Prostate cancer

Much Ado: Reduced Penis Size Post Prostate Cancer Treatment

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Prostate cancer is the most common cancer among men in the US. It is second only to lung cancer in causing death. As of 2009, the most recent CDC stats reported, over 200,000 men are diagnosed annually and almost 30,000 die. Prostate cancer is a disease of older men with over 65% of those diagnosed over the age of 65. In men under the age of 40, the rate of diagnosis is 1 in 10,000 compared to 1 in 15 for men between the ages of 60-69.

Even though prostate cancer is the most common cancer among men, it is the most survivable with 91% of the men living 10 years post diagnosis. Because of its high survival rate, the quality of life post diagnosis and treatment is of great concern. Depending upon the treatment selected, post treatment side effects include:

  • Urinary, bowel and erectile dysfunction
  • Infertility
  • Hormone and chemo side effects

A new study published in the journal Urology found that some men report slightly shorter penises post prostrate cancer treatment – a side-effect that they were none too pleased about. The study looked at complaints of reduced penis size in 948 men with recurrent prostate cancer. Results showed that only 2.63% (25) men reported a perceived reduction of less than 1/2 inch. Penis size was not measured pre- or post- treatment. In fact the study was conducted retrospectively – 5 years post treatment. Nevertheless, the authors and editors thought this worthy of publication.

According to the study’s lead author, Paul L. Nguyen, M.D., a radiation oncologist at Dana-Farber Cancer Institute and Brigham and Women’s Cancer Center in Boston:

“Some people might think this is frivolous — who cares about a slightly shortened penis — but it really does affect people’s lives,” he said in an interview. “If guys [in the study] had this bad result they were much more likely to regret the path they chose. This is important to talk about up front when people are making their decisions.”

Certainly, if in fact this was an actual, measurable side-effect of prostate cancer treatment, then men should be apprised of its possibility. Since the study was retrospective, no measurements were taken and the study was conducted entirely in a population of older men where age-related shrinkage is just as likely as treatment related shrinkage, it is difficult to determine what, if any effect, treatment had on actual penis size.

Even if there was measurable, though minute shrinkage, it seems like this may be the least of one’s worries when facing prostate cancer. Perhaps, we should be spending more time on mitigating the more severe treatment side-effects, or better yet, preventing prostate cancer altogether. Finally, why was this study published at all?

Humor in a Hospital Vein?

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For those who do not know, I am living a year (so far) of finding incurable prostate cancer metastasizing throughout by lymph system. A previous blog showed the cancer has sneaked through my vigilance.

But I can still smile, occasionally.

 

Humor in a Hospital Vein?

I know I have lost many pounds during the last year of medical procedures. Mostly muscle mass. I can tell. When the wind blows I fear I might take flight. Not yet. I also fear that I might lose my sense of humor. So, I have decided to record some the events during the recent medical onslaughts to have and to hold them later… just for laughs.

During my several hospital hideouts I threatened to write a book about all the medical mishaps… “How not to take it lying down.”

Every day a different nurse would tell me “you’re funny.” I remember my mother making a distinction, “funny ha-ha or funny peculiar.” Someone from the hospital heard of my humor and asked if I would like to write for the new internet site they were creating. I admitted, “I don’t think you want to hear what I have to say.” She went away.

These events occurred over three years in three different hospitals. No matter. It was all centered on one “victim”, me. For the most part the service was fine. Yet, there were quite a few anomalies along the way. I even took notes. But, when I got home, most of those were untranslatable. Muddy thoughts.

The Spanish Heart Attack

One Sunday morning in November 2009 I did not know I was suffering a heart attack while walking five blocks to work as a Guest Services/Tour Guide at the Lucas Oil Stadium. One of my compatriots also going to work, a former EMT, knew what was happening when I told him I could not keep up any longer. He assisted me to the door of the facility and into a medical unit. They checked and hauled me off to a hospital of choice… even at a difficult moment.

Always the tour guide I was pointing out things along the way. “There is the time clock.” One gurney journey guy said, “Don’t worry. You are not checking in. You are checking out.”

Lucky for me, the chief of the heart department was the on-call that weekend. And he was very attentive. Another heart surgeon said I was talking with him during the five stent procedure … in Spanish. He is from Valencia, Spain. In recovery, the nurse heard me speak to the doctor in Spanish. She turned and just stared. I said, “It is something new I picked up while under anesthesia.”

In the earliest exploratory surgery [TURP – trans urethral resection of the prostate] I was given an epidural anesthetic rather than a general because of concern for my heart during the process. When I came to, I told the medical personnel, “Women get epidurals all the time and they get babies. I asked, Where’s mine?” Blank stares all around.

The Scent of Illness

Next year, during my stay for a cholecystectomy [gall bladder removal] at least once a day, often more, the nurse might say “come on, we are going to another room.” One time they wanted my private room for an incoming prisoner. He needed privacy. On one occasion (about mid-week) my private double room was invaded by a loud patient declaring all the things he would not let them do. “I won’t have anybody sticking me with needles hundreds of times. And I won’t go three miles on the thread (sic) mill.”

The opinionated one in the next bed continued his harangue while I finally connected with a laxative attempt. The stench caused him to blurt, “Get that crap out of here.” I told him it was the first time he was correct since he arrived.

Across the hall, maintenance workers were repairing a tiled floor with a resulting acrid smell of their own. My allergy reacted to the fumes and the nurse began moving me to another room without warning. The other patient yelled, “If you didn’t like me you could have just told me.”  Two smells and him. I did the best I could.

