also review the literature discussing the use of 5α-reductase inhibitors as a promising means of improving the safety profile of TRT.”
According to the authors, for older hypogonadal men, administering TRT by injection, versus orally or transdermally, offers greater musculoskeletal benefits
because doses are higher by injection. But while doses are higher when injected, intramuscular TRT might be less likely to result in cardiovascular
risks than transdermal TRT. This could be because transdermal testosterone results in greater serum dihydrotestosterone (DHT) elevation, due to significant
expression of 5α-reductase in skin—not muscle.
Published April 29, 2015 by Urology Times
CALL 1-844-GoEPOCH For a FREE SCREENING!
Do you want to be more focused at work and at home? Feel more energized and enthused? Epoch can help!
Epoch Men’s Health clinics are offering free, fully comprehensive Men’s Health Screenings. Call 1-844-GoEPOCH (1-844-463-7624) today to set up your free screening and experience men’s healthcare the Epoch way – that’s the right way of getting your body healthy.
The free 100% Men’s Health Screening is an integral part of Epoch’s mission to keep men healthy. Screening takes about two minutes and is as simple as the prick of a needle. Consumption of food and/or beverages does not impact screening results. The screening includes:
- Total Testosterone
- Free Testosterone
Our lab also analyzes men’s bodies for other potential problems:
- Blood Pressure
- Metabolism (including diabetes)
- Vitamin and Nutrient Levels (including iron, B-12 and D)
- Hormones (including testosterone, estrogen, thyroid function and prolactin)
- Potential Internal Bleeding
- And much more.
We’ll use these screening and lab results to determine if you have any testosterone deficiencies. We’ll also discuss how you’re feeling and what symptoms – such as low energy, exhaustion, weight gain, sadness, forgetfulness, and hair loss – you might be experiencing. Your test results and symptoms could indicate
Low T or they may show that you’re suffering from a different condition altogether. Either way, our goal is to get to the root of your problem, create a treatment plan tailored to you, get you feeling great and help you experience the best possible quality of life.
Owned and operated by the physicians at Arkansas Urology, Epoch Men’s Health is a healthcare experience unlike any other in Arkansas. Our clinic environment is relaxed and professional, with men squarely in mind, intended to energize and inspire. And we’re conveniently located throughout central Arkansas – in Little Rock on South Bowman Road, in North Little Rock on East McCain Boulevard, in Conway on Exchange Avenue, and in Benton on Medical Park Drive.
Epoch Men’s Health isn’t another shot-box, Low T store; it’s real medicine. Check out EpochMensHealth.com to get the facts. And the call 1-844-GoEPOCH toll-free to set up your free, no obligation 100% Men’s Health Screening. Experience real men’s healthcare, the Epoch way.
Together, we are Epoch Health. Men’s Healthcare. Evolved.
Free 100% Men’s Health Screen at Arkansas Urology’s North Little Rock campus
Arkansas Urology and Epoch Men’s Health will observe National Prostate Cancer Awareness Month with the 10th annual Kickoff to Men’s Health: The Big Screen Event on Thursday, Sept. 25, from 5-8 p.m. The event will offer men the opportunity to receive a potentially lifesaving preventive screening at Arkansas Urology’s North Little Rock campus, located at 4200 Stockton Drive.
“Each man will receive what we call our FREE “100% Men’s Health” screening,” said Dr. Tim Langford, president of Arkansas Urology. “This typically involves very comprehensive lab work and/or an examination that includes a free prostate exam. We also analyze men’s bodies for potential problems with their heart, blood pressure, metabolism (including diabetes), vitamin and nutrient levels (including Iron, B-12 and D), urinalysis (for dehydration, kidney function and bladder cancer), LH, FSH, hormones (including testosterone, estrogen, thyroid function and prolactin) DNA tests for hypercoagulability, screening for potential internal bleeding and much more.”
New this year, Arkansas Urology and Epoch Men’s Health will be giving away a flat screen TV every 15 minutes to men who register and participate in the screening (about the amount of time for the screen itself). To schedule an appointment, please call 501-219-8900. Screening results may be mailed to participants or you may receive a phone call with specific results from a healthcare provider.
At last year’s event, 373 men were screened for prostate cancer. Of those, 20 were found to have elevated PSA (prostate-specific antigen) levels and/or abnormal physical exams. These men have been encouraged to schedule follow-up appointments with their primary-care physicians or urologists.
“Arkansas Urology is dedicated to hosting an annual screening event that will have a positive impact on men’s health outcomes in central Arkansas,” said E. Scot Davis, CEO of Arkansas Urology. “By offering free screenings, we hope to help prevent losing another Arkansan to prostate cancer.”
Learn about this year’s screening event at ArkansasUrology.com or visit EpochMensHealth.com