New Findings Affect Treatment of Men’s Health - Richard Escajeda, MD

The good news is that medical information is more accessible than ever before. The bad news is that often we are faced with conflicting stories relating to important health issues. I have been following new research on men’s health matters that seem to counter what has been previously held as medical fact.

The first study relates to the effectiveness of blood tests for prostate-specific antigen (PSA) in decreasing the rate of prostate cancer deaths. From 1987 to 1990, when PSA screening was coming into widespread use, researchers studied the test results from Medicare data of men aged 65-79. The PSA test was used more than five times as frequently in Seattle than Connecticut, the two sites specifically monitored. This led to 2.2 times more prostate biopsies and more than six times as many operations to remove the prostate gland. It should have also saved lives. However, 11 years later, men in Seattle and Connecticut had the same rate of prostate-cancer death. The conclusion of study leader, Michael J. Barry, MD, was “It doesn’t look like that pretty dramatic difference in intensity of testing made any difference in prostate cancer mortality.” Clearly more research is necessary, but this study raises questions about the effectiveness of the test in reducing prostate cancer mortality.

Benign prostate hyperplasia (BPH) universally affects men and is most common after age 50. As the usually walnut-sized prostate grows, sometimes as big as a grapefruit, it presses on the urethra (the outflow tract from the bladder), causing incomplete emptying, a weakened urine stream, the need to urinate frequently and urgently, and most notably, frequent bathroom breaks, especially at night. While BPH is often more of a nuisance than dangerous, it can result in bladder and urinary tract infections, or even kidney damage.

Typically, treatment for BPH involves surgery or prescription drugs. However, research shows that some symptoms may be treated as effectively with over-the-counter herbal remedies – sometimes less expensively and thus far, with no reported side effects.

Saw palmetto is the leading herbal treatment for BPH with annual U.S. sales of more than $25 million. There are pros and cons to the use of this herbal remedy. It brings relief in about one out of three patients, with a suspected effect similar to the most common prescription medication for BPH by blocking the production of a hormone that causes the prostate to grow.

The main drawback is that the majority of patients don’t get relief because the active ingredient in saw palmetto, like its exact mechanism, hasn’t been identified. Therefore, different formulations may produce different results. Another concern is that saw palmetto might artificially decrease the PSA level, potentially masking a cancerous elevation.

Most physicians recommend that patients discontinue taking the herbal remedy for a month prior to PSA testing. While I generally recommend pharmaceuticals to patients with more severe symptoms, it seems saw palmetto can improve mild to moderate BPH in many men.

Finally, there is a new study regarding the popular drug Viagra that shows it appears to be safe for some men with severe heart disease, as long as they are not taking nitroglycerine or similar drugs for their condition. Reports of heart attacks in several men who had used Viagra led researchers to worry that the drug posed a special risk to those with heart problems such as angina (chest pain). This new study, published in the New England Journal of Medicine, shows the usual dose of Viagra causes no damaging changes to the heart’s circulation in men with coronary artery disease (CAD).

Howard C. Hermann, MD, the lead author of the study said “ These findings should provide reassurance about the safety of Viagra for patients who take it, for urologists who prescribe it to treat erectile dysfunction, and for cardiologists, who probably don’t ask about erectile dysfunction as much as they should.” While the study provides useful information about Viagra’s effects on the heart’s regulatory system, I am interested in seeing more direct information about heart attacks in men taking the drug.

Richard T. Escajeda, MD, is with Cornerstone Family Practice at Archdale. For more information on men’s health, tune in to “Regional Health Talk” at 10 a.m. today on WMFR (1230 AM). To suggest a column topic, call 878-6200 or visit the hospital web site at www.highpointregional.com