What Men Need to Know About Prostate Cancer

Since 2003, the Movember Foundation has spent the eleventh month of every year raising awareness for a variety of men’s health issues. In that time, over £400 million has been raised and gone into the funding of over 1,000 different projects looking into issues such as testicular cancer, mental health and prostate cancer.

Prostate cancer is the most common cancer in men in the UK; around 40,000 new diagnoses are made every single year. Though the survival rate for prostate cancer is good (around 84% of men will survive for ten years or more), it’s still a huge health concern for British men. Diagnosis can often be delayed for many years, as symptoms do not always develop in the disease’s early stages, and those who survive can be affected by a number of unpleasant side effects.

In honour of Men’s Health Awareness Month, we’ve put together a guide to prostate cancer. If you’re concerned about your prostate health, or the prostate health of someone you love, read on.

The Causes of Prostate Cancer

No one precise cause for prostate cancer has been established, but there are some risk factors to be aware of. These include:

• Age: the older you get, the more likely you are to develop prostate cancer (most cases occur in the over-50s)

• Family history: having close family members who suffered from prostate cancer can be a risk factor

• Ethnicity: if you are of Afro-Caribbean or African descent, you have an increased likelihood of developing prostate cancer

• Lifestyle: if you are obese and/or you don’t exercise regularly you are more likely to develop prostate cancer

Lowering your Risk of Prostate Cancer

While you cannot alter your age, family history or ethnicity, knowing that you are high-risk for prostate cancer will typically help with early diagnosis (in the event that you develop the disease).

Men who are not of African descent and who have no family history of prostate cancer may want to speak to their GP about their risk once they hit 50. Men who are of African descent, or who have a family history of prostate cancer, should usually start to talk to a doctor about their risk a few years earlier – normally at around 45. Early diagnosis will usually make treatment easier and more successful.

To mitigate your risk you can also try practising a healthy lifestyle. Try to take regular exercise (the NHS recommends 2.5 hours of moderate exercise, or 75 minutes of more vigorous exercise a week, as well as strength exercises two days a week) and eat a healthy, balanced diet that is low in saturated fat, sugar and salt.

Symptoms of Prostate Cancer

Prostate cancer doesn’t always cause symptoms in its early stages, but it’s still a good idea to familiarise yourself with some of the indications of the disease. Symptoms can include:

• Needing to urinate more frequently, particularly during the night

• Difficulty in beginning to urinate, and maintaining urination

• Weak flow of urine

• Feeling that your bladder has not totally emptied when you have finished urinating

These symptoms do not necessarily point to cancer – many men experiencing trouble urinating as they get older, often as a result of benign enlargement of the prostate – but it's worth visiting a doctor.

When prostate cancer spreads it can cause other symptoms such as loss of appetite, testicular pain, unexplained weight loss, and pain in the back. Again, none of these symptoms is specific to prostate cancer, but you should visit your doctor if you are experiencing any of them.

Diagnosing and Living With Prostate Cancer

Diagnosing prostate cancer can be tricky, and normally involves a few different tests. You will usually have to give a urine sample, a blood sample, and have your prostate examined by the doctor.

Treatment will depend upon the nature of the cancer, and your age and general health. In some cases, living with prostate cancer will require the treatment of the disease’s side effects.

The good news is that our understanding of prostate cancer is improving all the time, and that there are many resources available to support men with the disease. Learn more by visiting Prostate Cancer UK or talking to your doctor.

The quest for a trustworthy male contraceptive continues but despite some innovative ideas and some ground-breaking medical discoveries, have we really come any closer to finding something that really will work?

The latest in a long list of potential male contraceptives is the testosterone injection. The testosterone is administered via injection into the buttocks and needs to be injected on a monthly basis. When the body detects too much testosterone in the system then it stops the production of sperm. A two year trial was carried out in China and 1,000 men participated. It was reported that 95% of pregnancies were prevented but it this good enough?  The female contraceptive pill is 99% effective at pregnancy prevention and that 4% risk is probably not worth taking – especially when it involves a monthly intramuscular injection.

