Thefastpharma. Health news blog
Mar 30
First, let’s review the territory. For a surgeon, this is precarious terrain indeed: The prostate is located deep in the pelvis, surrounded by structures that are fragile and vulnerable to injury—the rectum, the bladder, the sphincter responsible for urinary control, some large blood vessels, and the bundles of nerves that are responsible for erection. The [...] [...more]
Posted: under Men's Health-Erectile Dysfunction.
Tags: Men’s Health
First, let’s review the territory. For a surgeon, this is precarious terrain indeed: The prostate is located deep in the pelvis, surrounded by structures that are fragile and vulnerable to injury—the rectum, the bladder, the sphincter responsible for urinary control, some large blood vessels, and the bundles of nerves that are responsible for erection.
The operation begins with an incision through skin and muscle in the abdomen that extends from the pubic area to the navel. Almost immediately, before the prostate is ever reached, the surgeon removes a triangle of tissue on each side of the bladder; these triangles contain important lymph nodes. This is called a staging pelvic lymphadenectomy—dissection of the pelvic lymph nodes, to make sure they’re free of cancer. These lymph nodes are removed, then rushed to a pathologist for what’s called frozen-section analysis to check for cancer; the tissue is frozen, then sliced into very thin sections to be examined under the microscope.
(Note: Some doctors only have frozen-section analysis done if a man’s Gleason score is 8 or higher. One reason for this is that with lower-grade, well-to moderately well-differentiated tumors—Gleason 7 or less—the long-term prognosis of patients is different than for men with high-grade, poorly differentiated tumors. Most men with Gleason scores of 8 or higher will have metastases to bone within the first four years after surgery; therefore, removing the prostate ultimately does not benefit these men. But with Gleason scores of 7 or lower—even when there is a tiny bit of cancer in a lymph node—60 percent of men have no sign of metastases on bone scans ten years later. This doesn’t mean the cancer won’t eventually come back in these men, but that it can take years longer to return when the tumor is of a lower, better-differentiated grade. So, because these men can live for many years, they often benefit from having their prostate removed. And removing it now will help them avoid problems with urinary tract obstruction and bleeding later, when the cancer does return.) If the cancer has spread massively to the lymph nodes, the surgeon will stop the operation at this point, because surgery won’t help the situation. But if the
The radical retropubic prostatectomy (continued) lymph nodes are cancer-free—or nearly so (see above), and the cancer cells are not poorly differentiated—the operation continues.
Next, the major vein system that overlies the prostate and urethra (this is called the dorsal vein complex) is cut. Blood loss must be kept to a minimum so that the operation can be performed in a “bloodless field.” This is a crucial step; control of these veins makes a huge difference in the surgeon’s ability to see what’s happening, and it’s particularly significant for what happens next—cutting through the urethra. If the urethra is cut too close to the prostate, some cancer might be left behind; but if it’s cut too far away from the prostate, the urethral sphincter might be damaged—and such an injury can make a man incontinent.
Next, depending on the degree of cancer, the surgeon must make a decision that will affect the patient’s potency—to leave intact the neurovascular bundles, the wafer-thin packets of nerves that sit on either side of the prostate, or to remove one or both along with the prostate. These are the nerve bundles responsible for erection.
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Mar 30
Say a man is in otherwise good health, and he can reasonably expect to live at least ten more years. His cancer is localized to the prostate, and therefore it’s curable now. If he does nothing about it, he may miss his golden opportunity for cure. There’s no way of predicting if or when cancer [...] [...more]
Posted: under Men's Health-Erectile Dysfunction.
Tags: Men’s Health
Say a man is in otherwise good health, and he can reasonably expect to live at least ten more years. His cancer is localized to the prostate, and therefore it’s curable now. If he does nothing about it, he may miss his golden opportunity for cure. There’s no way of predicting if or when cancer will make that fatal leap beyond the prostate. Even in its earliest stages, prostate cancer doesn’t always spread considerately, in logical, creeping, easy-to-predict steps. And unfortunately, men with the earliest stages of prostate cancer can have metastases before they ever even develop a palpable tumor that can be felt by a doctor’s gloved finger during a rectal exam.
