Posts Tagged ‘prostate cancer’

6 Ways To Reduce Your Risk Of Prostate Cancer

May 13, 2017

Andrew Siegel MD  5/13/17

Prostate cancer is incredibly common– one man in seven will be diagnosed with it in his lifetime–with average age at diagnosis mid 60s. In 2015, an estimated 221,000 American men were diagnosed and 28,000 men died of the disease.  Although many with low-risk prostate cancer can be managed with careful observation and monitoring, those with moderate-risk and high-risk disease need to be managed more aggressively. With proper evaluation and treatment, only 3% of men will die of the disease. There are over 2.5 million prostate cancer survivors who are alive today.

Factoid: The #1 cause of death in men with prostate cancer is heart disease, as it is in the rest of the population. 

finger 2

This is the index finger of yours truly; observe the narrow digit, a most desirable feature for a urologist who examines many prostates in any given day.  The digital rectal exam of the prostate is a 15-second exam that is at most a bit uncomfortable, but vital in the screening process and certainly nothing to fear.

Wouldn’t it be wonderful if prostate cancer could be prevented? Unfortunately, we are not there yet—but we do have an understanding of measures that can be pursued to help minimize your chances of developing prostate cancer.

Factoid: When Asian men–who have one of the lowest rates of prostate cancer– migrate to western countries, their risk of prostate cancer increases over time. Clearly, a coronary-clogging western diet high in animal fat and highly processed foods and low in fruits and vegetables is associated with a higher incidence of many preventable problems, including prostate cancer.

The presence of prostate cancer pre-cancerous lesions commonly seen on prostate biopsy—including high-grade prostate intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP)—many years before the onset of prostate cancer, coupled with the fact the prostate cancer increases in prevalence with aging, suggest that the process of developing prostate cancer takes place over a protracted period of time. It is estimated that it takes many years—often more than a decade—from the initial prostate cell mutation to the time when prostate cancer manifests with either a PSA elevation, an acceleration in PSA, or an abnormal digital rectal examination. In theory, this provides the opportunity for intervention before the establishment of a cancer.

Measures to Reduce Your Risk of Prostate Cancer

  1. Maintain a healthy weight since obesity has been correlated with an increased prostate cancer incidence.
  2. Consume a healthy diet with abundant fruits and vegetables (full of anti-oxidants, vitamins, minerals and fiber) and real food, as opposed to processed and refined foods. Eat plenty of red vegetables and fruits including tomato products (rich in lycopene). Consume isoflavones (chickpeas, tofu, lentils, alfalfa sprouts, peanuts). Eat animal fats and dairy in moderation. Consume fatty fish containing omega-3 fatty acids such as salmon, tuna, sardines, trout and mackerel.  Follow the advice of Michael Pollan: “Eat food. Not too much. Mostly plants.”
  3. Avoid tobacco and excessive alcohol intake.
  4. Stay active and exercise on a regular basis. If you do develop prostate cancer, you will be in tip-top physical shape and will heal that much better from any intervention necessary to treat the prostate cancer.
  5. Get checked out! Be proactive by seeing your doctor annually for a digital rectal exam of the prostate and a PSA blood test. Abnormal findings on these screening tests are what prompt prostate biopsies, the definitive means of diagnosing prostate cancer. The most common scenario that ultimately leads to a diagnosis of prostate cancer is a PSA acceleration, an elevation above the expected incremental annual PSA rise based upon the aging process.

Important Factoid: An isolated PSA (out of context) is not particularly helpful. What is meaningful is comparing PSA on a year-to-year basis and observing for any acceleration above and beyond the expected annual incremental change associated with aging and benign prostate growth. Many labs use a PSA of 4.0 as a cutoff for abnormal, so it is possible that you can be falsely lulled into the impression that your PSA is normal.  For example, if your PSA is 1.0 and a year later it is 3.0, it is still considered a “normal” PSA even though it has tripled (highly suspicious for a problem) and mandates further investigation. 

  1. Certain medications reduce the risk of prostate cancer by 25% or so and may be used for those at high risk, including men with a strong family history of prostate cancer or those with pre-cancerous biopsies. These medications include Finasteride and Dutasteride, which are commonly used to treat benign prostate enlargement as well as male pattern hair loss. These medications lower the PSA by 50%, so any man taking this class of medication will need to double their PSA in order to approximate the actual PSA. If the PSA does not drop, or if it goes up while on this class of medication, it is suspicious for undiagnosed prostate cancer. By shrinking benign prostate growth, these medications also increase the ability of the digital rectal exam to detect an abnormality.

Bottom Line: A healthy lifestyle, including a wholesome and nutritious diet, maintaining proper weight, participating in an exercise program and avoiding tobacco and excessive alcohol can lessen one’s risk of all chronic diseases, including prostate cancer.  Be proactive by getting a 15-second digital exam of the prostate and PSA blood test annually.  Prevention and early detection are the key elements to maintaining both quantity and quality of life. 

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

 

Prostate Cancer Update 2017: A More Nuanced Approach

December 3, 2016

Andrew Siegel MD  12/3/2016

prostate_cancerAttribution of above image: Blaus (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)%5D, via Wikimedia Commons

It was not so long ago that all prostate cancers were lumped together, the thought being that a cancer is a cancer and best served by surgical removal. Consequently, with the best of intentions, some unnecessary surgical procedures were performed that at times resulted in impaired sexual function, poor urinary control, and unhappy patients.

Fortunately, urologists have become wiser, recognizing that individual prostate cancers are unique and that a nuanced approach is the key to proper management. Some prostate cancers are so unaggressive that no cure is necessary, whereas others are so aggressive that no treatment is curative. One thing is for certain—we have vastly improved our ability to predict which prostate cancers need to be actively treated and which can be watched.

The Challenge Of Diagnosing Prostate Cancer

The vast majority of patients who have undiagnosed prostate cancer have NO symptoms—no pain, no bleeding, no urinary issues, no anything. The possible diagnosis of prostate cancer is usually entertained under three circumstances: when there is an elevated PSA (Prostate Specific Antigen) blood test; when there is an accelerated PSA (when the change in PSA compared to the previous year is considered to be too high); and when there is an abnormal prostate DRE (digital rectal exam)—a bump, lump, hardness, asymmetry, etc. The bottom line is that if you don’t actively seek prostate cancer, you’re not going to find it. When prostate cancer does cause symptoms, it is generally a sign of locally advanced or advanced prostate cancer. Therein lies the importance of screening.

The Dilemma Of Screening For Prostate Cancer

The downside of screening is over-detection of low risk prostate cancer that may never prove to be problematic, but may result in unnecessary treatment with adverse consequences. The downside of not screening is the under-detection of aggressive prostate cancer, with adverse consequences from necessary treatment not being given.

How Is The Diagnosis of Prostate Cancer Made?

When the PSA is elevated or accelerated and/or if there is an abnormal prostate DRE in a reasonably healthy man with good longevity prospects, an ultrasound-guided prostate biopsy is in order. Obtaining tissue for an exam by a pathologist is the definitive and conclusive test. The biopsy will reveal if cancer is present and its location, volume and grade (aggressiveness).

If prostate cancer is present, it is useful to determine the risk potential of the prostate cancer (“risk stratify”) by classifying it into categories based upon the following:

T (Tumor) category

T1c: cancer found because of PSA elevation or acceleration with a normal DRE

T2a: palpable (that which can be felt on DRE) cancer of half or less of one side

T2b: palpable cancer of more than half of one side

T2c: palpable cancer of both sides

T3a: cancer outside prostate, but sparing the seminal vesicles (reproductive structures that store semen)

T3b: cancer involving seminal vesicles

T4: regional spread of cancer to sphincter, rectum, bladder or pelvic sidewall

Gleason Score

Dr. Gleason devised a system that grades prostate cancer by observing the cellular architecture of prostate cancer cells under the microscope. He recognized that prostate cancer grade is the most reliable indicator of the potential for cancer growth and spread. His legacy, the grading system that bears his name, provides one of the best guides to prognosis and treatment. The pathologist assigns a separate numerical grade ranging from 3 – 5 to each of the two most predominant patterns of cancer cells. The sum of the two grades is the Gleason score. The Gleason score can predict the aggressiveness and behavior of the cancer, with higher scores having a worse prognosis than lower scores.

Grade Group 1 (Gleason score 3+3=6)

Grade Group 2 (Gleason score 3+4=7)

Grade Group 3 (Gleason score 4+3=7)

Grade Group 4 (Gleason score 4+4=8)

Grade Group 5 (Gleason score 4/5+4/5=9 or 10)

The significance of the Gleason Grade Group can be understood by examining the PSA five years after surgical removal of the prostate, correlating survival with the Grade Group. Ideally, after surgical removal of the prostate gland the PSA should be undetectable. A detectable and rising PSA after surgical removal is a sign of recurrent prostate cancer. The five-year rate of PSA remaining undetectable (biochemical recurrence-free progression) for surgical removal of the prostate in Grade Groups 1-5 is the following: 96%, 88%, 63%, 48%, and 26% respectively, indicating the importance of the grading system with respect to prognosis.