It says it all really that one third of the participants dropped out before the trial had even been completed and this was seemingly down to the hassle of having to have an injection every month. Furthermore, some of the men were anxious over known potential side effects such as changes to mood, a decrease in sex drives and skin problems like acne. This injection might be more hassle than it’s worth especially considering its mere 95% prevention rate.

Other pills being developed and researched presently include a paralysing pill which temporarily paralyses certain muscles of the reproductive system in males and results in a dry ejaculation where no fluid is released. In addition, ultrasound blasts that could offer up to 6 months of sperm free testes and as discussed in a recent blog, scientists are still working on the gene, Katnal1, which could potentially help them to create the first ever non-hormonal male contraceptive.

Then there is the 10 year contraceptive which blocks the vas deferens with a coating of gel which breaks the membranes of sperm cells rendering them unable to fertilise an egg but just how safe and effective these contraceptives will prove to be when the time comes remains to be seen. The study in China has definitely not got us excited about the male contraceptive but we’ll keep this blog updated regularly in the event of a ground-breaking development.

It is an observed phenomenon that people tend to put on weight when they get old. This is normally related to a change in the production of hormones by the body. In men, testosterone levels reduce with age and the reduction in testosterone is associated with a gain in weight. Obese men quite often have low levels of testosterone.

We have seen a study that has been trumpeted in the medical press about injecting obese men with slow release testosterone, with a gradual reduction in weight and fatty mass being observed. These results do not particularly surprise us but it is the only long term study that we have seen. The patients were treated over a 5 year period and the average weight loss over that period was 13%.

The form of testosterone that was injected was testosterone undecanoate – this is available in the EU but we do not prescribe it as it really should be done in a face to face environment. We would also recommend that an androgen profile is done before this medication is prescribed.

There has been talk over the years about the possible production of the male contraceptive pill but recent studies show that we are getting closer to a discovery. Since the identification of a specific gene that stymies the late development of sperm in the testes, researchers have been excited about the first ever non-hormonal contraceptive treatment for men.

The gene has been identified as Katnal1 and where the gene’s function is disrupted, the sperm that await fertilisation in the testes are not released. The drug does not hinder sperm development in the early stages of development, meaning that the effects of the drug on sperm production can be reversed when the medication dosing is ceased.

Overall, this is an exciting development for men, women and for sexual health. Halving the responsibility in this way in terms of birth control will be a major development regarding contraceptive use. The gene has been identified and now a way to target the gene in human beings needs to be researched in order to progress with the development of a non-hormonal male contraceptive pill.

The Online Clinic are now prescribing treatment for Thrush, a fungal or yeast infection that both men and women can suffer from and can recur.  We are happy to treat those who have been diagnosed with the infection before and are familiar with the symptoms when they recur.

We now prescribe Fluconazole and it can be purchased online after a medical consultation has been filled out and a patient has been approved for treatment. Fluconazole is an oral treatment in the form of a capsule. Only one capsule is required to treat the infection. Symptoms will disappear within a period of 10 days. We are also prescribing Gyno-Daktarin cream and pessaries for women.

All of our treatments are available for next day delivery once orders are placed between Monday to Friday and before 4pm.

You can get your thrush treatment by clicking here.

The NHS information website is gushing over the health benefits of love and sex and there is no better day of the year to indulge than on Valentine’s Day. According to the experts, the act of hugging will lower blood pressure and this is according to an experiment which was carried out in order to gauge the effects of hugging on stress. Couples who held one another’s hands and then hugged for 20 seconds were physically better able to handle stressful situations experienced after the periods of hugging.

Love is definitely in the air this Valentine’s Day, with sales of Viagra, Cialis and Levitra up around 86% over the last few days.

During sexual activity, the heart gets a work out too and the heart rate reaches its peak during an orgasm. We are not suggesting that this light exercise replace the 150 minutes of exercise that are recommended we partake of on a weekly basis. Furthermore, this energetic activity also boosts the immune system and some studies suggest that there is a strong correlation between how often you engage in sexual activity and the strength of your immune system.

