Books

Issues

Resources

Free Reminder

Contact Us

The Long Version

Prostate Cancer Awareness Week (pcaw.org) has compiled information on the issue of Prostate Cancer.

The Long Version:

• What is the prostate?
• Prostatitis (infection)
• Treatment Options
• When to call a doctor
• Prevention

Prostate Enlargement (Benign Prostatic Hypertrophy)

• Treatment Options
• When to call your doctor
• Prevention of acute prostatitis and enlarged prostate (BPH)

Prostate Cancer

• Possible symptoms
• Treatment Options
• Prevention
• Prostate Massage
• Pain management
• Incontinence
• Erectile dysfunction/sex

Impotency

• Watch out
• Recommendations
• Considerations
• Summary

What is the prostate?

Cancer of the prostate is the leading cause of cancer death among non-smoking American men and African-American men are 2 ½ times more likely to get the disease than any other ethnic group in the world. It is still unknown exactly why African-American men have the highest incidence of prostate cancer in the world. Research has shown, though, that they typically develop the disease earlier than white Americans, but are diagnosed with it later, so their mortality rate is much higher than that of whites. One of every eight African-American men will develop the disease in his lifetime. It is primarily a disease of aging. Men in their thirties and forties rarely develop prostate cancer, but the incidence increases steadily after the age of fifty-five. Approximately 80 percent of all cases occur in men over the age of sixty-five and by the age of eighty, 80 percent of all men have prostate cancer to some degree. The American Cancer Society estimates that more than 381,000 new cases of prostate cancer will be diagnosed in 1998 and over 41,000 men will die of the disease. A male baby born today has a 13 percent change of developing prostate cancer at some time in his life, and a 3 percent change of dying from the disease. Many experts feel that every man will eventually develop prostate cancer if he lives long enough.

The three most common prostate problems are: infection (prostatitis), prostate enlargement (benign prostatic hupertrophy), and prostate cancer.

Currently, both the American Urological Association and the American Cancer Society recommend annual rectal exams as part of a man’s annual health checkup for all men from ages 40 to 70, and beginning at age 40 for men at high risk (African-American men and those with a family history of the disease)and all men 50 and over add a PSA blood test every year as well. According to Dr. Crawford, these guidelines might need to be redefined. When prostate cancer is detected and treated in its early stages, it has a high cure rate. They encourage discussing the options with your medical care practioner.

Based on past screenings conducted during Prostate Cancer Awareness Week, Dr. Crawford and his colleagues have observed that in men ages 50 to 59, the prostate cancer detection rate was the same regardless of whether they were screened every year or every two years. For men between the ages of 60 and 70, thought, the prostate cancer rate was higher if they only were screened every two years versus annually. Therefore, it may only be necessary for normal-risk men in their 50s to be screened every other year. Dr. Crawford also suggests that high-risk men between the ages of 35 and 39 and normal-risk men between the ages of 45 and 49 should get a baseline PSA test. This recommendation is based on PCAW data revealing that the majority of positive biopsies in high-risk men screened between the ages of 40 and 49 were detected in their first year of screening. Further studies indicated that 95 percent of all prostate cancers among high-risk men were found in the first two years of a man’s screenings. "Because we have no cure for advanced prostate cancer, early diagnosis and treatment are essential," Dr. Crawford said. "Asymptomatic men can ‘choose to know’ if they have prostate cancer so that they can ‘know to choose’ from treatment alternatives that can cure their cancer." Because early prostate cancer usually does not have any symptoms, it is extremely difficult to detect without testing. In fact, screenings using both PSA and DRE tests have proven to be the only reliable method of identifying the disease when it can be cured most easily. Currently, 58 percent of all cases are discovered while the cancer is still localized and at its most curable stage. You doctor can detect prostate cancer by digital rectal examination (don’t die from embarrassment) and by a PSA (prostate-specific antigen) blood test.

Prostate infection (Prostatitis)

Prostatitis, common in men of all ages, is the inflammation of the prostate gland. The usual cause is infectious bacteria that invade the prostate from another area of the body. Hormonal chances associated with aging may also be a cause. The inflammation can result in urine retention. This causes the bladder to become distended, weak, tender and itself susceptible to infection. Infection in the bladder is in turn early transmitted up the urethras to the kidneys.

There are two types of prostate infection, acute and chronic. Acute infections come on suddenly and have some or all of the follow symptoms: Fever and chills, pain and burning on urination and ejaculation, strong and frequent urge to urinate while passing only small amounts of urine, lower back or abdominal pain, blood in the urine (occasionally). Symptoms of chronic prostatitis are usually milder than those of an acute infection and fever and chills are usually not present. Either infection may occur with a urinary tract infection.

Sometimes, men will have painful urinary symptoms without infection. This condition may be called prostatodynia and is often related to stress or anxiety. Prostate infections usually respond well to home care and antibiotic treatment. If the infection recurs, long-term antibiotic treatment may be needed.

Prostatitis Treatment Options

Options for the home treatment:

• Drink as much water as you can tolerate
• Eliminate all alcohol and caffeine from your diet.
• Hot baths help soothe pain and reduce stress
• Aspirin or ibuprofen may help ease painful urinary symptoms

Other treatment options:

• If the prostate is infected, treatment with antibiotics and analgesics may be necessary.
• Although antibiotics are often used to treat prostatitis, the long-term use of such drugs can lead to bacterial resistance, which in turn necessitates more potent drugs, more expense, and more medical complications.
  