Hot Flashes and Room Havoc

My urologist and my oncologist are not yet certain which way to proceed with my condition. They say new treatments are coming soon. So far, I get a hormone shot (Lupron) every three months in an attempt to curtail the aggressiveness of the cancer through my lymph system. Like some other men with those hormone shots we get to experience the thrill of hot-flashes. A woman sitting next to me in the lobby said simply, “Welcome to the club.”

Already, we have found a large tumor on the left femur just below the hip and had it removed by RFA (radio frequency ablation) so I could walk again. No humor here.

It is not official but I might hold the record for the most rooms (four on one day) used during my one-week stay in that hospital. Actually it was nine days if you count the emergency room Saturday night and the Monday morning departure a week later when the nurse assistant hit me in the teeth without a warning at 6am. My reflexes almost hit her in the face. She yelled at the other patient, “Don’t yell at me” when he blurted the same phrase. Good, go after him.  Maybe then she won’t poke me with the thermometer again.

The best odd event? It came mid-week when my tall Tanganyikan nurse, single mother of three, came to check on me very early on Wednesday.  I had been warned I was not taking my meds. I thought I had. “No, here they are on your table.” They were out of sight behind my head in the bed. “I put them there when I left because the doctor came in. I told you.”  That was the problem in this particular hospital. The nurses run when the doctor arrives. The rule used to be the nurse would/should monitor the patient taking the meds. SO, I saw one pill in a small cup at 5am. I took it… because I was supposed to comply. At 6am the tall Tanganyikan asked where is that pill? I said I took it. She screamed, “You Did What? That was your suppository~”

How not to take it lying down (in hospital)! They’re building a new hospital. Buy not in my name.

Male Breast Cancer: Know the Facts

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Father’s Day is a day when we honor the men in our life. What better way to do so than to inform ourselves about potential health risks men face?

One rare, though oft ignored, due to its taboo nature, disease is male breast cancer. Men, like women, suffer from breast cancers that infiltrate the ductal tissue, lymph nodes and nipple. Also, like breast cancer in women, male breast cancer is marked by uncontrolled growth of the abnormal cells.

Incidence

Male breast cancer makes up less than 1% of all breast cancers. Approximately 2,000 cases of male breast cancer are reported each year in the U.S. Roughly 400 men die each year from the disease. It occurs most often in older men between the ages of 60 and 70. The cause is not entirely known, but both environmental influences and genetic factors likely play a role and as with women, hormones influence the growth of certain cancers. An interesting note: although male breast cancer remains relatively rare, the incidence of male breast cancer has increased by 26% since 1975 according to data from the National Cancer Institutes Surveillance, Epidemiology and End Results (SEER) database.

Risk Factors

Men who have previously undergone radiation therapy to treat malignancies in the chest area (for example, Hodgkin’s lymphoma) have an increased risk for the development of breast cancer.

The majority of breast cancers in men are hormone receptor positive. Remember, men have the same compliment of steroid hormones as women. They differ only in the concentrations/levels. Women have higher estrogens and men higher androgens. As many as 77% of tumors are either estrogen receptor-positive, meaning that they grow in response to stimulation by endogenous estrogens such as estradiol and estrone or exogenous synthetic estrogens, or are progesterone receptor positive, tumors grow in response to endogenous progesterone or synthetic progestins/progestagens. There is also evidence linking metastatic prostate cancer to male breast cancer and the medications associated with the treatment of prostrate cancer. Additional conditions associated with an increased rate of breast cancer include:  Klinefelter’s syndrome, cirrhosis of the liver and obesity.

Klinefelter’s syndrome is an inherited condition affecting about one in 1,000 men. Men with Klinefelter’s syndrome have inherited an extra female X chromosome, resulting in an abnormal sex chromosome makeup. Klinefelter’s patients produce high levels of estradiol and develop enlarged breasts. Men with Klinefelter’s have a 50 times greater risk for development of breast cancer than that of normal men.

Cirrhosis of the liver can result from alcohol abuse, viral hepatitis, or rare genetic conditions that result in accumulation of toxic substances within the liver. With cirrhosis, liver function is compromised and the levels of male and female hormones in the bloodstream are altered. Men with cirrhosis of the liver have higher blood levels of estradiol and estrone and have an increased risk of developing breast cancer.

Obesity. Men with a body mass index (BMI) greater than 30 have twice the breast cancer rate than men with BMIs <25.

Genetics. Men who have several female relatives with breast cancer also have an increased risk for development of breast cancer. About 15% of breast cancers in men are thought to be attributable to mutations in the breast cancer-associated  BRCA-2 gene.

Finasteride, a drug used to treat baldness (Propecia) and benign prostatic hyperplasia (Proscar), may be associated with an increased risk for male breast cancer. Further studies are needed to clarify whether a causal relationship between the drug and the disease actually exists.

Symptoms of Male Breast Cancer

The most notable symptoms of male breast cancer include:

  1. Lumps
  2. Changes to the nipple (inversion) or breast skin
  3. Pain or discharge of fluid from the nipple
  4. Enlarged lymph nodes under the arms.

Of note, men with breast cancer experience bloody nipple discharge and inversion more commonly than women.

Treatment for male breast cancer is usually a mastectomy. Other treatments include radiation, chemotherapy and/or hormone therapy.

This Father’s Day, ask yourself if the man in your life may be at risk. If he is, have a conversation with him about what you’ve just learned. Who knows, you may save a life, and wouldn’t that be a great Father’s Day gift?