But say a man is in his eighties. Even if his cancer is organ-confined and curable, it’s not likely that he will live long enough for
Watchful waiting doesn’t mean your doctor has written you off—it just means you get treatment for specific symptoms if and when you need it.
So who should opt for watchful waiting? At the top of this list should he men who are too old or too ill either to undergo the rigors of treatment or to live another ten years (long enough for such treatment to be worthwhile). Also in this group should be men with cancers that are considered too advanced to cure — men with stages T3 T4 N+, C and D. And finally, for men with cancers that are truly incidental (some men with, stage T1a and lie disease), watchful waiting is probably a reasonable gamble.
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Mar 30
For tumors that are confined to the prostate—stages T1 and T2 (A1, A2, B1 and B2)—there are two main choices: Surgery, the radical prostatectomy; and radiation therapy. Radiation also is used when the cancer has spread just outside the gland, to kill cancer cells and to shrink the prostate. High-energy X-ray beams are aimed at [...] [...more]
Posted: under Men's Health-Erectile Dysfunction.
Tags: Men’s Health
For tumors that are confined to the prostate—stages T1 and T2 (A1, A2, B1 and B2)—there are two main choices: Surgery, the radical prostatectomy; and radiation therapy. Radiation also is used when the cancer has spread just outside the gland, to kill cancer cells and to shrink the prostate. High-energy X-ray beams are aimed at the prostate and sometimes at nearby lymph nodes.
Table 4.1 Treatment Pros and Cons
Radical Prostatectomy
Radiation Therapy
Ideal candidate
Age
Younger than 70
Any age
Stage
T1b, T1c, T2 (and some men
TI, T2, T3, T4
with Tia disease)
Chief advantages
If cancer is confined to the
Less invasive
prostate, this is the best way
to cure
Chief disadvantages
Side effects:
May not cure localized cancer;
impotence 25-75%
Side effects:
incontinence 2-5%
rectal injury 1-2%
death 0.2%
impotence 40%
death 0.2%
.
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Mar 30
Recently, research published in the New England Journal of Medicine summarized a number of studies involving watchful waiting. In these studies, the article’s authors reported, the men treated with watchful waiting were carefully selected from a large group of patients because they were felt to have slow-growing cancers that were unlikely to spread. These patients [...] [...more]
Posted: under Men's Health-Erectile Dysfunction.
Tags: Men’s Health
Recently, research published in the New England Journal of Medicine summarized a number of studies involving watchful waiting. In these studies, the article’s authors reported, the men treated with watchful waiting were carefully selected from a large group of patients because they were felt to have slow-growing cancers that were unlikely to spread. These patients were not representative of the usual patient who walks into a doctor’s office—in other words, they were almost all “best-case scenarios.” Even so, ten years later, 40 percent of the men in these elite groups who had Gleason scores from 5 to 7 had developed metastases to bone, and by fifteen years, 70 percent had developed these metastases. (The survival time for patients with metastases to bone is about two to three years.) These observations drive home two points: One is that prostate cancer marches on; it continues to progress in most patients— even in those with the mildest-looking disease. And the other is that if a man with localized prostate cancer does not get effective treatment, and if he lives long enough, he will very likely die of prostate cancer.
Results of still another study show something different: In men with clinically localized prostate cancer, radical prostatectomy reduced the development of metastases and death from prostate cancer by 50 percent when compared with men who were followed with watchful waiting.
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Mar 30
A standard staging pelvic lymphadenectomy (dissection of the pelvic lymph nodes) generally is performed just before a radical prostatectomy. (This varies among doctors and hospitals; some doctors base this decision on the Gleason score.) If the lymph nodes are entirely free of cancer or—in some cases, almost entirely free—the surgeon proceeds with the operation to [...] [...more]
Posted: under Men's Health-Erectile Dysfunction.
Tags: Men’s Health
A standard staging pelvic lymphadenectomy (dissection of the pelvic lymph nodes) generally is performed just before a radical prostatectomy. (This varies among doctors and hospitals; some doctors base this decision on the Gleason score.) If the lymph nodes are entirely free of cancer or—in some cases, almost entirely free—the surgeon proceeds with the operation to remove the prostate.