When to call a doctor

It's time to check with your doctor:

• If urinary symptoms occur with fever, chills, vomiting, or pain in the back or abdomen
• If urine is red or pink with no dietary reason. Always call a doctor is your have blood in your urine.
• If symptoms continue for 5 days despite home care.
• If there is a sudden change or worsening of symptoms.
• If you have pain on urination or ejaculation and a discharge from the penis.
  

Prevention of prostatitis

Ways to prevent prostatitis:

• Increase your fluid intake to as much as 8 to 12 glasses per day. You are drinking enough when you are urinating more often than usual. Extra fluids help flush the urinary tract clean.
• Avoid alcohol and caffeine. Caffeine can cause a strong and frequent urge to urinate. Remember that colas contain caffeine as well as coffee and tea.
• Keep stress under control. A high level of stress is closely associated with prostatodynia.
  

Prostate Enlargement (Benign Prostatic Hypertrophy)

As men age, the prostate may enlarge. This seems to be a natural process and is not really a disease. Benign prostatic hypertrophy is the gradual enlargement of the prostate. It occurs in approximately half of all men over the age of fifty and three quarters of men over seventy years of age - a total of about 10 million American men - and is largely attributable to hormonal chances associated with aging. After the age of fifty or so, a man’s testosterone and free testosterone levels decrease while the levels of other hormones, such as prolactin and estradiol, increase. This creates an increase in the amount of dihydrotestosterone - a very potent for of testosterone - within the prostate. This causes a hyperplasia (overproduction) of prostate cells, which ultimately results in prostate enlargement. While not cancerous, however, as the gland gets bigger, it tends to squeeze the urethra and cause urinary problems. If it becomes too large, it obstructs the urethral canal, interfering with urination and the ability to empty the bladder completely. Because the bladder cannot empty completely, the kidneys also may not empty as they should. Dangerous pressure on the kidneys can result. In severe cases, the kidneys may be damaged both by pressure and by substances in the urine. Bladder infections are associated with both prostatitis and enlarged prostate.

The major symptom of enlargement of the prostate is the need to pass urine frequently, with frequency increasing as time goes on. A man may find himself rising several times during the night to urinate. There can also be pain, burning and difficulty in starting and stopping urination. The presence of blood in the urine is not uncommon.

An enlarged prostate gland is not a serious problem unless urination becomes extremely difficult, or backed-up urine causes bladder infections or kidney damage. Some dribbling is very common and not necessarily a sign of prostate problems.

Surgery is usually not necessary for an enlarged prostate. Although surgery used to be a common treatment, recent research shows that most cases of prostate enlargement do not get worse over time as previously thought. Many men find that their symptoms are stable and some even clear up on their own. In these cases, the best treatment is no treatment at all. Drugs are available that may help improve symptoms in some men. Your doctor can advise you on the various treatment options.

Prostate Enlarement Treatment Options

Home treatment:

• Avoid antihistamines and decongestants, which can make urinary problems worse.
• If you are bothered by a frequent urge to urinate at night, cut down on beverages, especially alcohol and caffeine, before bedtime.
• Don’t postpone urinating, and take plenty of time. Try sitting on the toilet instead of standing.
• If dribbling after urination is a problem, wash your penis once a day to prevent infection.

Other options:

• Enlarged prostate may be treated surgically with a procedure called transurethral resection of the prostate (TURP). About 350,000 TURPs were done in the United States in 1990. The procedure is twice as likely than are drugs or other treatments to provide long-term relief. Side effects of the procedure include retrograde ejaculation (in which the semen is pumped back up into the bladder) and in some cases impotence or incontinence. About 15 percent of men who have the procedure need another operation within eight years. Newer surgical procedures using laser technology and other technologies are available, but TURP remains the standard treatment. TURP is not used for prostatitis.
• The drug finasteride (Proscar) may be used to treat moderate prostate enlargement. It blocks an enzyme that converts the male hormone testosterone into dihydrotestosterone, which promotes the growth of prostate tissue. The drug has been shown to increase urine flow in 30 percent of test cases and to reduce the size of the prostate by 20 percent in more than half the test cases. In addition, because it reduces the amount of prostate tissue, it can skew the results of the blood test used to detect prostate cancer.
• Engaging in sexual intercourse while the prostate is infected and irritated may further irritate the prostate and delay recovery.
• Vasectomy for sterilization has been linked to prostate disorders and even cancer.
• Zinc deficiency is linked to enlargement of the prostate. Soil used for farming is often deficient in zinc, and unless you eat hulks of cereals or brewer’s yeast, it is difficult to get enough zinc in the diet. Alcohol causes a deficiency of zinc and other serious nutritional deficiencies. However, too much zinc (over 100 milligrams a day) can depress immune function.
• The injectable drug leuprolide (Lupron) may shrink an enlarged prostate. Side effects that can occur include impotence, decreased libido and even hot flashes. You should take this drug only if you are not concerned with potency. It is available by a doctor’s prescription only.
• All men aged forty or over should have a yearly rectal examination, during which the prostate gland is checked.
  