Number cores with cancer

Generally 12 – 14 biopsies are obtained, occasionally more. In general, the more cores that have cancer, the greater the volume of cancer and the greater the risk.

Percent of tumor involvement (PTI)

The percentage of any given biopsy core that has cancer present. In general, the greater the PTI, the greater the risk.

PSA

PSA is an excellent “tumor marker” for men with prostate cancer. In general, the higher the PSA, the greater the risk category.

PSA density

The relationship of PSA level to size of the prostate, determined by dividing the PSA by the volume of the prostate. The volume of the prostate is easily determined by ultrasound or by MRI (magnetic resonance imaging). A PSA density > 0.15 is greater risk.

 

Risk Stratification For Prostate Cancer

Based upon the aforementioned parameters, an individual case of prostate cancer can be assigned to one of five risk categories ranging from very low risk to very high risk. This risk assignment is helpful in predicting the future behavior of the prostate cancer and in the decision-making process regarding treatment.

Very Low Risk: T1c; Gleason score ≤ 6; fewer than 3 cores with cancer; less than 50% of cancer in each core; PSA density < 0.15

Low Risk: T1-T2a; Gleason score ≤ 6; PSA < 10

Intermediate Risk: T2b-T2c or Gleason score 7 or PSA 10-20

High Risk: T3a or Gleason score 8-10 or PSA > 20

Very High Risk: T3b-T4 or Gleason grade 5 as the predominant grade (the first of the two Gleason grades in the Gleason score) or > 4 cores Gleason score 8-10

 

Prostate Cancer Treatment

Prostate cancer treatment is based upon risk category and life expectancy and includes the following:

RALP (robotic-assisted laparoscopic prostatectomy): surgical removal of the prostate gland using robotic assistance

RT (radiation therapy): this can be used as definitive treatment or alternatively for recurrent disease after RALP or immediately following healing from RALP under the circumstance of adverse pathology report

ADT (androgen deprivation therapy): a means of decreasing testosterone level, since the male sex hormone testosterone stimulates prostate growth

AS (active surveillance): actively monitoring the disease with the expectation to intervene with curative therapy if the cancer progresses. This will involve periodic DRE, PSA, MRI, and repeat biopsy.

Observation: monitoring with the expectation of giving palliative therapy (relieving pain and alleviating other problems that may surface without dealing with the underlying cause)  if symptoms develop or a change in exam or PSA suggests that symptoms are imminent.

 

Prostate Cancer Treatment Based Upon Risk Stratification

Very Low Risk

< 10 year life expectancy: observation

10-20 years life expectancy: AS

> 20 years life expectancy: AS or RALP or RT

Low Risk

<10 years life expectancy: observation

>10 years life expectancy: AS or RALP or RT

Intermediate Risk

<10 years life expectancy: observation or RT + ADT 4-6 months

>10 years life expectancy: RALP or RT + ADT 4-6 months

High Risk

RALP or RT + ADT 2-3 years

Very High Risk:

T3b-T4: RT + ADT 2-3 years or RALP (in select patients) or ADT

Lymph node spread: ADT or RT + ADT 2-3 years

Metastatic disease: ADT

Bottom Line: Excluding skin cancer, prostate cancer is the most common cancer type in men, accounting for 26% of newly diagnosed cancers with men having a 1 in 7 lifetime risk. The median age of prostate cancer at diagnosis is the mid 60s and in 2015 there were 221,000 new cases per year, 27,500 deaths (the second most common form of cancer death, after lung cancer) and there are currently about 2.5 million prostate cancer survivors in the USA.  It is important to diagnose prostate cancer as early as possible in order to decide on the most appropriate form of management—whether it is surgery, radiation, or observation/monitoring. Risk stratification can help the decision-making process.

“Appropriate treatment implies that therapy be applied neither to those patients for whom it is unnecessary nor to those for whom it will prove ineffective. Furthermore, the therapy should be that which will most assuredly permit the individual a qualitatively and quantitatively normal life. It need not necessarily involve an effort at cancer cure. Human nature in physicians, be they surgeons, radiotherapists, or medical oncologists, is apt to attribute good results following treatment to such treatment and bad results to the cancer, ignoring what is sometimes the equally plausible possibility that the good results are as much a consequence of the natural history of the tumor as are the bad results.”

Willet Whitmore, M.D.

(Dr. Whitmore served as chief of urology for 33 years at what is now Memorial Sloan-Kettering Cancer Center. He died of prostate cancer at age 78 in 1995.)

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

 

 

 

 

“Doc, My Penis Is Shrinking”

October 8, 2016

Andrew Siegel MD  10/8/16

cuixes_de_lapol%c2%b7lo_de_pinedo

Image above: Roman copy of Apollo Delphinios by Demetrius Miletus at the end of the second century (Attribution: Joanbanjo (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons)

Not a day goes by in my urology practice when I fail to hear the following complaint from a patient: “Doc, my penis is shrinking.” The truth of the matter is that the penis can shrivel from a variety of circumstances, but most of the time it is a mere illusion—a sleight of penis, if you will. Weight gain and obesity cause a generous pubic fat pad, the male equivalent of the female mons pubis, which will make the penis appear shorter and retrusive. However, penile length is usually intact, with the penis merely hiding behind the fat pad, the “turtle effect.” Lose the fat and presto…the penis reappears. Having a plus-sized figure is not such a good thing when it comes to size matters, as well as many other matters.

Factoid: It is estimated that with every 35 lbs. of weight gain, there is one-inch loss in apparent penile length.

The 9-letter word every man despises: S-H-R-I-N-K-A-G-E, immortalized by Jason Alexander playing the character George in the Seinfeld series. Jerry’s girlfriend Rachel catches a glimpse of naked George after he has stepped out of a swimming pool. Suffice it to say that George’s penis was in a “non-optimized” state. George tries to explain: “Well I just got back from swimming in the pool and the water was cold.” Jerry makes the diagnosis: “Oh, you mean shrinkage” and George confirms: “Yes, significant shrinkage.”

Penis size has not escaped our “bigger is better” American mentality where large cars, homes, breasts,  buttocks and mega-logos on shirts are desirable and sought-after assets. The pervasive pornography industry–where many male stars are “hung like horses”– has given the average guy a bit of an inferiority complex.

Factoid: The reality of the situation is that the average male has an average-sized penis, but in our competitive society, although average is the norm, average curiously has gotten a bad rap.

Adages concerning penile size and function are common, e.g., “It’s not the size of the ship, but the motion of the ocean.” Or even better, as seen on a poster in a gateway while boarding an airplane: “Size should never outrank service.” The messages conveyed by these statements have significant merit, but nonetheless, to many men and women, size plays at least some role and many men have concerns about their size. Whereas men with tiny penises may be less capable of sexually pleasing a woman, men who have huge penises can end up intimidating women and provoking pain and discomfort.

Leonardo Da Vinci had an interesting take on perspectives: “Woman’s desire is the opposite of that of man. She wishes the size of the man’s member to be as large as possible, while the man desires the opposite for the woman’s genital parts.”

Penile Stats

As a urologist who examines many patients a day, I can attest to the fact that penises come in all shapes and sizes and that flaccid length does not necessarily predict erect length and can vary depending upon many factors. There are showers and there are growers. Showers have a large flaccid length without significant expansion upon achieving an erection, as opposed to growers who have a relatively compact flaccid penis that expands significantly with erection.

With all biological parameters—including penis size—there is a bell curve with a wide range of variance, with most clustered in the middle and outliers at either end. Some men are phallically-endowed, some phallically-challenged, with most somewhere in the middle of the road. In a study of 3500 penises published by Alfred Kinsey, average flaccid length was 8.8 centimeters (3.5 inches). Average erect length ranged between 12.9-15 centimeters (5-6 inches). Average circumference of the erect penis was 12.3 centimeters (4.75 inches). As with so many physical traits, penis size is largely determined by genetic and hereditary factors. Blame it on your father (and mother).

Factoid: Hung like a horse—forget about it! The blue whale has the mightiest genitals of any animal in the animal kingdom: penis length is 8-10 feet; penis girth is 12-14 inches; ejaculate volume is 4-5 gallons; and testicles are 100-150 pounds. Hung like a whale!

Factoid: “Supersize Me.” In order to make their genitals look larger, the Mambas of New Hebrides wrap their penises in many yards of cloth, making them appear massive in length. The Caramoja tribe of Northern Uganda tie weights on the end of their penises in efforts to elongate them.

