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September 18, 2007 > Prostate Cancer & Erectile Dysfunction: Seminar Discusses Risks, Diagnosis & Treatments

Prostate Cancer & Erectile Dysfunction: Seminar Discusses Risks, Diagnosis & Treatments

The statistics from the American Cancer Society and the National Institutes of Health should make any man sit up and take notice:

* An estimated 219,000 cases of prostate cancer will be diagnosed in the United States in 2007, with 27,000 deaths resulting from the disease. Prostate cancer ranks as the second leading cancer cause of death among men, surpassed only by lung cancer.
* As many as 30 million American men suffer from erectile dysfunction (ED), sometimes called impotence. Worldwide, an estimated 52 percent of men over age 40 suffer from erection problems, but fewer than 15 percent of these men seek or receive therapy for the condition.

To help men learn more about these two serious health issues, Washington Hospital is sponsoring a special Health & Wellness seminar on prostate cancer and erectile dysfunction on Tuesday, September 25, from 6 to 7:30 p.m. Urologist Dr. Rao Sunkavally will outline the risk factors, diagnosis and treatment for these conditions. The seminar will be held in the Conrad E. Anderson, M.D. Auditorium in the Washington West Building located at 2500 Mowry Avenue in Fremont.

Prostate Cancer

"The primary risk factor for prostate cancer is age, with the risk increasing after age 40," Dr. Sunkavally explains. "That risk is increased for men who have a family history of prostate cancer. For example, if a man has a father, brother or uncle with prostate cancer, his risk doubles. If the man has two close relatives with prostate cancer, his risk increases fivefold."

Other risk factors for prostate cancer include:
* Ethnicity - African-American men are up to 60 percent more susceptible to getting prostate cancer than Caucasians and are twice as likely to die from the disease. Asian-Americans have the lowest incidence.
* Environmental factors - such as exposure to heavy metals - may be a contributing factor.
* Lifestyle choices - such as a diet high in fat, alcohol consumption and perhaps eating too much red meat - may play a role.

The first step in diagnosing prostate cancer is a physical examination that includes a digital rectal exam (DRE) and a prostate-specific antigen (PSA) blood test.
"If the patient's PSA level is high and the DRE indicates the prostate is enlarged, we would do an ultrasound to scan the prostate and take several samples of tissue," Dr. Sunkavally says. "This is done as an office procedure, with local anesthetic, and takes about 20 minutes."

If the biopsy samples come back positive, the next steps are to determine the "grade" of the tumor to see how aggressive it is and the "stage" of the cancer to identify any spread - or metastases - outside the prostate.

"Prostate cancers are graded on a scale of 1 to 10, with anything above grade 6 considered highly aggressive," Dr. Sunkavally notes. "The biopsy of the prostate doesn't always give an accurate indication of the extent, or stage, of the cancer, but a PSA level between 4 and 10 would suggest that the cancer is confined to the prostate more than 60% of the time."

Treatment options for prostate cancer generally depend on the patient's age and personal preferences. "For a slow-growing cancer in someone over age 75, it might be more appropriate to take a 'watch-and-wait' approach," says Dr. Sunkavally.

"For more aggressive cancers in younger men, the treatment options could include surgical removal of the prostate, external-beam radiation or brachytherapy -- which is placement of radioactive pellets or 'seeds' in the prostate," he adds. "Another option is cryo-ablation, or freezing cancer cells in the prostate with cold probes. Prostate cancer also responds well to hormone ablation treatment to lower the testosterone levels. We also can use chemotherapy for cancer that has spread outside the prostate."

Erectile Dysfunction

One common side effect of treatment for prostate cancer is ED. But ED can and does happen even among men without prostate cancer. Additional risk factors for ED are similar to those for cardiovascular disease:
* Hypertension (high blood pressure)
* High cholesterol
* Obesity
* Diabetes
* Smoking

"ED can be the result of 'psychogenic' factors such as anxiety or depression, which is usually the case among younger men," Dr. Sunkavally explains. "In older men, though it is often caused by 'organic' factors such as hardening of the arteries, low testosterone levels, neurogenic (nerve) disorders, adverse side effects of medications or, of course, surgeries such as prostate removal. Radiation of the pelvic area can cause ED, too."

Dr. Sunkavally notes that diagnosing ED entails taking an extensive patient history, conducting lab tests for various risk factors and evaluating the patient's testosterone levels.

"The first step in treating ED is to try the various new medications available, such as Viagra, Levitra and Cialis," he says. "These medications are pretty effective, in general, even in psychogenic cases. If the patient does not respond to the drugs, we may inject a medication to cause an erection and evaluate the blood flow to the penis. Patients can be taught to perform these injections themselves. Other treatment options include penile implants - which do not interfere with either sensation or orgasm - and vacuum devices."

For more information about the upcoming seminar, or to register to attend, please call (800) 963-7070.

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