When to call your doctor

It's time to call your doctor:

• If fever, chills, or back or abdominal pain develop.
• Diuretics, tranquilizers, antihistamines, decongestants, and antidepressants can aggravate urinary problems. If you take these drugs, ask your health professional if there are other medications without these side effects.
• If the symptoms of an enlarged prostate last longer than two weeks. Early examination enables you to confirm the diagnosis and consider treatment options.
  

Prevention of acute prostatitis and enlarged prostate (BPH)

Ways to prevent acute prostatitis and enlarged prostate:

• Acute inflammation or enlargement of the prostate gland often responds to certain herbal teas. If no improvement takes place or if the symptoms recur, consult a urologist.
• Take steps to reduce your blood cholesterol level. Studies have shown a connection between high cholesterol and prostate disorders. Cholesterol has been shown to accumulate in enlarged or cancerous human prostates.
• Alternative treatments may be employed by herbalists or naturopaths. Natural systems of medicine, which include the use of healing herbs, diet, exercise, and relaxation techniques, can reduce and prevent symptoms associated with BPH. Such natural approaches are thousands of years old and used throughout the world to support and restore health. Some of them, like extracts of the fruits of saw palmetto, a small palm that grows in the southeaster U.S., have long been noted as effective to support prostate health. Research now shows that this safe, simple preparation may equal widely prescribed pharmaceutical preparations in treating BPH, without the side effects. Other herbs that contribute to prostate health are also reviewed in Christopher Hobbs book: Saw Palmetto: The herb for prostate health and are explained in detail.
• Use hydrotherapy to increase circulation in the prostate region. One method involves sitting in a tub that contains the hottest water tolerable for fifteen to thirty minutes once or twice a day. Another form of hydrotherapy involves spraying the lower abdomen and pelvic area with warm and cold water, alternating between three minutes of hot water and one minute of cold. Still another technique involves sitting in hot water while immersing the feet in cold water for three minutes, and then sitting in cold water while immersing the feet in hot water for one minute.
• Eat 1 to 4 ounces of raw pumpkin seeds every day. Pumpkin seeds are helpful for almost all prostate troubles because they are rich in zinc. As an alternative, pumpkin seed oil can be taken in capsule form.
• Eliminate from your lifestyle such items as tobacco, alcoholic beverages (especially beer and wine), caffeine (especially coffee and tea), chlorinated and flouridated water, spicy and junk foods, and tomato and tomato products. Limit your exposure to pesticides and other environmental contaminants.
• If you have prostatitis, increase your fluid intake. Drink two to three quarts of spring or distilled water daily to stimulate urine flow. This helps to prevent cysitits and kidney infection as well as dehydration.
• Get regular exercise. Do not ride a bicycle, however; this may put pressure on the prostate. Walking is good exercise.
• If your prostate is enlarged, be cautious about using over-the-counter cold and allergy remedies. Many of these products contain ingredients that can inflame the condition and cause urinary retention.
• Avoid exposure to very cold weather. 
  

Prostate Cancer

Although it is relatively common, in most cases prostate cancer is a slow growing cancer. Most prostate cancers arise in the rear portion of the prostate gland; the rest originate near the urethra. Prostate cancers double in mass every six years, on average.

Possible symptoms

The disease often causes no symptoms at all until it reaches an advanced stage and/or spreads outside the gland. Or it could be one or more of the following: Pain or a burning sensation during urination, frequent urination, a decrease in the size and force of urine flow, an inability to urinate, blood in the urine, and continuing lower back, pelvic or suprapublic discomfort. However, these symptoms most often are caused not by cancer but by benign enlargement or inflammation of the prostate. That’s why professional evaluation and diagnosis is so necessary.

The rate of prostate cancer in the U.S. is rising. In part, this is due to the aging of our population. Just a generation ago, the life expectancy for white men was sixty-five years; today, it is close to eighty years. However, the rate of prostate cancer is rapidly rising in all men, even those under fifty. This is significant because, in general, the younger a man is when he is diagnosed with prostate cancer, the worse his prognosis. The increase in prostate cancer among younger men points to the role of diet and exposure to environmental toxins in the development of the disease.

African-American men have the highest incidence of prostate cancer, while Asian-American have the lowest. Men with a family history of prostate cancer also run a higher risk of developing the disease. The incidence is higher among married men that it is among unmarried men. Also at increased risk are men who have had recurring prostate infections, those with a history of venereal disease, and those who have taken testosterone. Researchers have also found a link between a high-fat diet and prostate cancer. This may be due to the fact that heavy fat consumption raises testosterone levels, which could then stimulate growth of the prostate, including any cancer cells it may be harboring. Exposure to cancer-causing chemicals increases risk as well. Some experts believe that vasectomy may increase a man’s chances of developing prostate cancer. And, while it isn’t conclusive, some medical professionals are recommending to have the vasectomy reversed.