Men who feel secure in love and are in a loving relationship have less risk of developing angina and ulcers. The NHS suggests this Valentine’s Day that we put the theory into practice. People certainly seem to be taking this to heart as our prescriptions for Viagra, Cialis and Levitra are up around 86% over the last few days as men prepare for a romantic evening.

There was talk of a Viagra condom not so long ago but now Durex has announced the potential marketing of their own condom that is intended to assist men who have difficulty maintaining an erection while wearing a condom. The patented formula inside the condom is Zanifil gel.

The gel is held at the tip of the condom and is absorbed into the skin rapidly and aids blood flow. The key ingredient, nitroglycerin, has been used for treating chest pain and heart failure for over a century. This nitroglycerin widens blood vessels by relaxing the muscles lining the walls.

The product will not be a treatment for erectile dysfunction but will be used by healthy men to heighten sexual pleasure and can be purchased without prescription.

The drug is manufactured by Futura, a British company and the product so far is known as CSD500 although we can expect a more glamorous name to appear for marketing purposes.

In clinical trials, participants used the condom as they would a regular condom and improvements in erection and penis size were noted. Many women reported that the condom made sexual activity longer lasting.

This project look set to enjoy success and will be geared specifically towards men who find it difficult to maintain an erection while wearing a condom. Additionally, the condom will hopefully mean that more men will wear condoms and perhaps contribute to a decrease in rates of sexually transmitted infections.

According to a new survey commissioned by MHN (Men’s health network), 70% of men find it easier to look after their cars than they do their health. Men tend to ignore symptoms for illnesses that they could easily treat and will experience these symptoms for 6 months to a year before seeking medical help.

MHN partnered up with Abbott Laboratories and rounded up 501 men between the ages of 45 and 65 years and their spouses. The study’s author conceded that men are taught by society to be tough in the face of illness and physical pain but doctors say that this is not acceptable and that after 40 years, men do not have the choice to ignore telling symptoms.

It is recommended that men have an annual check-up which includes a cholesterol check, blood pressure test, hormone level tests and prostate and testes examinations. Men pop pills for erectile dysfunction (ED) without viewing the condition as a symptom of another possible cardiovascular related condition. It is also known that erectile dysfunction can be an indication of a future suffering from heart disease and in cases this can develop 3 to 5 years after ED commences.

Men need to have their own MOT especially as they get older. Chest pain, body hair loss and ED are some of the symptoms that require an examination and those who suffer from obesity, diabetes, asthma and HIV are at even greater risk.

Scientists have warned that men with high cholesterol and those who smoke may be risking their life span being cut short by ten years compared to their healthy counterparts.

The study, which was based in the UK, showed that men with unhealthy lifestyles could be seriously curtailing their life expectancy. The researchers from Oxford University examined data taken from 19,000 civil servants aged between 40 and 69 and then followed them to discover what happened to them over 30 years later.

They discovered that there were three risk factors that had a serious impact on how long they lived, which were: high blood pressure; high cholesterol; and whether or not they smoked. All three are strongly associated with the lifestyle choices people make, as both high cholesterol and high blood pressure are often caused by an unhealthy diet and lack of exercise.

Published in the British Medical Journal, the study was originally set up in the late 1960s, a period when vascular heart disease was rife. The civil servants had their heaight, weight, blood pressure, cholesterol and blood glucose measures taken and were then asked about their lifestyle and medical history.

When they were traced in 2005, 13,501 of the volunteers had died. The scientists discovered that there was a 15 year life expectancy difference between the 5% with the lowest risk factors and the 5% with the highest risk factors.

The team said that their findings showed that men aged 50 with the three risk factors could expect to live to 74, which those with no risk factors were likely to survive until 83. They added that men who took steps to reduce the risk factors in their life, by attempting to lower their blood pressure and cholesterol and stop smoking, could expect to significantly prolong their lives.

Men tend to get a bad rap in the media. Joe Blogs is often depicated as a beer-chugging, X-Box playing slob who loves curry, loves boobs and blondes. And cars and hilarious ‘pranks’ involving petrol and singed eyebrows.

Looks like those stereotypes have just been thrown on their head, as Men’s Health became the best-selling magazine in the sector for the first half of 2009. FHM had been the best-selling title for the past 13 years, but it seems today’s men are becoming increasingly health conscious.