“Acute” Shrinkage

Penile size in an individual can be quite variable, based upon penile blood flow. The more blood flow, the more tumescence (swelling); the less blood flow, the less tumescence. “Shrinkage” is a real phenomenon provoked by exposure to cold (weather or water), the state of being anxious or nervous, and participation in sports. The mechanism in all cases involves blood circulation.

Cold exposure causes vasoconstriction (narrowing of arterial flow) to the body’s peripheral anatomy to help maintain blood flow and temperature to the vital core. This principle is used when placing ice on an injury, as the vasoconstriction will reduce swelling and inflammation. Similarly, exposure to heat causes vasodilation (expansion of arterial flow), the reason why some penile fullness can occur in a warm shower.

Nervous states and anxiety cause the release of the stress hormone adrenaline, which functions as a vasoconstrictor, resulting in numerous effects, including a flaccid penis. In fact, when the rare patient presents to the emergency room with an erection that will not quit, urologists often must inject an adrenaline-like medication into the penis to bring the erection down.

Hitting it hard in the gym or with any athletic pursuit demands a tremendous increase in blood flow to the parts of the body involved with the effort. There is a “steal” of blood flow away from organs and tissues not involved with the athletics with “shunting” of that blood flow to the organs and tissues with the highest oxygen and nutritional demands, namely the muscles. The penis is one of those organs from which blood is “stolen”—essentially “stealing from Peter to pay Paul” (pun intended!)—rendering the penis into a sad, deflated state. Additionally, the adrenaline release that typically accompanies exercise further shrinks the penis.

Cycling and other saddle sports—including motorcycle, moped, and horseback riding—put intense, prolonged pressure on the perineum (area between scrotum and anus), which is the anatomical location of the penile blood and nerve supply as well as pelvic floor muscles that help support erections and maintain rigidity.  Between the compromise to the penile blood flow and the nerve supply, the direct pressure effect on the pelvic floor muscles, and the steal, there is a perfect storm for a limp, shriveled and exhausted penis. More importantly is the potential erectile dysfunction that may occur from too much time in the saddle.

“Chronic” Shrinkage

Like any other body part, the penis needs to be used on a regular basis—the way nature intended—in order to maintain its health. In the absence of regular sexual activity, disuse atrophy (wasting away with a decline in anatomy and function) of the penile erectile tissues can occur, resulting in a “de-conditioned,” smaller and often temperamental penis.

Factoid: If you go for too long without an erection, smooth muscle, elastin and other tissues within the penis may be negatively affected, resulting in a loss of penile length and girth and negatively affecting ability to achieve an erection.

Factoid: Scientific studies have found that sexual intercourse on a regular basis protects against ED and that the risk of ED is inversely related to the frequency of intercourse. Men reporting intercourse less than once weekly had a two-fold higher incidence of ED as compared to men reporting intercourse once weekly.

Radical prostatectomy as a treatment for prostate cancer can cause penile shrinkage. This occurs because of the loss in urethral length necessitated by the surgical removal of the prostate, which is compounded by the disuse atrophy and scarring that can occur from the erectile dysfunction associated with the surgical procedure. For this reason, getting back in the saddle as soon as possible after surgery will help “rehabilitate” the penis by preventing disuse atrophy.

Peyronie’s Disease can cause penile shrinkage on the basis of scarring of the erectile tissues that prevents them from expanding properly.  For more on this, see my blog on the topic:

https://healthdoc13.wordpress.com/2015/05/23/peyronies-disease-not-the-kind-of-curve-you-want/

Medications that reduce testosterone levels are often used as a form of treatment for prostate cancer. The resultant low testosterone level can result in penile atrophy and shrinkage. Having a low testosterone level from other causes will also contribute to a reduction in penile size.

Are There Herbs, Vitamins or Pills That Can Increase Penile Size?

Do not waste your resources on the vast number of heavily advertised products that will supposedly increase penile size but have no merit whatsoever.  Realistically, the only medications capable of increasing penile size are the oral medications that are FDA approved for ED. Daily Cialis will increase penile blood flow and by so doing will increase flaccid penile dimensions over what they would normally be; the erect penis may be larger as well because of augmented blood flow.  Additionally, for many men this will restore the capability of being sexually active whereas previously they were unable to obtain a penetrable erection, thus allowing them to “use it instead of losing it” and maintain healthy penile anatomy and function.

Is Penile Enlargement Feasible Through Mechanical Means?

It is possible to increase penile size using tissue expansion techniques. The vacuum suction device uses either a manual or battery-powered source to create a vacuum in a cylinder into which the penis is placed. The negative pressure pulls blood into the penis, expanding penile length and girth. A constriction ring is placed around the base of the penis to maintain the erection. The vacuum is used to manage ED as well as a means of penile rehabilitation and is also used prior to penile implant surgery to increase the dimensions of the penis and allow a slightly larger device to be implanted than could be used otherwise. It can also be helpful under circumstances of penile shrinkage.

vsd

Vacuum Suction Device

The Penimaster Pro is a penile traction system that is approved in the European Union and Canada for urological conditions that lead to shortening and curvature of the penis. In the USA it is under investigation by the FDA. It is a means of using mechanical stress to cause penile tissue expansion and enlargement.

penimaster

Penimaster Pro

What’s The Deal With Penile Enlargement Surgery?

Some men who would like to have a larger penis may consider surgery. In my opinion, penile enlargement surgery, aka, “augmentation phalloplasty,” is highly risky and not ready for prime time. Certain procedures are “sleight of penis” procedures including cutting the suspensory ligaments, disconnecting and moving the attachment of the scrotum to the penile base, and liposuction of the pubic fat pad. These procedures unveil some of the “hidden” penis, but do nothing to enhance overall length. Other procedures attempt to “bulk” the penis by injections of fat, silicone, bulking agents, tissue grafts and other implantable materials. The untoward effects of enlargement surgery can include an unsightly, lumpy, discolored, painful and perhaps poorly functioning penis. Realistically, in the quest for a larger member, the best we can hope for is to accept our genetic endowment, remain physically fit, and keep our pelvic floor muscles well conditioned.

What’s Up With Penile Transplants?

The world’s first penis transplant was performed at Guangzhou General Hospital in China when microsurgery was used to transplant a donor penis to a recipient whose penis was damaged beyond repair in an accident. Subsequently, there have been several transplants done for penile trauma.  Hmmm, now here is a concept for penile enlargement!

What To Do To Avoid Shrinkage issues?

  • Accept that cold, stress and athletics will cause temporary shrinkage
  • Be aware that cycling and other saddle sports can cause shrinkage as well as erectile dysfunction: wear comfortable and protective shorts; get measured for a saddle with an appropriate fit; frequently rise up out of the saddle, taking the pressure off the perineum
  • Eat a healthy diet and stay physically active to maintain a lean physique
  • Use it or lose it: stay sexually active
  • Do pelvic floor exercises (a.k.a. Man Kegels): visit http://www.MalePelvicFitness.com
  • “Rehab” the penis to avoid disuse atrophy after radical prostatectomy: oral ED meds, pelvic floor muscle training, vibrational stimulation, vacuum suction device, penile injection therapy; consider “pre-hab” before the surgery
  • Seek urological care for Peyronie’s disease

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

http://www.TheKegelFix.com

E-book available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback available via websites. Author page on Amazon:

http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix

https://www.youtube.com/watch?v=uHZxoiQb1Cc 

Co-creator of the comprehensive, interactive, FDA-registered Private Gym/PelvicRx, a male pelvic floor muscle training program built upon the foundational work of renowned Dr. Arnold Kegel. The program empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance weights, this program helps to improve sexual function and to prevent urinary incontinence: www.PrivateGym.com or Amazon.  

In the works is the female PelvicRx DVD pelvic floor muscle training for women.

Pelvic Rx, Vacuum Suction Devices and many other quality products can be obtained at http://www.UrologyHealthStore.com. Use promo code “UROLOGY10” at checkout for 10% discount. 

12 MYTHS ABOUT KEGEL EXERCISES

July 9, 2016

Andrew Siegel MD 7/9/16

A “myth” is a widely held but false belief or idea. With respect to Kegel pelvic floor exercises, there are many such myths in existence. The goal of this entry is to straighten out these false notions and misconceptions and provide indisputable truths and facts about pelvic floor exercises. Much of this entry is excerpted from my new book THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health. (www.TheKegelFix.com)

 Facts_Myths.svg

(attribution Nevit Dilmen, 2015)

 

Myth 1: The best way to do Kegels is to stop the flow of urine.

Fact: If you can stop your stream, it is proof that you are contracting the proper muscles. However, this is just a means of feedback to reinforce that you are employing the pelvic floor muscles. The bathroom should not be your Kegel gymnasium!

Myth 2: Do Kegel exercises as often as possible.

Fact: Kegel exercises strengthen and tone the pelvic floor muscles and like other muscle-conditioning routines should not be performed every day. Kegel exercises should be done in accordance with a structured plan of progressively more difficult and challenging exercises that require rest periods in order for optimal muscle growth and response.  Three to four times weekly is sensible. 

