American men are good at a lot of things but taking care of their health is not one of them.
Only about half as many men as women have a regular physical exam, and men account for 30 percent fewer doctor visits each year than women — even when you factor out prenatal visits.
Men are almost twice as likely to die from heart disease. The incidence of stroke is 19 percent higher for men. Significantly more men than women are diagnosed with AIDS each year. Fifty percent more men die of cancer.
Although the incidence of depression is higher among women, men represent 80 percent of all suicide cases and are 43 percent more likely to be admitted to a psychiatric hospital.
Prostate cancer is the most frequently diagnosed cancer among men, accounting for 36 percent of all cancer cases. An estimated 180,000 men will be newly diagnosed with prostate cancer this year, of which 37,000 will die.
These statistics, coupled with his own early diagnosis of prostate cancer from a PSA lab test, prompted U.S. Rep. Randy “Duke” Cunningham (R-Calif.) to introduce legislation to establish an Office of Men’s Health in the Department of Health and Human Services. (An Office of Women’s Health already exists at the NIH.) The bill (H.R. 4653), which was introduced late last year, died in committee.
However, a spokeswoman from Cunningham’s office said he is reintroducing the bill in 2001 and plans to make it a priority on his legislative agenda. Sen. Strom Thurmond (R-S.C.) has introduced an identical bill (S.2925) in the Senate.
It will take more time than the next Congressional session to make a dent in this country’s “tough guys don’t feel pain” boys-to-men socialization process, but an Office of Men’s Health might be a start. In fact, anything that helps educate and motivate men to seek medical testing and treatment earlier would be much appreciated by those of us with brothers, fathers, sons, husbands, boyfriends and friends.
— Coleen Curran
Controversies continue to surround prostate cancer
Prostate cancer and its causes, diagnosis and treatment seem to be a lightening rod for controversy. Last February, in our Men’s Health section, we spoke with Dr. William Catalona, M.D. of the Washington University School of Medicine in St. Louis, about the controversy over screening for prostate cancer. Catalona and many other urologists, who diagnose and treat men with prostate cancer every day, support more widespread screening of men while others in the medical community do not.
Those in opposition say that available tests are unreliable, providing a high number of false positive results. They note that too many men undergo needless and expensive biopsies that put them at risk for serious complications such as incontinence and impotency.
In February 2000, the American Urological Association came out with new practice guidelines for treating potential prostate cancer patients.
The AIU policy recommends that all men who have at least a 10 year life expectancy should be offered regularly scheduled prostate cancer testing starting at age 50. Physicians should consider a biopsy to confirm a prostate cancer diagnosis when a prostate specific antigen (PSA) level is at least 4.0 ng/ml or when the PSA level of a patient significantly increases from one test to the next or a digital rectal exam (DRE) is abnormal.
The policy further states that PSA testing detects more prostate cancers than DRE, and it detects them earlier, but the two procedures should be used in conjunction with each other.
In 2000 the FDA approved two new tests that increase the chances for an accurate diagnosis.
The free PSA test, produced by Beckman Coulter of Fullerton, Calif., as an adjunct to the total PSA test, gives physicians a ratio to help pinpoint those out-of-range total PSAs in the “gray” zone that really are prostate cancer. By doing this, it helps eliminate unnecessary biopsies. For example, a man with a total PSA of 10 or higher has a 60 percent chance of prostate cancer, while a man with a total PSA less than 2.5 has almost no chance of having prostate cancer. But for those in between 2.5 and 10 ng/ml, the diagnosis isn’t so easy. If two men each have total PSAs of 4 and one has a free PSA greater than 25 percent and the other has a free PSA of less than 8 percent, these men have two very different odds that a biopsy will show prostate cancer. For the first man, the odds are 8 percent, while the odds for the second man is 60 percent.
Recently, a second test to help refine the accuracy of a prostate cancer diagnosis came on the market. The complex PSA test, made by Bayer Diagnostics of Tarrytown, N.Y., determines the percent of PSA complexed to other molecules (cPSA). PSA can be complexed to any of several enzyme inhibitors. There is considerable evidence that the percent of cPSA is higher in men with prostate cancer.