Testing

It is believed by most that there is no way to prevent the disease, but early detection can make it possible to catch the cancer before it spreads to other parts in the body. A careful rectal exam of the prostate is the simplest and most cost-effective approach for detecting prostate cancer. The American Urologic Association recommends that ever man have an annual exam beginning at least by age forty. The American Cancer Society no longer recommends testing. They suggest discussing the options with your health care professional. (Wonder what that's all about? When early detection clearly saves lives, who gains from not being tested except those who know they don't have prostate cancer. And, without symptoms, who knows? Maybe the doctors and hospital and funeral homes gain? Families sure don't. Gives one something to think about!) A blood test to detect elevated levels of a substance called prostate-specific antigen (PSA) is an excellent screening test for prostate cancer. PSA is currently the most valuable "tumor marker" available to diagnose and evaluate the effectiveness of therapy for prostate cancer. A PSA test result between 0 and 4 is considered to be within the normal range; a PSA over 10 is assumed to indicate cancer until proven otherwise. High PSA levels can be caused by factors other than cancer, including benign enlargement or inflammation of the prostate, an activity as innocuous as bicycle riding, or even the rectal exam itself. If a man’s PSA level is found to be high, the test should always be repeated, because it does yield false-positive or false-negative results an estimated 10 to 20 percent of the time. Having the test repeated every year may help a physician to better interpret the results; in healthy men, PSA levels tend to remain relatively stable, rising only gradually from year to year, while cancer causes the levels to rise more dramatically.

Ultrasound scanning of the prostate is often done to follow up on an abnormal rectal exam or PSA test. Other diagnostic tests, including computerized tomography (CT) scans, bone scans, and magnetic resonance imaging (MRI) may be necessary, but are costly. Ultimately, if test results point consistently to the presence of cancer, a tissue diagnosis must be done to confirm it. This can be done only by microscopic examination of a needle biopsy, preferably directed under ultrasound control. Repeated biopsies may be needed in some cases. This invasive procedure may itself cause complications. Bleeding, urinary retention, impotence and sepsis (blood poisoning) have been reported.

Prostate Cancer Treatment Options

Some of the treatment options for prostate cancer:

• If the disease is caught early, treatment is usually successful. If the cancer has spread beyond the prostate, however, it is difficult to treat and cure. Unfortunately, prostate cancer can be difficult to diagnose in its early stages. Many cases are diagnosed only after the cancer has spread outside the gland. Once this happens, the survival rate over the next five years is about 40 percent. If the disease spreads to the lymph nodes, bones or other organs, the chances of survival drop to 20 percent.
• Berries help protect DNA from damage and mutation that may result in cancer.
• Experimental therapies such as cryoablation (freezing of cancer cells) and laser surgery are sometimes used in prostate cancer treatment.
• If the cancer has spread into the capsule of the gland, the standard approach is some form of radiation therapy. Ten-year survival rates are 50 to 60 percent. Radiation therapy leaves men impotent 50 percent of the time. It may also adversely affect the bladder and rectum. (See Brachytherapy - seed implants.)
• If the disease is confined to the prostate and a man is healthy and under seventy years old, removal of the gland (radical prostatectomy) is often recommended. About 50 percent of men who have this done, even with the new "nerve sparing" techniques, become impotent. Significant incontinence occurs in up to 25 percent of cases. Watchful waiting, with nutritional support and lifestyle change, is becoming the preferred approach if the cancer is in the early stages.
• If the cancer has spread outside the gland, treatment is aimed at trying to block production of testosterone, which fuels the cancer. This can be done by means or orchiectomy (surgical removal of the testes) or by suppressing the production and action of hormones. For the latter, either goserelin (Zoladex) or leuprolide (Lupron) is given by monthly injections (they are fundamentally the same drug); in addition, flutamide (Eulexin) is taken orally. Together, these agents effectively shut down testosterone production and use by the body. Both orchiectomy and hormone suppression cause impotence in nearly 100 percent of the cases.
• Estrogen’s have been used effectively for the treatment of prostate cancer for sixty years. However, they can cause breast growth and other feminising effects, as well as cardiac complications.
• Many consider prostate cancer to be one of the most overtreated diseases in America. Physicians in Europe have long used a conservative approach with comparable results. In addition, a 1994 report in The New England Journal of Medicine reported on a large group of men who refused traditional treatment. Surprisingly, they fared just as well as - and possibly better than - men who did accept medical treatment. A conservative approach making critical lifestyle and dietary changes and using nutritional supplementation may work just as well. And yet, 31,000 men will die of prostate cancer this year because they either didn't catch it time, or chose watchful waiting past the cut-off point. That's roughly the same percentage of women who die of breast cancer.
• Dr. Hans Nieper, a German cancer specialist, uses Carnivora, a substance derived from a South American plant, to treat prostate cancer. Fresh cabbage and carrot juice are used in clinics worldwide in cancer therapy.
• A high-fat, low-fiber diet is linked not just to heart disease, but also to prostate cancer. Chemical reactions occur when fat is cooked, leading to the production of free radicals, which play a major role in certain cancers. It is logical to assume that the accelerating increase in prostate cancer since the 1950s must be attributable at least in part to a parallel increase in fat consumption in the U.S. According to the Journal of the National Cancer Institute, men who eat red meat five times a week may have a risk of prostate cancer that is nearly three times higher than that for men who eat red meat less than once a week. Butter consumption also appears to contribute to this disease., Researchers theorize that a diet high in fat raises the levels of testosterone and other hormones in the body, which stimulate the prostate - and any cancerous cells in it - to grow. A high intake of milk and coffee may also increase the risk of developing prostate cancer.
• Research has shown that soybeans and soy products, such as tofu, soy four and soymilk, have cancer-fighting powers due to the presence of a protein called genistein. Genistein apparently retards tumor growth by preventing the growth of new blood vessels to feed the tumor. It appears to be particularly effective against prostate cancer, but also works against breast cancer in women and colon cancer in both sexes.
• A man who is impotent as a result of treatment for prostate cancer may be able to remain sexually active through penile prostheses and other devices. (November 1 starts off International Impotency Awareness Month by reviewing current information on Viagra.)
• Studies from Israel indicate shark cartilage may be effective in treating prostate cancer. Its antiangiogenic potential seems to inhibit new blood vessels formation, especially in highly malignant vascular cancers.
• In 1993, the Journal of the American Medical Association revealed a connection between vasectomy and an increased risk of prostate cancer. Reported studies of 48,000 and 29,000 men who had vasectomies showed a 66-percent and 56-percent higher rate of prostate cancer, respectively. The risk increased with age and the number of years since the vasectomy was performed. Since then, a panel called the National Institutes of Health found no biological cause-and-effect relationship between vasectomy and prostate cancer. Not all experts accept that finding, however.
• A man with prostate cancer needs support and understanding from family members, friends and physicians. Besides coming to grips with cancer and its treatments, he also has to deal with the possible loss of sexual potency, which can be very difficult. A number of the books listed in the reference section below provide a great deal of detailed information and practical advice to help the man with prostate cancer and his family to deal with the many difficult aspects of this disease.
• Diet and nutrition are important not only for treatment, but for prevention. An anticancer diet is composed primarily of brown rice, fresh raw fruits and vegetables, fresh juices, legumes, raw nuts and seeds, and whole grains, and excludes alcohol, coffee, refined carbohydrates, and strong tea. Regular intake of zinc (50 milligrams daily) and essential fatty acids (in supplement form or from cold-pressed sesame, safflower or olive oil) in later life also may help prevent the development of problems.
  