We need to clarify here: When prostate cancer has spread to the lymph nodes, it cannot be cured. However, if the cancer fits certain conditions—if cancer in the lymph nodes is microscopic and the Gleason score is lower than 8—there is still a chance that surgery will help control the disease locally. This is important for younger men who can expect to live a long time. In this case, for men younger than 70, many surgeons will still perform a radical prostatectomy, because there is a good chance that these men may live for many years before the cancer reappears elsewhere. Also, surgery in these men reduces the risk of other cancer-related problems, such as urinary obstruction or bleeding, developing later.
If disease that was thought to be localized turns out to be widespread, however, the operation generally does not continue; it wouldn’t do any good. (Imagine what a blow this is to the patient; worse, even though he didn’t have the full operation, he still had an incision and his lymph nodes removed; he’ll have to be in the hospital for nearly a week, just to recover from this. This is why staging candidates carefully before surgery is so important—because it could help a man avoid such an ordeal.)
The laparoscopic pelvic lymphadenectomy has a reduced hospital stay (see above). But if the lymph nodes are negative, giving the green light to a radical retropubic or perineal prostatectomy, many men then go ahead and have that surgery.
The goal behind the “Minilap” is to provide the best of both worlds. It begins with an incision slightly larger than in the laparoscopic procedure. If there’s cancer in the lymph nodes, the incision is closed. But if the lymph nodes are cancer-free, this incision is lengthened and the radical retropubic prostatectomy is performed under the same anesthetic.
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Mar 27
When young people begin going out or when they fall in love (or what they think might be love), they often find themselves faced with questions about how to handle the strong romantic and sexual feelings they may be having. When two people are attracted to each other, they quite naturally want to be physically [...] [...more]
Posted: under Men's Health-Erectile Dysfunction.
Tags: Men’s Health
When young people begin going out or when they fall in love (or what they think might be love), they often find themselves faced with questions about how to handle the strong romantic and sexual feelings they may be having. When two people are attracted to each other, they quite naturally want to be physically close. Being physically close may mean something as simple as holding hands or kissing goodnight after a date. Or it may mean more than this. Physical closeness may even include something as intimate as sexual intercourse.
Some young people don’t have much trouble in deciding what kind of physical closeness is right for them or in making decisions about ‘how far’ they want to go in terms of physical intimacy. For instance, some young people have very strong religious or moral beliefs or other values that guide them in making these sorts of decision. But, other young people aren’t as certain. For example, some young people aren’t sure what’s right or wrong when it comes to deciding how far to go. And even those who are sure sometimes have a difficult time sticking to their beliefs when they’re actually in a situation in which they have to make these decisions. So we usually spend a good deal of time, especially in our classes for older boys and girls, discussing the topic of making decisions about how to handle romantic and sexual feelings. We don’t have enough space to cover everything we discuss in class, but in the following pages we’ll answer some of the most commonly asked questions.
Some of the questions you’ll find here are questions about what’s OK or not OK or what’s morally right or wrong when it comes to young people acting on their romantic or sexual feelings. If there were one set of answers with which everyone agreed, it would be easy to answer these sorts of questions, and our job as sex education teachers/writers would be much easier. We could just give the agreed-upon answers and that’s all there’d be to it. But it’s not that simple. The fact is that different people have different ideas on these issues and there isn’t one agreed-upon set of answers. Therefore, when we’re discussing these sorts of question in our classes and in our books, we don’t give one answer. Instead, we try to present the many different opinions that people have and to explain why people feel the way they do about these issues, without ‘taking sides’. We do it this way because we think it’s important for young people to hear all sides of a question and come up with their own answers rather than just going along with someone else’s opinion. Far too many young people don’t think these questions through on their own, and this can lead to trouble. For example, some young people answer questions about how to handle their sexual and romantic feelings based on what they think everyone else is doing. Not only are they often wrong about what ‘everyone else’ is doing, but the fact is that just because ‘everyone else’ does it does not mean it’s right for you.