While the debate over prostate cancer screening may be lessening due to more precise testing methods, other issues are taking its place.
Recent research by England’s Imperial Cancer Research Fund charity found links between higher prostate cancer incidence and eating a diet high in animal fat. Previous studies noted lower prostate cancer risk among men who lived in countries with a low per-capita consumption of meat and dairy products.
“We knew that daily meat consumption triples the risk of benign prostate disease, regular consumption of cow’s milk doubles it and failure to consume vegetables almost quadruples it,” said Neal D. Barnard, M.D., author of Foods That Fight Pain. “And a major 1997 review specifically linked the consumption to prostate cancer risk.”
The new study measured IGF-I biomarker levels in 696 British men and found that they were 9 percent lower in vegetarians who consume no animal products. IGF-I, or Insulin-like Growth Factor, is apparently an important stimulator of cancers including prostate.
With all the evidence linking meat eating and milk drinking to prostate cancer, the People for the Ethical Treatment of Animals (PETA) couldn’t resist launching a new ad campaign/publicity stunt that makes fun of the National Dairy Council’s popular “Got Milk?” advertisements. A PETA billboard, which featured New York City Mayor Rudolf Guiliani with a milk mustache and the headline, “Got Prostate Cancer?” was rejected by advertisers in New York City but erected in Lancaster County, Pennsylvania.
“The only positive aspect of the PETA ad is that it focuses attention on prostate cancer,” said Judd W. Moul, M.D., director of the Department of Defense Center for Prostate Disease Research. “Unfortunately, it is not appropriate to take advantage of a prostate cancer survivor, as PETA has done. Mayor Guiliani has done good things for the cause of fighting prostate cancer by being public about his illness.”
With better information about its causes and more accurate lab tests to pinpoint its diagnosis, prostate cancer may soon lose its spot as the third most common cause of cancer deaths among men.
| Testosterone patch may improve angina in men
An English study suggests that some men with chronic stable angina are relieved from chest pain when taking low doses of the male hormone, testosterone. The study, performed by researchers from Royal Hallamshire Hospital in Sheffield, found that men with angina, who wore skin patches that delivered small daily doses of testosterone, exercised pain-free longer and felt better overall than those on a non-medicated patch. Researchers know that sex hormones play a role in heart disease risk largely because women experience much higher heart disease rates after menopause when estrogen levels drop. However, the bad news for men is that testosterone is widely believed to be bad for the heart. Katherine M. English, MBChB, MRCP, one of the study’s researchers noted that athletes who use anabolic steroids or synthetic hormones are at greater risk for sudden cardiac death, suggesting that high levels of male hormones are related to bad news for the heart and/or blood vessels. In a departure from the common thinking about testosterone, the study suggests that testosterone can improve angina symptoms by relaxing blood vessel walls, allowing more blood to reach the heart. The study authors noted that the testosterone contributed to feelings of “well-being” in patients and that the testosterone patches did not appear to contribute to the risk of prostate cancer among study participants. Some studies have indicated that male hormones may contribute to prostate gland cancer. In an interview with WebMDHealth.com, English said that the men in the study had low or borderline levels of testosterone, and when it was restored to normal levels, they felt better, had more strength and were in a better mood. The one year (1998-99) study screened 61 men with coronary artery disease. Of those, 22 were treated while 24 took placebo treatment. Of the three patients who withdrew from active treatment, one suffered a myocardial infarction, one had a severe skin reaction and one had an elective coronary angioplasty performed earlier than expected. Not only does low-dose testosterone therapy appear to produce improvements in myocardial ischemia, according to the study but participants showed improvements in pain perception and physical problems. This suggests that the measured effects on myocardial ischemia were affecting quality of life. The researchers also noted the study was designed only to measure the response to treatment, not to examine the mechanism behind any change. Therefore, their suggestion that testosterone may act via a selective coronary vasodilatory action is “speculative” and requires further study. |