Prevention of prostate cancer

Since the prostate produces seminal fluid, there is a long-standing belief that regular ejaculations (two or three times per week) will help prevent an enlarged prostate. There is little scientific proof of this, but it is risk-free.

Diet is also a factor. Some recommend to maintain a whole-foods diet.:

• Eat plenty of whole grains, raw nuts and seeds, and unpolished brown rice. Millet cereal is a good source of protein. Eat wheat, oats and bran. Also eat plenty of cruciferous vegetables such as broccoli, Brussels sprouts, cabbage and cauliflower and yellow and deep orange vegetables such as carrots, pumpkin, squash and yams. This type of diet is important for the prevention of cancer as well as for healing.
• nclude in the diet apples, fresh cantaloupe, all kinds of berries, Brazil nuts, cherries, grapes, legumes (including chickpeas, lentils and red beans) and plums. All of these foods help to fight cancer.
• Consume freshly made vegetable and fruit juices daily. Carrot and cabbage juices are good choices.
• Include in the diet foods that are high in zinc such as mushrooms, pumpkin seeds, seafood, spinach, sunflower seeds, and whole grains. Zinc nourishes the prostate gland and is vital for proper immune function.
• Restrict your intake of dairy products. Moderate consumption of soured products such as low-fat yogurt and kefir is acceptable.
• If you experience difficulty urinating or notice an increasing trend toward waking up to urinate during the night, consult your health care provider. This may indicate prostatic obstruction.
• Use cold-pressed organic oils such as sesame, safflower or olive oil to obtain essential fatty acids.
• Do not eat red meat. There is a define correlation between high red meat consumption (five servings a week or more) and the development of prostate cancer.
• Eliminate from the diet alcoholic beverages, coffee and all teas except for caffeine-free herbal teas.
• Strictly avoid the following foods: junk foods, processed refined foods, salt, saturated fats, sugar and white flour. Instead of salt, use a kelp or potassium substitute. If necessary, a small amount of blackstrap molasses or pure maple syrup can be used as a natural sweetener in place of sugar. Use whole wheat or rye instead of white flour.
• Unless otherwise recommended, take vitamins and other supplements daily with meals, with the exception of vitamin E, which should be taken before meals.
• Try to avoid all known carcinogens. Eat only organic foods, if possible. Avoid tobacco smoke, polluted air, polluted water, noxious chemicals and food additives. Use only distilled water or reverse-osmosis-filtered water. Municipal and well water can contain chlorine, fluoride and agricultural chemical residue.
• Do not take any drugs except those that are prescribed by your physician. Always seek counsel and alternative opinions before deciding which treatments, if any, you will pursue.
• Prostate Massage. We haven’t been able to find a lot of information on this subject but understand that Tibetan monks practice a meditation that includes self-massage of the prostate. Also, there is a video that focuses on self anal massage for men that includes a very short mention of prostate massage about 23 minute in. However, for those wanting to practice self prostate massage, it provides very good information on cleanliness and preparation of the anal area prior to starting the practice. It is available through Erospirit Research Institute and their website at www.erospirit.org
  

Pain management

In most cases, pain is manageable. No one should have to suffer, especially terminally ill cancer patients. And, while many of the major pain killers like morphine are controlled by the federal government, and the DEA has been very active in prosecuting doctor’s for alleged "over prescription", many of these patients report that the pain in too great in lower dosages. (See the film " and see what you think.)