Staff at Men’s Health have put the rise in sales down to the new ‘hetropolitan’ man, who prefers to read about ways to keep in shape rather than the more raunchy subject matter covered by FMH, Zoo and Nuts.

The deputy editor of the monthly magazine Mike Shallcross said that the new breed of male chooses ‘solid, actionable advice’ about health, nutrition, mental health and fitness over ‘topless Hollyoaks girls’ or expensive clothes.

Speaking to the Guardian newspaper, Mr. Shallcross said that the stereotype of his magazine – obsessed with body building and read by teenage boys desperate to bulk up – was outdated. He describes the content as taking a ‘holistic’ approach to health, covering many different aspects of fitness and wellbeing.

The changing tastes and priorities of the British man were further proved by the fact that two weekly magazines at the raunchier end of the magazine scale, Nuts and Zoo, have seen sales fall by 25% and 31% respectively.

British scientists have developed a topical spray that could help men suffering from premature ejaculation and enable them to prolong their time to climax after penetration. The clinical trials have indicated that the spray may prolong erections from seconds to up to nearly four minutes.

Of the 300 men who took part in the trials, 90% reported that there was a marked improvement in their sexual performance and most graded the product as “excellent”. The man who led the study, Professor Wallace Dinsmore of the Royal Victoria Hospital in Belfast, is extremely pleased with the results. “The spray improved sexual performance and satisfaction and was well tolerated by both patients and their partners, with no systemic side effects."

The results come from the last stage in the clinical trials, which means that the spray could be on sale within two years. Once that happens, it is likely it will sell extremely well, as it is believed up to 40% of men suffer from this condition.

A couple of months ago we reported on The Online Clinic blog about the growing number of young men in the Western world who are turning to Viagra because they feel inadequate in regards to their sexual performance. The study, which was carried out in Ireland, suggested that many of these insecurities were the result of young men feeling that women today were more sexually demanding than in previous generations, though of course who is to know? Whether or not this is a global phenomenon is unknown and it has to be noted that different cultures will invariably have differing opinions on the subject.

Another issue that is inextricably linked to these insecurities is that of premature ejaculation. Though often a cause of great distress and embarrassment to men who suffer with the condition, it is often treated as little more than a joke or an inability to perform sexually. How exactly ‘premature’ is defined is, of course, extremely subjective. If reports of the marathon sex sessions of Sting and his wife Trudi Styler are to be believed then anything short of twelve hours is premature!

Experts disagree on the definition of ‘premature’ and probably always will. In May, the International Society for sexual Medicine suggested that coming to orgasm within sixty seconds of having sex could be deemed premature. It also added the proviso, however, that there had to be a feeling of embarrassment or distress for it to meet the definition, again highly subjective and reactive terms and hardly ‘scientific.’

A study of 200 Dutch men, however, has shown that men who suffer from premature ejaculation might do so as a result of their genetic make-up. The scientists found that men who climaxed too soon were twice as likely to have a particular version of a gene that controls the hormone serotonin - the so called ‘happy hormone’. As a result of these findings scientists are now developing drugs to control the levels of serotonin in the brain as a treatment for premature ejaculation. But don’t hold your breath – a licensed product will be many years away!

On The Online Clinic blog last week we reported that most of the British men questioned in a survey on Erectile Dysfunction were unaware that forty percent of them would suffer from the condition at some point after the age of forty. It is not a particularly surprising fact. Unless men go out of their way to research health issues in the media, either printed or on the internet, they are probably not going to going to be particularly well informed about the various health risks which may occur at certain ages. So nothing revelatory there then!

Perhaps more surprising was the answer given to men’s major health concern after the age of forty - hair loss. Then again, perhaps not! Hair loss has always been something of a joke in this country. We laugh at men with ‘comb-overs’, that desperate attempt to make a few strands of hair cover a bald scalp. Neil Kinnock was told to ditch his to be taken more seriously and the Rab C Nesbit actor became iconic in the Hamlet photo booth commercial attempting to cover his bald pate before the camera flashed. Of course, he failed every time.