Myth 3: Do Kegels anywhere (stopped at a red light, waiting in line at the supermarket, while watching television, etc.).

Fact: Exercises of the pelvic floor muscles—like any other form of exercise—demand attention, mindfulness and isolation of the muscle group. Until you are able to master the exercise regimen, it is best that the exercises be performed in an appropriate venue, free of distraction, which allows single-minded focus and concentration. This is not to say that once you achieve mastery of the exercises and a fit pelvic floor that you should not integrate the exercises into activities of daily living. That, in fact, is one of the goals.

Myth 4: The best way to do a Kegel contraction is to squeeze your PFM as hard as possible.

Fact: A good quality Kegel contraction cycles the pelvic floor muscles through a full range of motion from maximal relaxation to maximal contraction. The relaxation element is as critical as the contraction element. As vital as “tone and tighten” are, “stretch and lengthen” are of equal importance. The goal is for pelvic muscles that are strong, toned, supple and flexible.

Myth 5: Keeping the Kegel muscles tightly contracted all the time is desirable.

Fact: This is not a good idea. The pelvic muscles have a natural resting tone to them and when you are not actively engaging and exercising them, they should be left to their own natural state. “Tight” is not the same as “strong.” There exists a condition—pelvic floor muscle tension myalgia—in which there is spasticity, extreme tightness and pain due to excessive tension of these muscles.

Myth 6: Focusing on your core muscles is sufficient to ensure Kegel fitness.

Fact: No. The Kegel muscles are the floor of the “core” group of muscles and get a workout whenever the core muscles are exercised. However, for maximal benefit, focus needs to be placed specifically on the Kegel muscles. In Pilates and yoga, there is an emphasis on the core muscles and a collateral benefit to the pelvic muscles, but this is not enough to achieve the full potential fitness of a regimen that isolates and intensively exercises the Kegel muscles.

Myth 7: Kegel exercises do not help.

Fact: Oh yes they do! Kegel exercises have been medically proven to help a variety of pelvic maladies including pelvic relaxation, sexual dysfunction and urinary and bowel incontinence. Additionally, pelvic training will improve core strength and stability, posture and spinal alignment.

Myth 8: Kegels are only helpful after a problem arises.

Fact: No, no, no. As in any exercise regimen, the best option is to be proactive and not reactive. It is sensible to optimize muscle mass, strength and endurance to prevent problems from surfacing before they have an opportunity to do so. Kegel exercises pursued before getting pregnant will aid in preventing pelvic issues that may arise as a consequence of pregnancy, labor and delivery. If you strengthen your pelvic floor muscles when you are young, you can help avoid pelvic, urinary and bowel conditions that may arise as you age. Strengthen and tone now and your body will thank you later.

Myth 9: You can stop doing Kegels once your muscles strengthen.

Fact: Not true…the “use it or lose it” principle applies here as it does in any muscle-training regimen. Just as muscles adapt positively to the stresses and resistances placed upon them, so they adapt negatively to a lack of stresses and resistances. “Disuse atrophy” is a possibility with all muscles, including the Kegel muscles. “Maintenance” Kegels should be used after completing a course of pelvic muscle training.

Myth 10: It is easy to learn how to isolate and exercise the Kegel muscles.

Fact: Not the case at all. A high percentage of women who think they are doing Kegel exercises properly are actually contracting other muscles or are bearing down and straining instead of drawing up and in. However, with a little instruction and effort you can become the master of your pelvic domain.

(Note well: During June office visits I saw a nurse practitioner, a personal trainer and a physical therapist in consultation for pelvic issues.  None of them knew how to properly contract their pelvic muscles and needed to be instructed…and these are people in the know!)

Myth 11: Kegels are bad for your sex life.

Fact: Just the opposite! Kegels improve sexual function as the pelvic muscles play a critical role in genital blood flow and lubrication, vaginal tone, clitoral erection and orgasm. Kegels will enhance your sex life and his as well. A strong pelvic floor will enable you to “hug” his penis as energetically as you can hug his body with your arms!

Myth 12: Kegels are just for women.

Fact: Au contraire…men have essentially the same pelvic muscles as do women and can reap similar benefits from Kegels with respect to pelvic, sexual, urinary and bowel health. For more information on this topic, refer to Male Pelvic Fitness: Optimizing Sexual and Urinary Health (www.MalePelvicFitness.com).

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo; paperback edition available at TheKegelFix.com

Author page on Amazon: http://www.amazon.com/Andrew-Siegel/e/B004W7IM48

Apple iBook: https://itunes.apple.com/us/book/the-kegel-fix/id1105198755?mt=11

Trailer for The Kegel Fix: https://www.youtube.com/watch?v=uHZxoiQb1Cc  

Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount. 

Erection Recovery Program

December 5, 2015

Andrew Siegel MD   12/5/15

Reviresco – (Latin, re- + viresco) “I become green or verdant again”; “I am renewed or revived.”

Outliving Your Penis

It is very possible that you will “outlive” your penis. It will always be there for you in terms of a “spigot” to allow you the privilege of standing up to aim your urinary stream with reasonable accuracy, although this too suffers the ravages of time. However, in terms of being able to obtain or maintain an erection, your penis may perish decades before you do, for a variety of reasons.

The focus of today’s blog is ED due to prostate cancer treatment, although it is equally relevant to any man suffering with ED for any reason.  Having one’s prostate removed is a highly successful means of curing prostate cancer.  However, despite advances in technical and surgical approach, trauma to nerves, blood vessels, and muscular tissue during surgery can compromise sexual function, with ED being the most common complication.  The effect of radical prostatectomy on the penis is not unlike the effect of a stroke on the brain: in both situations a neuro-vascular (nerve/blood vessel) event occurs that may profoundly disturb function.  90% of men experience some degree of ED in the early post-surgery recovery period. The good news is that there are effective “rehab” and even “prehab” methods to optimize preservation and return of sexual function.  

Even if your penis has “expired” in terms of becoming rigid, it is still capable of being stimulated to ejaculation and orgasm, a phenomenon eventually discovered by many men. This is a small consolation (pun intended) for suffering with ED.

If your penis is not completely lifeless, it may be impaired such that you can obtain an erection, but lose it prematurely, or you can obtain at best a partially firm, non-penetrable erection. As if having a crippled penis were not severe enough punishment, to add insult to injury one of the consequences of lack of erections and sexual inactivity is further compromise of the future potential for erections. In other words, you need to obtain erections in order to maintain erections.

Use It Or Lose It

Erections not only provide the capacity for penetrative sex, but also serve to keep the erectile chambers (erectile smooth muscles and vascular sinus tissues) richly oxygenated, elastic and functioning. If one goes too long without an erection, damage to this erectile apparatus can result in penile atrophy (shrinkage) and compromised function. In a vicious cycle, the poor blood flow from disuse induces scarring and further damage to erectile smooth muscle and sinus tissues that often gives rise to venous leakage (rapid loss of erections as blood cannot be properly trapped within the erectile chambers). The bottom line is that in the absence of regular erections, one will likely lose length, girth and function, with the penis hobbled by its inability to properly trap blood.

As an aside, one of the functions of sleep erections—the spontaneous nocturnal erections that occur during REM (rapid eye movement) sleep in healthy men—is to maintain the erectile chambers in good working order. As sleep has an important restorative function for the human body, so sleep erections have a vital restorative function for the human penis.

Penile Resurrection

Achieving erections when they fail to occur by natural means is vital for sexual “resurrection” (l like the sound of this word—say it slowly). In time, the nerves that were “stunned” and/or injured by radical prostatectomy will usually heal and during this convalescing time, obtaining erections will help preserve erectile tissue. The implication is that even if you are sexually inactive, if you anticipate being sexually active in the future, you need to keep the penis and erectile apparatus fit.

Many urologists recommend penile “rehabilitation” when healed up after radical prostatectomy. Traditional rehab involves a combo of pills, injections and vacuum therapy, a.k.a. vacuum suction device (VSD). Some men use one, two or all three of these rehab strategies.

The oral ED medications (Viagra, Levitra, Cialis, and Stendra) can help maintain penile blood flow and provide the benefits that derive from maintaining tissue oxygenation. However, they are double-edged swords as they cannot be used in the face of certain medical conditions, have side effects, are expensive (costing about $40 per pill) and are not effective in all comers.

For those who do not respond to pills, the next step is often penile injections. Vasodilator drugs are injected directly into the erectile chambers to induce an erection. A mixture of one or more medications is often used for this purpose. Unfortunately–despite its effectiveness–many men are not fond of putting a needle in their penis and often nix this means of treatment.

The VSD is the third traditional rehab element. Starting 6 weeks or so after surgery and pursued for 10 minutes daily, the VSD mechanically engorges the penis in an effort to keep the erectile chambers healthy.