AIDS and cancer patients have long reported the positive affect of marijuana to reduce pain and improve the appetite, often an after effect of chemotherapy. California and Arizona have passed laws allowing doctors to prescribe marijuana for certain ailments. Even the New England Journal of Medicine has favored doctors who prescribe marijuana. However, the federal government, not really caring about people’s pain, has threatened to charge any doctor prescribing it with a felony. Similar drugs have not received the governments okay since they fear a person may become addicted, which is seldom the case. Regardless of research to the contrary, "Even if the person is dying, it seems that they (the government) would rather see him die in pain rather than become an addict for the short time he has to live," says Dr. Aubrey Pilgrim in his book A Revolutionary Approach to Prostate Cancer. X-rays can be used to reduce or eliminate pain for some time and Metastron (Stronitium 89) radiation works well on bone metastases. Quadremet, which is a radioactive dryg similar to Metasmon, has fewer side effects and Novantrone is the first chemotherapy drug approved for treatment of pain from advanced hormone refractory prostate cancer. For information, call 800.220.6302. Finally, there are a number of ways to deal with pain. If you aren’t successful with you current doctor, find one who will help. No one deseerves to have to live in pain.

Incontinence

The leakage of urine. Other happens after radical prostatectomy. It often requires the use of under garment pads like Attends or Depends. Some men are embarrassed about change these pads several times a day. Some alternatives are: Have a radical prostatectomy using the Gaker procedure which preserves the bladder sphincter. The procedure was published in The Journal of Urology, 8/96 or have your doctor call Dr. Douglas Gaker at 513.423.0739 for a video on the procedure. You can also do exercises to strengthen the lower sphincter, which might include the Kegel exercises, originally developed by Dr. Arnold Kegel for women. These exercises can be done in private or in public - no one will know. Other treatments that might help include penile clamps, condom catheters, biofeedback, artificial urinary sphinter, collagen and fat injections, and medication. There are other products yet to be approved by the FDA than are being used in Europe like poly-Teflon which is used instead of collagen as a bulking agent. (Resources.)

Erectile dysfunction/sex

The penis is a vascular organ which requires exercise. A healthy male will normally experience 3 to 4 erections during their sleep which may last a hour or more each. They are a normal body function whose purpose is to oxygenate the penile erectile tissue. Its inability to achieve and maintain an erection suitable for vaginal intercourse is called "male erectile dysfunction (ED) or impotency, for short. Impotency affects over 30 million men and their partners. So, having to face the possibility of impotency as an after-affect of prostate cancer treatment can be of major concern. To some men it is a symbol of the loss of their manhood, and can be critical to a man’s ego and self-image. And often, because of this, some men are afraid to seek help. And, often when he does, the physician feels uncomfortable or is unable to help because many aren’t aware of the options. If the truth were known, however, virtually 100% of impotency problems can be successfully diagnosed and treated, whether physical or emotional, unless there is permanent injury or severance of the nerves and or vascular supply necessary in the erectile process.

Medications taken for hypertension and depression usually inhibit normal erectile function and can be changed to an alternative which may allow the return to normal sexual function. In addition, three drugs may offer hope. Viagra has achieved very good results in men with psychogenic impotence and also in men with organic impotence. The intensity of the erection is enhanced as well as overall performance and there may be major side effects, and a risk of death for some patients. A doctor will be able to determine if Viagra is right for you. (This too will be reviewed November 1. For books on the subject, check "Books" "Issues" "Health-General".) Vasomax has been used for years as an injectable medication and is now being tested in pill form. It is another medication which works to dilate penile blood flow in men with mild vascular problems. Apo-Morphine is being evaluated for treatment of only psychogenic impotence.

Vacuum erection devices work to create an erection mechanically by drawing the blood into the penis. While this eliminates the need for medication, it does require some preparation time which decreases spontaneity. However, they work for many men and are covered by Medicare and many insurance companies.

Medical Urethral System for Erection (MUSE) is a cream which is absorbed through the urethra and dilates the cavernosal spongy tissue of the erectile chambers. It has about a 66% success rate and anxiously awaits approval to replace injectable forms of therapy.

Injection Therapies - Papaverine was the first effective medical treatment for ED. To date, there are two currently approved by the FDA. Caverject and Edex which are effective in about 85% of patients. Occasionally, Papaverine by itself or with Regitine and Prostaglandin E will be used, which is much better than any on eof them used alone. Some men will have erections lasting a few minutes to 45 minutes. Dosage determines this. Used immediately after radical prostatectomy or radiation therapy may prevent atrophy of the smooth muscle necessary for erection which is associated with non-use of the penis.

Penile Prosthesis, rigid, semi-rigid or inflatable implants, can very a scary thing for many men. Getting your questions answered is most important because it is a serious decision. They are only necessary in about 10% of patients. For men who have become impotent following radical surgery, radiation or cryosurgery, or have arthritis and decreased manual dexterity, this procedure may be the last hope. The success rate is very high and they remain effective at a 90-95% rate 5 years after implantation.

