Monday, March 3, 2014

SELECT Study and Prostate Cancer

In 2001 the Selenium and Vitamin E Cancer Prevention Trial (SELECT) was initiated to determine if selenium or vitamin E would decrease the risk of prostate cancer.  In 2008, the study was stopped early (planned to cease in 2012) because the results demonstrated that there was no protective effect from selenium and suggested that vitamin E increased prostate cancer risk by 17%.

Vitamin E, found in vegetables, nuts, and eggs acts as an antioxidant.  Selenium does the same and is found in meat.  These are thought to prevent the effects of oxidation on fat cells, which are thought to increase mutations that can become malignant.

Currently, the evidence from the trial suggests the idea that the risk of prostate cancer may be increase by these supplements.  Currently, as published in the Journal of the National Cancer Institute, these supplements not only appear not provide protection, but may possibly increase the risks of prostate cancer.

In reality, patients looking to prevent prostate cancer should not start these medications, and then confer with their physicians prior to attempting any new dietary changes. 

"Men using these supplements should stop, period. Neither selenium nor vitamin E supplementation confer any known [health] benefits — only risks," said lead author Alan Kristal, DrPH, from the Fred Hutchinson Cancer Research Center in Seattle, in a press statement.

Tuesday, November 26, 2013

Shockwave Therapy for Erectile Dysfunction

In my practice I see both a high number of patients suffering from kidney stones and from erectile dysfunction.  Shockwave therapy, or ESWL, is a therapeutic method of fragmenting renal stones using ultrasound to initiate stone passage with decreased pain.

In a new study, a similar method of treating erectile dysfunction has been proposed.  ESWL has been shown to induce blood vessel formation and increased flow post-therapy.  In theory, using the same therapy to induce improved blood flow to the penis may correct erectile dysfunction.

While only a novel study at this time, over a several week course that involved two treatments per week, 15 men showed improved erectile function.  These participants were selected as they had cardiac-disease induced erectile dysfunction (ie. not related to surgery, etc.).  The same patients responded to the oral therapies currently on market for erectile dysfunction.

At 1 month of follow up the same men not only noted improved erectile function, but also no longer required the same medications for intercourse.  Furthermore, in 10 of the men, this effect was sustained for a year.

I find this therapy to be quite interesting, and should this hold up in further research, may be a groundbreaking improvement in treatment of this disease. 

Saturday, November 16, 2013

Stephen Colbert Prostate Exam

In honor of Movember and prostate cancer awareness, Stephen Colbert performed an on-air prostate exam.  Nashville band The Black Keys joined Stephen, John Lithgow, and Katie Couric during his exam last week.  Check out the link below for the video.

Stephen Colbert Prostate Exam

Wednesday, October 30, 2013

Chronic Testicle Pain

Orchialgia, commonly known as testicular pain, is a frustrating condition for both patients and urologists.  Present in all age groups, this condition can be quite limiting and can lower one's quality of life.

Common causes of this discomfort including recurrent urinary tract infections, epididymitis, and varicoceles. 

An initial evaluation should include a urine culture and a scrotal ultrasound to rule out other pathology.  In an infection is present, several weeks of antibiotics may be required to penetrate the tissue of the epididymis to cure infection.  Further therapy via conservative methods with sitz baths, scrotal support,  and nonsteroidal anti-inflammatory agents (ibuprofen, Aleve) are typically employed with success.

With post-vasectomy pain, orchialgia can be common.  This occurs in approximately 1 in 1000 men and is linked to pressure build up in the epididymis as sperm continues to be produced.  This pain can be dull with exacerbation from ejaculation.  The first treat should be the above conservative measures for 3 months.  Should these fail, vasectomy reversal or removal of the epididymis (epididymectomy) are considerations.

In men with pain post-hernia, the treatment can be more difficult.  Many times the ileoinguinal nerve will be entrapped post-hernia repair.  In this condition, conservative methods will allow for resolution.  If not, exploration and removal of any material may offer relief.

Finally, the most frustrating orchialgia is that of unknown etiology.  Without a specific cause, treatment can be quite difficult.  Again, conservative measures should be introduced for 3 months.  At the same time, consideration of alternative sources of discomfort (irritable bowel, ureteral stones, etc.) should be explored.  In these conditions, I have found success with addition of pelvic muscle physical therapy.  Finally, should all other measures fail, use of nerve blocks and microsurgical denervation of the genitofemoral nerve is considered.

Monday, September 30, 2013

Child's Play

Even a 6 year old can use the robot.  Come try for yourself at the October 20th Tennessee Titans game.  We will have robot in the Fun Zone.

Monday, September 9, 2013

Omega-3 Fatty Acids and Prostate Cancer: Is There Cause for Fear?

In July 2013 a study was published in the Journal of the National Cancer Institute linking elevated blood levels of omega-3 fatty acids to prostate cancer development.  As you would expect, any such announcement would be met with both anxiety and concern.  In order to discuss this in greater detail let's look into how the study was performed.

The data was gathered from the SELECT trial (2001), which originally was started to determine if selenium or vitamin E could reduce prostate cancer development; neither of which was the case.  The authors of the current study used blood sample information from SELECT and compared this to the rate of prostate cancer development.  They found that patients with elevated levels of omega-3 fatty acids had a 43% higher risk of developing prostate cancer, and a 71% higher chance of developing high-grade (more fatal) prostate cancer.

What is important to realize is that this study was not a randomized attempt to determine if omega-3 fatty acids increase the risk of prostate cancer.  Multiple studies have been done without this being shown.  Furthermore, the statistical difference between the control group and the study (fatty-acid group) was 0.2%.  Whether this was meaningful in the real world is not yet known.

In addition, whether this level difference was due to use of dietary supplements was unknown as this was not asked during the study.  Were these men eating more fish, using supplemental pills (and what type or dose), or is there an unknown factor?

Therefore, the story is still incomplete.  Omega-3 fatty acids are essential nutrients -- meaning that we must get them from our diet as we cannot produce them.  Evidence exists that they promote cardiovascular health and cognitive function and higher levels have been associated with reduced risk of death from all causes. 

As a result, I recommend we promote a well-rounded diet.  If you can eat without needing supplements you can likely obtain all the nutrients you need without assistance.  Obviously, this is an area in need of much study which I suspect will be coming.