The Erection Recovery Program

“Prehab” is a means of pre-rehabilitation that is started shortly after the diagnosis of prostate cancer, during the time period when one awaits being operated upon. Instead of waiting for after-the-fact rehab, prehab intends to maximize sexual function before surgery in an effort to hasten recovery of erectile function after surgery. Committing to the erection recovery program before the trauma of surgery permits one to go into the operation optimally prepared.

The Erection Recovery Program combines two non-pharmacological, non-invasive tools—vibratory nerve stimulation and pelvic floor muscle training—to stimulate the nerves that produce erections and to strengthen the muscles that contribute to erectile rigidity, respectively. The traditional rehab program can be highly effective; however, it addresses primarily blood flow, a vital element of erectile physiology, while not focusing on nerve stimulation and pelvic floor/perineal muscle function, important contributors to the erectile process.

Vibratory-tactile nerve stimulation in men was originally conceived (pun intended) for spinal cord injured patients who desired to father children but were incapable of doing so because of their inability to ejaculate. However, vibro-tactile nerve stimulation is equally effective in inducing erection as well as ejaculation/orgasm in the non-spinal cord injured population and its use has been expanded to the general male population.

The pelvic floor/perineal muscles activate at the time of sexual stimulation, compressing the deep roots of the penis and fostering hypertensive blood pressures in the erect penis in excess of 200 mm, responsible for rock-hard rigidity. Pelvic floor muscle training has been used to bolster the strength, power and endurance of these muscles in order to optimize erectile rigidity and durability. Without well functioning pelvic floor/perineal muscles, full rigidity will not occur.

Oral meds, injection and/or vacuum therapy help prevent erectile tissues from losing elasticity and becoming scarred and less functional from the absence of erections. Similarly, nerve stimulation and pelvic floor/perineal muscle training help maintain the integrity of the erectile tissues as well as help prevent the pelvic floor/perineal muscles from atrophying in the absence of erections.  By keeping the pelvic floor/perineal muscles fit, when erections ultimately do return, function can be optimized.

The combination of nerve stimulation and pelvic floor muscle strengthening is a powerful alliance that is prescribed “prehab” as well as after radical prostatectomy to shorten the time it takes to recover erections. Its merits are its simplicity, safety, efficiency and the fact that it is actually pleasurable to pursue. It does not preclude the use of the traditional rehab program, which can be used in conjunction with the Erection Recovery Program.

Specifically, the Erection Recovery Program consists of the Viberect nerve stimulation device and the Pelvic Rx pelvic floor muscle training program. Viberect, manufactured by Reflexonic, is an FDA-certified hand-held penile vibro-tactile nerve stimulation device that triggers erection and ultimately ejaculation. The Pelvic Rx program, manufactured by Adult Fitness Concepts, is a FDA-registered, comprehensive, interactive follow-along exercise program to increase pelvic floor muscle strength, tone, power, and endurance. Basic Training strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises, while Complete Training provides maximum opportunity for gains via resistance equipment.

Bottom Line: 

The critical principle for erectile recovery is achieving an erection for at least several times weekly during the recovery period after prostate surgeryPenile vibro-tactile nerve stimulation coupled with pelvic floor muscle training is a synergistic combination that promotes initiation and maintenance of erections, respectively. 

This Erection Recovery Program is used prehab (prior to radical prostatectomy) and continued after surgery.  It offers a non-pharmacological option for erection recovery, but can also be used in conjunction with traditional penile rehab programs that use medications.  The Erection Recovery Program is also appropriate for any man who wants to improve sexual function, regardless of the underlying cause.  

To obtain the Erection Recovery Program:

http://www.viberect.com/erection-recovery-program-combo-pack.html

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

5 Things Every Woman Should Know About Her Man’s Pelvic Health

November 28, 2015

Andrew Siegel MD   11/28/15

4910841630_d096720d0d_o (1)

(Attribution: Pier-Luc Bergeron, A happy couple and a happy photographer; no changes made, https://www.flickr.com/photos/burgtender/4910841630)

Since this is Thanksgiving weekend and a broadly celebrated family holiday, I cannot think of a better time to blog about how wives/girlfriends/partners can help empower their men’s pelvic health.

  1. His Erections
  2. Prostate Cancer
  3. Bleeding
  4. Testes Lumps/Bumps
  5. Urinary Woes

 

Erectile Dysfunction: A “Canary in the Trousers”

If his erections are absent or lacking in rigidity or sustainability, it may just be the “tip of the iceberg,” indicative of more serious underlying medical problems. The quality of his erections can be a barometer of his cardiovascular health. Since penile arteries are tiny (diameter of 1-2 millimeters) and heart arteries larger (4 millimeters), it stands to reason that if vascular disease is affecting the penile arteries, it may affect the coronary arteries as well—if not now, then perhaps soon in the future. Since fatty plaque deposits in arteries compromise blood flow to smaller blood vessels before they do so to larger arteries, erectile dysfunction may be considered a genital “stress test.”

Bottom Line: If your man is not functioning well in the bedroom, think strongly about getting him checked for cardiovascular disease. His limp penis just may be the clue to an underlying more pervasive and serious problem.

Prostate Cancer

One in seven American men will develop prostate cancer in their lifetimes and most have no symptoms whatsoever, the diagnosis made via a biopsy because of an elevated or accelerated PSA (Prostate Specific Antigen) blood test and/or an abnormal rectal exam that reveals an asymmetry or lump. Similar to high blood pressure and glaucoma, prostate cancer causes no symptoms in its earliest phases and needs to be actively sought after.

With annual PSA testing, he can expect a small increase each year correlating with prostate growth. A PSA acceleration by more than a small increment is a “red flag.” The digital exam is simply the placement of a gloved, lubricated finger in the rectum to feel the size, contour and consistency of the prostate gland, seeking hardness, lumps or asymmetry that can be a clue to prostate cancer. It is not unlike the female  pelvic exam.

Bottom Line:  As breast cancer is actively screened for with physical examination and mammography, so prostate cancer should be screened for with PSA and digital rectal exam. In the event that prostate cancer is diagnosed, it is a treatable and curable cancer. Not all prostate cancers demand treatment as those with favorable features can be followed carefully, but for other men, treatment can be lifesaving.

Bleeding

Blood in the urine can be visible or only show up on dipstick or microscopic exam of the urine. Blood in the urine should also be thought of as a “red flag” that mandates an evaluation to rule out serious causes including cancers of the kidney and bladder. However, there are many causes of blood in the urine not indicative of a serious problem, including stones, urinary infections and prostate enlargement.

Blood in the semen is not uncommonly encountered in men and usually results from a benign inflammatory process that is usually self-limited, resolving within several weeks. It is rarely indicative of a serious underlying disorder, as frightening as it is to see blood in the ejaculate. Nonetheless, it should be checked out, particularly if it does not resolve.

Bottom Line: If blood is present when there should be none—including visible blood in the urine, blood stains on his undershorts or blood apparent under the microscope—it should not be ignored, but should be evaluated. If after having sex with your partner you notice a bloody vaginal discharge and you are not menstruating, consider that it might be his issue and make sure that he gets followed up.

Testes Lumps and Bumps

Most lumps and bumps of the testes are benign and not problematic. Although rare, testicular cancer is the most common solid malignancy in young men, with the greatest incidence being in the late 20s, striking men at the peak of life. The excellent news is that it is very treatable, especially so when picked up in its earliest stages, when it is commonly curable.

A testicular exam is a simple task that can be lifesaving. One of the great advantages of having his gonads located in such an accessible locale—conveniently “gift wrapped” in the scrotal satchel—is that it makes them so easy to examine. This is as opposed to your ovaries, which are internal and not amenable to ready inspection. This explains why early testes cancer diagnosis is a cinch as opposed to ovarian cancer, which most often presents at an advanced stage. In its earliest phases, testes cancer will cause a lump, irregularity, asymmetry, enlargement or heaviness of the testicle. It most often does not cause pain, so his absence of pain should not dissuade him from getting an abnormality looked into.

Your guy should be doing a careful exam of his testes every few weeks or so in the shower, with the warm and soapy conditions beneficial to an exam. If your man is a stoic kind of guy who is not likely to examine himself, consider taking matters into your own hands—literally: At a passionate moment, pursue a subtle, not-too-clinical exam under the guise of intimacy—it may just end up saving his life.

Bottom Line: Have the “cajones” to check his cajones. Because sperm production requires that his testes are kept cooler than core temperature, nature has conveniently designed mankind with his testicles dangling from his mid-section. There are no organs in the body—save your breasts—that are more external and easily accessible. If your man is not willing to do self-exams, at a moment of intimacy do a “stealth” exam under the guise of affection—it just might be lifesaving.