Watch out

I’m usually more skeptical of Western medicine and chemical solutions than natural or Eastern methods. With anything, you should get as much information as possible and know what you’re doing. One place to turn is the Cedars of Sinai Comprehensive Cancer Center, which publishes a monthly newsletter dealing with cancer advances, therapies, prevention and support concerns. The February, 1997 issue included an article titled "Unproven Methods of Cancer Management" which discussed the potential dangers of various claimed cures such as macrobiotic diets, psychic surgery, quack drugs such as Prostada, shark cartilage and biological products, electronic gadgets, and devices, herbal and fold remedies, dietary approaches, bogus diagnostic tests, metabolic therapies, mental imagery, faith healing, homeopathic and many other unproven treatments and modalities. It can be found at www.csccc.com There is also a newsletter, published by the National Council Against Health Fraud with short articles about many of the current health frauds. Write PO Box 1276, Loma Linda, CA 92354. If you encounter a scam, contact the National Fraud Information Center, 1.800.876.7060 or you may write the Federal Trade Commission, Room 1105, Washington, D.C. 20580. Do as much checking as possible before you spend good money, and possibly risk your life, using up-proven methods to cure prostate cancer or anything else for that matter.

Recommendations

Some recommendations:

• Eat a healthy, well-balanced diet. Include in the diet pumpkin seeds, bee pollen, or royal jelly. (Caution: Bee pollen may cause an allergic reaction in some individuals. Start with a small amount, and discontinue use if a rash, wheezing, discomfort or other symptom occurs.
• Avoid alcohol, particularly before sexual encounters.
• Do not consume animal fats, sugar, fried or junk foods.
• Do not smoke. Avoid being around cigarette smoke.
• Avoid stress.
• Consult a urologist for testing to determine whether impotence is caused by an underlying illness that requires treatment.
• Consider possible psychological factors that may be contributing to impotence, especially repressed anger or a fear of intimacy. Exploring psychological issues with a qualified therapist can help.
• If you suspect impotence may be related to a drug you are taking, discuss this with your physician. There may be satisfactory, alternatives that will not cause this problem. Certain blood pressure medications and tranquilizers often cause erectile difficulties. The drugs cimetidine (Tagamet) and ranitidine (Zantac) which are used to treat ulcers and heartburn, also have significant side effects in some men. (Caution: Do not stop taking a prescription drug or change the dosage without consulting your physician.
• Investigate the possibility of heavy metal intoxication. A hair analysis can reveal possible heavy metal poisoning.
• Keep in mind that sexual function changes with age. As you age, you may require more stimulation and a longer period of time to achieve an erection.
  

Considerations

Some considerations:

• A study done at the Boston University School of Medicine linked overall health to impotence. Researchers studied the medical histories of 1300 men aged 40 to 70. They found some impotence in a total of 52%. Men who were being treated for heart disease, high blood pressure, or diabetes were one and a half to four times more likely than the overall group to be completely impotent later in life. The situation was even worse for men who had heart disease or hypertension and who smoked.
• Alcohol intake decreases the body’s ability to produce testosterone. Research at Chicago Medical School revealed that drinking alcohol may cause the mormonal equivalent of menopause in men. Alcohol not only affects sexual function, but also helps set the stage for a heart attack and other dangerous conditions.
• Arteriosclerosis, which restricts blood supply to the penis and to the nerves that govern sexual arousal, may result in a "failure to perform." If impotence is related to clogged blood vessels, a diet low in fats can actually help reverse the problem.
• A study done at Boston University showed that men who smoked one pack of cigarettes a day for five years were 15 percent more likely to develop clogging in the arteries that serve the penis, a situation that can cause impotence. In addition, heavy smoking decreases sexual capability by damaging the tiny blood vessels in the penis. The use of marijuana and cocaine also can result in impotence.
• Duplex untrasonography, a noninvasive method of measuring penile blood flow, is a reliable method of determining whether arterial occlusion plays a role in impotence. If you doctor believes atherosclerosis to be the underlying problem, he or she may advise vascular surgey to improve blood flow to the penis.
• According to figures from impotence organizations, only about 5 percent of the estimated 30 million men affected are aware of therapy options.
• Urologists differ in the types of treatment they recommend for impotence, but many opt first for nonsurgical treatment.
• Injections of the drugs papaverine (Pavabid) and phentolamine (Regitine) or prostaglandin E1 (PGE1) into the base of the penis before intercourse have been shown to be roughly 80% effective in producing "satisfactory erection" in impotent men who have tried it. The drug alprostadil also is available in an injection kit (Caverject). These drugs work by relaxing smooth muscle, causing the blood vessels in the penis to dilate, promoting an erection that can last an hour or more. An estimated 300,000 men in the U.S. use this technique each year. Possible side effects include priaprism (prolonged, painful erections). Also, although the injections are done with a tiny needle, and are supposed to be painless when done properly (proper technique is crucial), this prospect is unappealing to many men. A less invasive technique, which involves instilling alprostadil into the urethra with a tiny plunger, is under development and is expected to become available in the near future.
• Yohimbine (sold under the brand names Dayto, Yocon, and Yohimex) is a prescription drug that has been approved by the FDA for treatment of impotence. Its effectiveness is questionable, however. Many experts consider it to be, in essence, a placebo. Yohimbine has an effect on the body similar to that of adrenaline; it speeds up the heartbeat and elevates blood pressure. Beware of yohimbine if you have high blood pressure.
• Three drugs may offer hope. Viagra has achieved very good results in men with psychogenic impotence and also in men with organic impotence. The intensity of the erection is enhanced as well as overall performance and there may be major side effects, and a risk of death for some patients. A doctor will be able to determine if Viagra is right for you. (For books on the subject, check "Books" "Issues" "Health-General".) Vasomax has been used for years as an injectable medication and is now being tested in pill form. It is another medication which works to dilate penile blood flow in men with mild vascular problems. Apo-Morphine is being evaluated for treatment of only psychogenic impotence.
• Medical Urethral System for Erection (MUSE) is a cream which is absorbed through the urethra and dilates the cavernosal spongy tissue of the erectile chambers. It has about a 66% success rate and anxiously awaits approval to replace injectable forms of therapy.
• Injection Therapies - Papaverine was the first effective medical treatment for ED. To date, there are two currently approved by the FDA. Caverject and Edex which are effective in about 85% of patients. Occasionally, Papaverine by itself or with Regitine and Prostaglandin E will be used, which is much better than any on eof them used alone. Some men will have erections lasting a few minutes to 45 minutes. Dosage determines this. Used immediately after radical prostatectomy or radiation therapy may prevent atrophy of the smooth muscle necessary for erection which is associated with non-use of the penis.
• If impotence is linked to high levels of the hormone prolactin, bromocriptine (Parlodel) may be prescribed to correct the problem.
• A number of vacuum devised are used to promote erection. With these devices, a cylinder is placed over the penis and a hand pump is used to create a vacuum in the cylinder. This in turn causes blood to flow into the penis, creating an erection. The user then puts a constriction band around the base of the penis, causing the erection to last up to thirty minutes. These devices are available by prescription only. Some 100,000 men in the U.S. choose this treatment each year. While this eliminates the need for medication, it does require some preparation time which decreases spontaneity. However, they work for many men and are covered by Medicare and many insurance companies. Problems abound with this technique, however.
• Since the early 1970s, more than 250,000 American men have turned to inflatable penile implants to mechanically create erections. Penile implants are surgically installed devices that are made of silicone or polyurethane. One type is made of two semi-rigid but bendable rods; another type consists of a pump, a fluid-filled reservoir, and two cylinders into which the fluid is pumped to create an erection. Penile implants are now coming under FDA scrutiny. Since 1984, the FDA’s Center for Devices and Radiological Health has logged more than 6,500 reports of problems with inflatable devices - a large number for a medical device, according to the FDA. With the development of more effective agents, implants are now considered to be a last resort, to be tried only when all other methods have failed. Penile Prosthesis, rigid, semi-rigid or inflatable implants, can very a scary thing for many men. Getting your questions answered is most important because it is a serious decision. They are only necessary in about 10% of patients. For men who have become impotent following radical surgery, radiation or cryosurgery, or have arthritis and decreased manual dexterity, this procedure may be the last hope. The success rate is very high and they remain effective at a 90-95% rate 5 years after implantation.
• Dr. Robert Frankt of Budapest University in Hungary found a great increase in sexual vitality and energy in men using a combination of two herbs, green oats (Avena sativa) and stinging nettle. "Feeling one’s oats" is an expression that originated centuries ago, and probably with good reason: a study by the Institute for Advanced Study of Human Sexuality found that men who suffered from reduced sexual desire and diminished performance were helped by green oats. Nettle if full of vital minerals and is good also for hypoglycemia, allergies, depressions, prostate and urinary tract disorders, and a host of other problems.
• Circumcised men, it is said, have a much higher rate of impotency than uncircumcised men. We will continue to monitor for additional information in this area.

Summary

This will give you some background on the subject. The important thing to remember is "Don’t wait." The longer you wait, the greater the worry, the more difficult the treatment and recovery, and you’ll miss out on a lot of great evenings in bed, too. So, find a qualified doctor who is knowledgeable of the latest medical therapies. If you need help in locating someone, one of the following organizations can help: Impotence Institute of America & Impotence Anonymous - 1.800.669.1603 or Male Potency Centers of America - 1.800.438.7683. The Institute also offers anonymous groups where men can hear the experiences of other men which usually relates to what they are going through. And, there is an excellent tape discussing all of the causes of impotence, diagnostic treatment options and therapies by Dr. Aubrey Pilgrim for $15 + shipping by calling 1.714.644.7200.

The appropriate treatment for impotence depends upon whether the cause is physical or psychological. A man whose impotence is psychologically based generally still has erections during sleep, whereas an individual whose impotence is physical in origin usually does to. One easy, inexpensive way to test for nocturnal erections is with postage stamps. Glue a strip of stamps around the shaft of the penis before going to bed. If the ring of stamps is broken in the morning, the cause of the impotence is likely psychological. If the strip is unbroken, the impotence is likely physiological. You can also purchase a kit called Snap Gauge from UroHealth Corporation. This test is designed to detect the measure the rigidity of erections experienced during sleep. Call 800.328.1103 for more information.