Conversely, bald men have often been held up as sex symbols embodying virility and manliness. Men like Patrick Steward  (Star Trek’s Captain Jean Luc Picard) and Telly Savalas, in his day, are held up as sex symbols as a result of their lack of locks. Indeed Yul Brynner only became a star when he shaved his head to hide his pattern baldness.

Why then do we not allow men the right to worry about losing their hair? Many men find the experience traumatic. It knocks their self-confidence and makes them feel less attractive, hardly a laughing matter. If men want to take Propecia, a highly effective hair loss treatment, have a hair transplant or even to hang upside down from a bar (apparently it increases blood supply to the follicles) then surely that is their prerogative. Women have makeup and hair and beauty treatments to enhance their looks are men not entitled to preserve their assets too?

The most aggressive form of prostate cancer affects up to 10,000 men in the United Kingdom every year. This particular form of the disease is also the most deadly as it is resistant to the chemotherapy that is currently available. The typical life expectancy following treatment is only eighteen months. Prostate cancer is the most common cancer among men.

It was, therefore, with great anticipation that a new drug to treat prostate cancer was announced this week. The drug is called Abiraterone and has been hailed as the most significant breakthrough in the field for seventy years. Before the development of this drug it had been assumed, incorrectly, that prostate cancer was just driven by the sex hormone testosterone that is produced in the testicles. Currently available treatments work on this premise, by actually stopping the testicles from producing testosterone. Experts have now discovered, however, that it is not only testosterone which drives the cancer but also sex hormones from sources around the whole body including hormones which are produced by the tumour itself. Abiraterone does not only block the production of testosterone, but also blocks the production of sex hormones throughout the entire body.

The results were published in the Journal of Clinic Oncology and concern a study of 21 patients with advanced, aggressive prostate cancer. Data has been collected on a total of 250 patients worldwide and the results have all been equally encouraging. Taking the drug resulted in significant tumour shrinkage and caused a drop in levels of a key protein produced by the cancer. This protein is called prostate specific antigen. Many of the patients who took part in the study have said that taking the drug has resulted in a significant improvement in the quality of their lives.

The scientists hope that the drug may also have significant effects in the treatment of patients with other types of cancer, including those with breast cancer. This is an extremely exciting breakthrough in the treatment of prostate cancer. It is hoped that a pill form will be available in two to three years.

A new test for prostate cancer has been approved for use in the UK which could ultimately replace the current method of diagnosing this type of cancer.  The new test measures a genetic chemical which transfers DNA coding from the PCA3 gene.  Elevated levels of this chemical indicates that prostate cancer is present. The test is called the Progensa PCA3.

The current test for prostate cancer is called the Prostate Specific Antigen (PSA) test.  The PSA test looks for a protein that leaks from the prostate gland when cancer is present but the results can be inaccurate which causes a lot of stress for the patient while he awaits the results of the biopsy which has to be performed to confirm whether or not cancer is actually present.  Certain medications, such as Propecia, can mask the real levels of PSA so your doctor should be aware of any medications that you are taking so that the results of a PSA test can be read within context.

Around 35,000 men a year are diagnosed with prostate cancer so anything that can make the detection easier and the tests more reliable must be a good thing.  The new test costs around £200 compared with £10 for a PSA test so it is unlikely that the NHS will be providing this test on a generalised basis immediately but patients should be aware of it and might be able to request it where prostate cancer is suspected by the GP.

It is 10 years since Viagra was first prescribed to treat erectile dysfunction in the UK and despite the active ingredient (sildenafil) almost never making it as a medicine, it is now turning out to be a bit of a wonder drug with potential new applications being investigated on a continual basis.

Sildenafil was originally developed as a potential treatment for angina but initial trial results were very disappointing.  The drug seemed to have little impact on the condition and there were more effective competitors on the market.  During one of the patient trials, a doctor discovered that along with other side effects such as indigestion and back pain, this new drug allowed previously impotent men to achieve erections! This was a potentially very exciting breakthrough so it was immediately reported to Pfizer – the drug’s patent holder.  Five years later the drug was approved, not for treating angina but for erectile dysfunction.