Urinary Woes

Most organs shrink with the aging process. However, his nose, ears, scrotum and prostate are the exceptions, enlarging as he ages. Unfortunately, the prostate is wrapped precariously around the urinary channel and as it enlarges it can constrict the flow of urine and can cause a host of symptoms. These include a weaker stream that hesitates to start, takes longer to empty, starts and stops and gives him the feeling that he has not emptied completely. He might notice that he urinates more often, gets up several times at night to empty his bladder and when he has to urinate it comes on with much greater urgency than it used to. He might be waking you up at night because of his frequent trips to the bathroom. Almost universal with aging is post-void dribbling, an annoying after-dribble.

Bottom Line: It is normal for him to experience some of these urinary symptoms as he ages. However, if he is getting up frequently at night, dribbling on the floor by the toilet, or has symptoms that annoy him and interfere with his quality of life, it is time to consider having him looked at by your friendly urologist to ensure that the symptoms are due to benign prostate enlargement and not other causes, to make sure that no harm has been done to the urinary tract and to offer treatment options.

Wishing you the best of health and a wonderful Thanksgiving weekend,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

Her Breasts and His Prostate…So Similar, So Mysterious

July 18, 2015

Andrew Siegel MD  7/18/15

prostate breast

(Thank you, Wikimedia, for above image)

The female breasts and the male prostate are both sources of fascination, curiosity, and fear. Hidden deep in the pelvis at the crossroads of the male urinary and reproductive systems, the prostate is arguably man’s center of gravity. On the other hand, the breasts—with an equal aura of mystery and power—are situated in the chest superficial to the pectorals, contributing to the alluring female form and allowing ready access for the hungry infant, curiously an erogenous zone as well as a feeding zone.

Interestingly enough, the breasts and prostate share much in common, both serving important “nutritional” roles. Each functions to manufacture a milky fluid; in the case of the breasts, the milk serving as nourishment for infants and in the case of the prostate, the “milk” serving as sustenance for sperm cells, which demand intense nutrition to support their arduous  marathon journey traversing the female reproductive tract.

Breasts are composed of glandular tissue that produces milk, and ducts that transport the milk to the nipple. The remainder of the breast consists of fatty tissue. The glandular tissue is sustained by the female sex hormone estrogen and after menopause when estrogen levels decline, the glandular tissue withers, with the fatty tissue predominating.

The prostate—on the other hand—is made up of glandular tissue that produces prostate “milk,” and ducts that empty this fluid into the urethra at the time of sexual climax. At ejaculation the prostate fluid combines with other reproductive secretions and sperm to form semen. The remainder of the prostate consists of fibro-muscular tissue. The glandular tissue is sustained by the male sex hormone testosterone and after age 40 there is a slow and gradual increase in the size of the prostate gland because of glandular and fibro-muscular cell growth.

Access to the breasts as mammary feeding zones is via stimulation of the erect nipples through the act of nursing. Access to the prostate fluid is via stimulation of the erect penis, with the release of semen and its prostate fluid component at the time of ejaculation.

Both the breasts and prostate can be considered to be reproductive organs since they are vital to nourishing infants and sperm, respectively. At the same time, they are sexual organs. The breasts can be thought of as accessories with a dual role that not only provide milk to infants, but also function as erogenous zones that attract the interest of the opposite sex and contribute positively to the sexual and thus, reproductive process. Similarly, the prostate is both a reproductive and sexual organ, since sexual stimulation resulting in climax is the means of accessing the prostate’s reproductive function.

Both the breasts and prostate are susceptible to similar disease processes including infection, inflammation and cancer. Congestion of the breast and prostate glands can result in a painful mastitis and prostatitis, respectively. Excluding skin cancer, prostate cancer is the most common cancer in men (accounting for 26% of newly diagnosed cancers with men having a 1 in 7 lifetime risk) and breast cancer is the most common cancer in women (accounting for 29% of newly diagnosed cancers with women having a 1 in 8 lifetime risk). Both breast and prostate tissue are dependent upon the sex hormones estrogen and testosterone, respectively, and one mode of treatment for both breast cancer and prostate cancer is suppression of these hormones with medication, e.g., Tamoxifen and Lupron, respectively. Both breast and prostate cancer incidence increase with aging. The median age of breast cancer at diagnosis is the early 60’s and there are 232,000 new cases per year, 40,000 deaths (the second most common form of cancer death, after lung cancer) and there about 3 million breast cancer survivors in the USA. The median age of prostate cancer at diagnosis is the mid 60’s and there are 221,000 new cases per year, 27,500 deaths (the second most common form of cancer death, after lung cancer) and there are about 2.5 million prostate cancer survivors in the USA.

Both breast and prostate cancer are often detected during a screening examination before symptoms have developed. Breast cancer is often picked up via mammography, whereas prostate cancer is often identified via an elevated or accelerated PSA (Prostate Specific Antigen) blood test. Alternatively, breast and prostate cancer are detected when an abnormal lump is found on breast exam or digital rectal exam of the prostate, respectively.

Both breast and prostate cells may develop a non-invasive form of cancer known as carcinoma in situ—ductal carcinoma-in-situ (DCIS) and high grade prostate intraepithelial neoplasia (HGPIN), respectively—non-invasive forms in which the abnormal cells have not grown beyond the layer of cells where they originated, often predating invasive cancer by years.

Family history is relevant with both breast and prostate cancer since there can be a genetic predisposition to both types and having a first degree relative with the disease will typically increase one’s risk. Imaging tests used in the diagnosis and evaluation of both breast and prostate cancers are similar with both ultrasonography and MRI being very useful. Treatment modalities for both breast and prostate cancer share much in common with important roles for surgery, radiation, chemotherapy and hormone therapy.

In a further twist to the relationship between breast and prostate cancer, a recent study showed that women with close male relatives with prostate cancer are more likely to be diagnosed with breast cancer. Compared to women with no family history of breast or prostate cancer, those with a family history of both were 80% more likely to develop breast cancer.

Breast and Prostate Cancer Myths and Facts

“Only old people get breast or prostate cancer.

Fact: 25% of women with breast cancer develop it before age 50, whereas less than 5% of men with prostate cancer develop it before age 50; however, many men in their 50s are diagnosed with the disease.

“Men can’t get breast cancer and women can’t get prostate cancer.”

Fact: 1700 men are diagnosed with breast cancer with 450 deaths on an annual basis.  Women have structures called the Skene’s glands, which are the female homologue of the male prostate gland. On very rare occasions, the female “prostate” can develop cancer. The Skene’s glands are thought to contribute to “female ejaculation” at the time of sexual climax. 

“All lumps in the breast or prostate are cancer.”

Fact: 80% of breast lumps are due to benign conditions as are 50-80% of prostate “nodules.”  If an abnormality is found, further evaluation is necessary.  

“It’s not worth getting screened for breast cancer because of the USPSTF (United States Preventive Services Task Force) recommendation against routine screening mammography in women aged 40 to 49 years and against clinicians teaching women how to perform breast self-examination.  It’s not worth getting screened for prostate cancer because the USPSTF also recommended against prostate-specific antigen (PSA)-based screening for prostate cancer.”

Fact: In my opinion, the USPSTF has done a great deal of harm to public health in the USA with their recommendations. The goal of screening is to pick up cancers in their earliest stages at times when treatment is likely to be most effective. Not all cancers need to be treated and the treatment can differ quite a bit based upon specifics, but screening populations at risk is a no-brainer.  For breast cancer and prostate cancer–the most common cancer in each gender–it is important to screen aggressively to obtain the necessary information to enable doctors and their patients make sensible decisions, which are individualized and nuanced, depending on a number of factors.

The reader is referred to a terrific recent article in the NY Times concerning screening for prostate cancer: http://www.nytimes.com/2015/07/06/opinion/bring-back-prostate-screening.html

Wishing you the best of health,

2014-04-23 20:16:29

AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in your email in box go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: http://www.MalePelvicFitness.com.  Work in progress is The Kegel Fix: Recharging Female Sexual, Urinary and Pelvic Health.

Co-creator of Private Gym pelvic floor muscle training program for men: http://www.privategym.com—also available on Amazon.

The Private Gym program is the go-to means of achieving pelvic floor muscle strength, tone, power, and endurance. It is a comprehensive, interactive, easy-to-use, medically sanctioned and FDA registered follow-along exercise program that builds upon the foundational work of Dr. Arnold Kegel. It is also the first program designed specifically to teach men how to perform the exercises and a clinical trial has demonstrated its effectiveness in fostering more rigid and durable erections, improved ejaculatory control and heightened orgasms.

Prostate Cancer Screening: What’s New?

February 28, 2015

Andrew Siegel MD 2/28/15

The Dilemma

The downside of screening is over-detection of low-risk prostate cancer that may never prove to be problematic, but may result in unnecessary treatment with adverse consequences. The downside of not screening is the under-detection of aggressive prostate cancer, with adverse consequences from necessary treatment not being given.

The Buck Stops Here

Prostate biopsy (ultrasound guided) is the definitive and conclusive test for prostate cancer. An elevated PSA (Prostate Specific Antigen) blood test or an abnormal DRE (digital rectal exam) are the findings that typically lead to the recommendation for prostate biopsy.

What’s New In Prostate Cancer Screening?

The following are refinements in the screening process that can help make the decision about whether or not to proceed with a prostate biopsy, potentially sparing some from the need to undergo the biopsy and clearly indicating the need for biopsy in others.

  • Free PSA
  • PSA Velocity
  • PSA Density
  • PCA-3
  • Prostate MRI
  • 4K Score

Free PSA

PSA circulates in the blood in a “free” form, which it is unbound and a “complex” form, in which it is bound to a protein. The free/total PSA can enhance the specificity of PSA testing. The greater the free/total PSA, the greater the chances that benign enlargement of the prostate is the cause of the PSA elevation. In men with a PSA between 4-10, the probability of cancer is less than 10% if the ratio is greater than 25% whereas the probability of cancer is almost 60% if the ratio is less than 10%.

PSA Velocity

It is extremely useful to compare the PSA values from year to year. Under normal circumstances, PSA increases by only a small increment, reflecting age-related benign prostate growth. PSA acceleration at a rate greater than anticipated is a red flag that may be indicative of prostate cancer and is one of the most common prompts for undergoing biopsy.

PSA Density

There is a direct relationship between prostate size and PSA, with larger prostates producing higher PSA levels. PSA density (PSA/prostate volume) is the relationship of the PSA level to the size of the prostate. PSA density > 0.15 is a red flag that may be indicative of prostate cancer.

PCA-3 (Prostate Cancer Antigen-3)

PCA-3 is a specific type of RNA (Ribonucleic Acid) that is released in high levels by prostate cancer cells. Its expression is 60-100x greater in prostate cancer cells than benign prostate cells, which makes this test much more specific for prostate cancer than PSA.  PCA-3 is a urine test. The prostate is gently “massaged” via DRE to “milk” prostate fluid into the urethra. The first ounce of urine voided immediately after massage is rich in prostatic fluid and cells and is collected and tested for the quantity of PCA-3 genetic material present. Urinary levels of PCA-3 are not affected by prostate enlargement or inflammation, as opposed to PSA levels. PCA-3 > 25 is suspicious for prostate cancer.

Prostate MRI (Magnetic Resonance Imaging)

MRI is a high-resolution imaging test that does not require the use of radiation and is capable of showing the prostate and surrounding tissues in multiple planes of view, identifying suspicious areas. MRI uses a powerful Tesla magnet and sophisticated software that performs image-analysis, assisting radiologists in interpreting and scoring MRI results. A validated scoring system known as PI-RADS (Prostate Imaging Reporting and Data System) is used. This scoring system helps urologists make decisions about whether to biopsy the prostate and if so, how to optimize the biopsy.

PI-RADS classification Definition
I Most probably benign
II Probably benign
III Indeterminate
IV Probable cancer
V Most probably cancer

4Kscore Test

The 4Kscore Test measures the blood content of four different prostate-derived proteins: Total PSA, Free PSA, Intact PSA and Human Kallikrein 2. Levels of these biomarkers are combined with a patient’s age, DRE status (abnormal DRE vs. normal DRE), and history of prior biopsy status (prior prostate biopsy vs. no prior prostate biopsy). These factors are processed using an algorithm to calculate the risk of finding a Gleason score 7 or higher (aggressive) prostate cancer if a prostate biopsy were to be performed. The test can increase the accuracy of prostate cancer diagnosis, particularly in its most aggressive forms.

(It cannot be used if a patient has received a DRE in the previous 4 days, nor can it be used if one has been on Avodart or Proscar within the previous six months. Additionally, it cannot be used in patients that have within the previous six months undergone any procedure to treat symptomatic prostate enlargement or any invasive urologic procedure that may be associated with a PSA elevation.)

As of now, the test is not covered by insurance and costs $395 from the lab that performs it.

Bottom Line: Excluding skin cancer, prostate cancer is the most common cancer in men (accounting for 26% of newly diagnosed cancers with men having a 1 in 7 lifetime risk). The median age of prostate cancer at diagnosis is the mid 60’s and there are 221,000 new cases per year, 27,500 deaths (the second most common form of cancer death, after lung cancer) and there are currently about 2.5 million prostate cancer survivors in the USA.  It is important to diagnose prostate cancer as early as possible in order to decide on the most appropriate form of management–surgery, radiation, or observation/monitoring (the most common treatment pathways, although there are other options as well).  These refinements in the screening process can help urologists make the decision about whether or not to proceed with a prostate biopsy.  

 

Wishing you the best in health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the inbox of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health:available in e-book (Amazon Kindle, Apple iBooks, B & N Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

Private Gym Male Pelvic Floor Muscle Training  Program: http://www.PrivateGym.com -available on Amazon as well as Private Gym website

 

PSA Absurdity

January 31, 2015

Andrew Siegel MD   1/31/15

Women_Against_Prostate_Cancer_logo

(Image designed  by Abby Cycotte for WAPC)

Prostate cancer is the most commonly diagnosed cancer in males (excluding skin cancers)—paralleling breast cancer in females in many ways—with an estimated 233,000 new cases diagnosed in 2014. Over the latest 5-year period for which data is available, the death rate for prostate cancer decreased based upon improved early detection and treatment. There are 3 million prostate cancer survivors in the USA. The vast majority of prostate cancers are diagnosed by Prostate Specific Antigen (PSA) screening, a simple blood test.

Prostate cancer screening with PSA has been the subject of intense controversy and debate, a controversy that I—as a practicing urologist—don’t quite get. A major backlash against screening occurred in 2012. It started with the United States Preventive Services Task Force (USPSTF) grade “D” recommendation against PSA screening and their call for total abandonment of the test. Of note, there was not a single urologist on the committee. The same organization had previously advised that women in their 40’s should not undergo routine mammography, setting off another blaze of controversy. As a busy clinical urologist for almost three decades, I was deeply disturbed by their recommendation.

In 2013 the American Urological Association (AUA) issued guidelines recommending against PSA testing before age 55, with testing every other year between ages 55-69 and then only after “informed decision making,” a discussion between physician and patient weighing benefits and harms.

AUA Guideline Statements:

  1. Do not screen men under age 40.
  2. Do not screen men age 40-54, unless high risk (family history or African American), in which case decision should be individualized.
  3. Screen men 55-69 after informed decision making.
  4. Screening interval of “two years or more” may be preferred to annual screening to reduce harms of screening.
  5. Do not screen men older than 70 or any man with life expectancy less than 10-15 years, although some men in excellent health may benefit from screening.

When these guidelines came out, I was in disbelief and shock. Why did the AUA—whose mission statement is “to promote the highest standards of urological clinical care through education, research and in the formulation of health care policy”—kowtow on this vital issue?

Further fueling the controversy and confusion is the lack of consensus among professional groups including the European Association of Urology, the National Comprehensive Cancer Network and the Prostate Cancer World Congress. Uncertainty in the lay press has prompted both patients and physicians to question PSA testing and recommendations for prostate biopsy.

Is there really any harm in screening? Screening provides information and there are no side effects aside from whatever complications may ensue from drawing a small amount of blood. There are potential side effects from prostate biopsy (although they are few and far between) and certainly there are potential side effects with treatment; however, it seems that both the USPSTF and the AUA have confused screening with treatment. The potential side effects of active treatment should not influence the diagnosis of prostate cancer by the proper means. “Treatment or non-treatment decisions can be made once the cancer is found, but not knowing about it in the first place surely burns bridges.”—Dr. Jay Smith

I ardently disagree with the assertions of the task force and the AUA. Urologists, radiation oncologists, and medical oncologists (those physicians who are in the “trenches” and take care of prostate cancer on a daily basis) understand how devastating prostate cancer can be and the importance of early detection.

So what has been the upshot of this controversy? What has happened is that instead of proceeding directly to prostate biopsy, many more men with an elevated or accelerated PSA are having repeat PSA testing (often fractionated to determine free PSA/total PSA), the PCA-3 urine test and a prostate MRI. If the regulatory agencies had cost savings on their agenda, they have failed miserably as more testing (that incurs a significant expense) is being done than ever before.

Busy urologists are seeing more and more indecision and equivocation among primary care physicians who are confronted with patients who want screening, but guidelines that suggest that it is not necessary. Despite the USPSTF recommendations and AUA guidelines, urologists are actually seeing more referrals for elevated PSA than ever before.