Since the launch in 1997, Viagra has been used by an estimated 30 million men worldwide and despite the emergence of competing products, it remains the top choice for men with ED who use the services of The Online Clinic.

Viagra is now being tested for the following applications: relief of jet lag symptoms; treating stroke victims in the immediate recovery phase; helping underweight babies develop in the womb; and treatment of heart failure patients.  We intend to bring you news of these trials as soon as we have some more information, so please come back in the next few weeks to see if there have been any developments.

A study in China involving 7,684 men has concluded that smoking can be a major contributory factor to erectile dysfunction.  This is something that we have long suspected but this authoritative piece of research to be published in the American Journal of Epidemiology demonstrated that the statistical link is significant.

There appeared to be a direct correlation between the quantity of cigarettes smoked and the incidence or severity of the erectile problems.  There also appeared to be a stronger association in participants who also had diabetes.  The study included men aged 35-75 who did not have any vascular disease.

Help is at hand here if you want to give up smoking.  We are prepared to prescribe Champix for smoking cessation and there are a number of treatments for erectile dysfunction, including Viagra , that we are also prepared to prescribe.  As always, whether we will prescribe something will depend on your medical circumstances so you must complete a consultation form before we can make a decision.

A study conducted by the Southwest Oncology Group which surveyed more than 17,000 men over 55 years of age with a seven year follow-up period, has concluded that long term use of finasteride is unlikely to cause sexual dysfunction for most men who decide to take the treatment.  The study focussed on Proscar, which is the 5 mg daily dose used to treat Benign Prostatic Hyperplasia rather than the 1 mg a day dose called Propecia which is used to treat hair loss in men. It seems logical however that if no discernable problems could be detected in the long term with the 5 mg dose, then it is unlikely that the 1 mg daily dose would cause a problem in the long term either.

The study grew out of the Prostate Cancer Prevention Trial which was set up to determine whether finasteride could actually prevent prostate cancer.  The trial concluded that finasteride could reduce a man’s chances of getting prostate cancer by almost 25%.  It should be emphasised however that finasteride is not licensed for this preventative purpose.

Earlier studies into the effects of finasteride were very short term and did not take into account other factors such as age, medical condition or smoking status.  Given the other factors, it was concluded that the small average decrease in sexual function was not an important difference and that much larger differences were simply due to individual variations.

Back in January we brought you news of an exciting new drug in development which can be used to treat erectile dysfunction in men and hypoactive sexual desire disorder in women.  We now have information that the Phase IIb trials for use in men were a success and a meeting has been arranged with the FDA in August to discuss the results and to run through the requirements for the Phase III trials.  Bremelanotide tackles erectile dysfunction in a completely different way from the current generation of drugs such as Viagra.  Bremelanotide targets the central nervous system and is the first medication in a class known as melanocortin agonists.  Because of the way that this new medicine works, it is unlikely to be contraindicated for patients with heart problems or who use nitrates.  Although it will be a while before this medication is available to prescribe, initial findings do appear positive.

A revolution in the way that sexual dysfunction is treated could be just around the corner. Bremelanotide (formerly known as PT-141), which forms part of a new class of drugs called melanocortin agonists, is being developed in the United States by Palatin Technolgies. The drug works through a mechanism of actions involving the central nervous system rather than directly on the vascular system like currently available drugs, such as Viagra and Cialis. Given that Bremelanotide works in a completely different way from existing drugs on the market, it is thought that it may be able to be used by patients for whom the current generation of drugs are either contraindicated or are ineffective.

According to market data, around 40% of men who are prescribed the currently available drugs to treat erectile dysfunction do not refill their prescription as a result of a lack of efficacy or intolerable side effects. Palatin therefore believes that there is significant market demand for an alternative form of drug therapy.

Bremelanotide has been shown in four Phase 2 clinical trials to be effective in treating erectile dysfunction and it is currently undergoing Phase 2A clinical trials to treat pre-menopausal women suffering from sexual dysfunction, early results of which are encouraging according to Palatin. The drug is administered by way of a nasal spray and seems to have few side effects which are not dose related.

We will bring you more news on this exciting drug as soon as we have it.