Hard Facts:

  1. PSA screening has resulted in downward stage migration—detecting prostate cancer in an early and curable stage, before it spreads and becomes incurable. If these guidelines are adhered to, we will most certainly give back the gains we have made and experience a reverse stage migration and a return to the pre-PSA era when up to 20% of men presented with advanced disease.
  2. PSA testing unequivocally reduces metastatic prostate cancer (cancer that has spread) and death from prostate cancer: USA death rates from prostate cancer have fallen 4% annually since 1992, five years after introduction of PSA testing.
  3. Rigid guidelines unfortunately do not allow for a nuanced and individualized approach to early prostate cancer detection. PSA has many shortcomings, but used intelligently and appropriately will continue to save lives.
  4. Baseline PSA testing for men in their 40’s is useful for predicting the future of prostate cancer.
  5. Not permitting men age 40-55 the opportunity for screening denies them the potential to diagnosis a disease that is potentially lethal; this population has a long life expectancy and therefore the greatest need for early diagnosis and curative treatment.
  6. Older men in good health with over a 10-year life expectancy should not be denied PSA testing simply on the basis of their age.
  7. 95% of male urologists and 80% of primary care physicians have annual PSA screening—clearly, those in the know feel that screening is beneficial.
  8. Death from prostate cancer is unpleasant, often involving painful metastases to the spine and pelvis and not uncommonly, kidney and bladder outlet obstruction; our charge as urologists is to try to not let this scenario come to fruition.

When interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging, risk assessment and monitoring of prostate cancer patients. Marginalizing this important test does a great disservice to those who may benefit from early prostate cancer detection.

I have practiced urology in both the pre-PSA era and the post-PSA era. In my early years of training, it was not uncommon be called to the emergency room to treat men who could not urinate, who on digital rectal exam were found to have rock-hard prostate glands and imaging studies that showed diffuse spread of prostate cancer to their bones—metastatic prostate cancer with a grim prognosis. In the post-PSA era, that scenario—fortunately—occurs on an extremely infrequent basis thanks to PSA screening. The vast majority of men who present that way these days are those who have opted NOT to obtain a screening PSA as part of their annual physical exams.

Bottom Line: The downside of screening is over-detecting low-risk prostate cancer that may never prove to be problematic, but may result in unnecessary treatment with adverse consequences. The downside of not screening is under-detecting aggressive prostate cancer, with adverse consequences from necessary treatment not being given. We need to separate screening from treatment and screen smarter.”—Dr. Judd Moul

The major challenge for those of us who treat prostate cancer is to distinguish between clinically significant and clinically insignificant disease and to decide the best means of eradicating clinically significant disease to maintain quantity and quality of life. Not all prostate cancers require active treatment and not all prostate cancers are life threatening. The decision to proceed to active treatment is one that men should discuss in detail with their urologists to determine whether active treatment is necessary, or whether surveillance may be an option, appropriate in selected men with low-risk prostate cancer (low PSA; minimum number of biopsies showing cancer; low-grade cancer as determined by the pathologist). Those at greater risk can be managed appropriately (surgery or radiation) and many cured, avoiding the potential for progression of cancer and painful metastases and death.

“PSA is the best screening test we have for prostate cancer, and until there is a replacement for PSA, it would be unconscionable to stop it. Contrary to the USPSTF report, compelling evidence shows that PSA screening reduces prostate cancer deaths. This evidence needs to be shared with the public.”
–Dr. William Catalona

The Samadi Challenge For Prostate Cancer

Dr. David Samadi, Chief of Prostate Robotic Surgery at Lenox Hill Hospital, has created a challenge to women, since they are the proactive gender in terms of understanding the importance of health risks, screening and routine checkups and are often the driving force in men’s health.  Men are much more reluctant to engage with the health care system than women—particularly preventive health care—and Dr. Samadi sees women playing a pivotal role in encouraging men to focus on prostate health. On a larger scale, he sees women as ideal advocates and champions to help raise global awareness for prostate cancer. The Samadi Challenge involves women learning the risk factors for prostate cancer, improving the lifestyles of the men in their lives, encouraging men to have annual screening and in the case of being diagnosed with prostate cancer, urging men to seek appropriate treatment. Dr. Samadi launched a FaceBook page: “Women for Prostate Health,” a means to help women initiate a conversation about prostate health.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

Co-founder of Private Gym: http://www.PrivateGym.com–available on Amazon and Private Gym website

 

5 Side Effects of Radical Prostatectomy You Don’t Hear Much About

December 27, 2014

Andrew Siegel MD  12/27/14

shutterstock_orange gu tract closeup

Having your prostate removed is a highly effective means of curing prostate cancer. Unfortunately, because of the prostate’s “precarious” location—smack in a busy area at the crossroads of the urinary and genital tracts, connected to the bladder on one end, the urethra on the other end, touching on the rectum, and nestled behind the pubic bone in a well-protected nook of the body—it’s removal has the potential for causing some unwanted and undesirable side effects.

Trauma to nerves, blood vessels, and muscular tissue during surgery can potentially compromise sexual function and urinary control. Generally, patients are informed about ED, urinary incontinence, the possibility of the surgery failing to cure the cancer and the risk of rectal injury. However, there are other possible complications that may affect your sexual quality of life that are often glossed over, perhaps because they are not considered that important in the grand scheme of cancer care.

Note that there are many men who undergo radical prostatectomy and experience absolutely no complications whatsoever, achieving “trifecta” status: a PSA (Prostate Specific Antigen) that is undetectable, full urinary control and intact erectile function. A small percentage of men experience significant urinary incontinence whereas many men will experience mild urinary incontinence. Many men note a decline in their ability to obtain and maintain an erection after the radical prostatectomy. What about the side effects that often go less mentioned?

Additional sexually related side effects that may occur including the following:

  • Ejaculation of urine at the time of sexual climax
  • Urinary leakage with sexual stimulation
  • Altered sensation of climax
  • Pain with climax
  • Penile shortening and deformity

 

Ejaculation of Urine at Sexual Climax

After radical prostatectomy, ejaculations are typically “dry” because of the removal of the structures that supply the contents of the ejaculate: prostate gland, seminal vesicles and the clipping of the sperm ducts. However, some men after radical prostatectomy may ejaculate urine at the time of sexual climax. This can be a nuisance and embarrassment to both the patient and his partner. This problem is most prevalent during the first year after prostatectomy and tends to improve with time.

Coping strategies are urinating before sex and/or using a condom or constrictive penile loop that pinches the urethra closed. Pelvic floor muscle training can strengthen the levator ani muscle, which contributes strongly to the voluntary urinary sphincter.

Urinary Incontinence at the Time of Sexual Stimulation

Urinary leakage is not always restricted to the moment of ejaculation as some patients can have it with foreplay. Once again, this is a potential bother and embarrassment to both patient and partner. Like ejaculation of urine, this issue is most commonly experienced during the first year after radical surgery and thereafter tends to improve.

Altered Sensation of Climax

Most men after radical prostatectomy will experience an altered perception of climax. Some will experience diminished pleasure, often with a feeling of diminished intensity of orgasm. Some are bothered by the dry climax. On occasion, one loses the ability to climax. In rare instances, a patient after radical prostatectomy will notice an increase in orgasm intensity.

Pain With Climax

Up to 20% of men after radical prostatectomy will experience discomfort or pain with climax, which is often perceived in the penis, testes or the rectum. With time both the intensity and frequency of pain usually decrease, although a small percentage of men will have persistent pain that persists beyond several years following the surgery.

Penile Shortening and Deformity

After radical prostatectomy, it is common to experience an alteration in penile size with a decrease in flaccid length, erectile length and erectile girth. The loss in penile length occurs during the first several months after the radical prostatectomy and whether the situation is reversible seems unlikely.

The shortening is likely based on factors including loss of urethral length, nerve and blood vessel damage and the presence of erectile dysfunction with its associated “disuse atrophy.” Lack of regular erections results in less oxygen delivered to the penile smooth muscle and elastic fibers with subsequent scarring and hence shortening.

The solution is to resume sexual activity as promptly as conceivable after surgery, pursuing “penile rehabilitation” to help avoid disuse atrophy. Pelvic floor exercises, oral medications of the Viagra class, the vacuum suction device, and penile injection therapy have proven to be helpful.

Up to 15% of men after radical prostatectomy will experience a penile deformity resulting in what appears to be a “waistband” or alternatively a penile curvature with erections.

Bottom Line: The potential sexual side effects from radical prostatectomy aside from ED may be bothersome and adversely affect one’s quality of life.

Reference: Frey AU, Sonksen J, Eode M: Neglected Side Effects After Radical Prostatectomy: A Systematic Review. J Sex Med 2014; 11:374-385

 

Wishing you the best of health and a peaceful upcoming 2015,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

6922

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

Private Gym: http://www.PrivateGym.com -available on Amazon as well as Private Gym website

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to properly strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic strength and tone. This FDA registered program is effective, safe and easy-to-use: The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximum opportunity for gains through its patented resistance equipment.