Or, to take another example, some young people don’t think through these issues on their own and just go along with what their parents or their religions say is right or wrong. Now, please don’t misunderstand what we’re saying here. We’re not saying that you shouldn’t follow your parents’ or your religion’s teachings or rules. In fact, we think parents and religions usually have excellent advice that’s well worth following. But we’ve found that young people who just accept what they’ve been taught without thinking things through for themselves frequently run into problems when they’re actually in situations in which they have to make decisions about how far to go. Often these young people find that they don’t stick by the rules they’ve been taught. The rules sort of ‘crumble’, or ‘fall apart’ or ‘cave in’ in the face of the tremendous pressure to experiment sexually that’s often put on young people. We think this happens because the rules weren’t really their own in the first place. The rules were someone else’s rules. We believe that it’s not until you consider all the different viewpoints and decide for yourself what rules to follow that the rules become truly your own. And it’s not until the rules are truly your own that they become rules you can really live by. So you’ll find many viewpoints in the answers to the questions about what’s right/wrong or OK/not OK in the following pages. We hope this will help you find your own answers.
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Mar 27
In the past, many people felt that homosexuality was sinful or abnormal, and there are still some who think it’s morally wrong or the sign of a mental illness that needs to be ‘cured’ by a psychiatrist. However, nowadays, most people no longer feel that homosexuality is either wrong or an illness. They feel that [...] [...more]
Posted: under Men's Health-Erectile Dysfunction.
Tags: Men’s Health
In the past, many people felt that homosexuality was sinful or abnormal, and there are still some who think it’s morally wrong or the sign of a mental illness that needs to be ‘cured’ by a psychiatrist. However, nowadays, most people no longer feel that homosexuality is either wrong or an illness. They feel that it’s a personal matter, that some people just happen to be homosexuals and that being homosexual is a perfectly healthy, normal and acceptable way to be.
What’s a bisexual?
A bisexual is a person who is equally attracted to males and females and whose sexual activities may involve either sex.
If a person has a lot of homosexual feelings while growing up, will this person be a homosexual as an adult?
Having homosexual feelings and experiences while you’re growing up has nothing at all to do with whether or not you’ll be a homosexual as an adult. Some young people who have homosexual feelings and experiences while they’re growing up turn out to be homosexuals and some turn out to be heterosexuals. Some adult homosexuals had homosexual feelings while they were growing up; others had heterosexual feelings; still others didn’t have strong feelings one way or the other while they were growing up.
Can a person know for sure that they’re gay even though they’re still young?
Yes. At least, some gay adults say that they knew they were homosexuals right from the time they were teenagers or even from when they were little children.
If you think you might be a homosexual and would like to talk to someone about your feelings, you can ring the Gay Switchboard on 071-837-7324.
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Mar 27
In addition to asking about STDs, the boys in our classes also ask questions about other health problems. Here are some of the questions they ask. I’ve never had sex, but I have symptoms like you said you get from STDs. I have pain, it burns when I urinate, and, sometimes, a little bit of [...] [...more]
Posted: under Men's Health-Erectile Dysfunction.
Tags: Men’s Health
In addition to asking about STDs, the boys in our classes also ask questions about other health problems. Here are some of the questions they ask.
I’ve never had sex, but I have symptoms like you said you get from STDs. I have pain, it burns when I urinate, and, sometimes, a little bit of stuff leaks out of my penis. If it’s not an STD, what is it?
There are a number of diseases other than STDs that can cause these kinds of symptoms. For example, urethritis (an infection of the urethra) can cause these symptoms. Sometimes urethritis germs are passed through sexual contact, but you can also pick up these germs in other ways.
What is jock itch?
‘Jock itch’ or ‘jock rot’ is a fungus infection caused by wearing clothes that are too tight or that don’t let the air circulate freely. It causes redness, soreness and itching on the genitals and the inside of the thighs. Rubbing cornflour on the area may be enough to cure the problem, but in some cases you need to get special medication from the doctor to clear it up. Keeping the area clean and dry, washing your clothes frequently and avoiding tight clothing will help prevent the problem.
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Mar 27
We’ll be talking about health problems associated with the sex organs and sexual activity. The boys and girls in our classes have many questions about these subjects. They are especially curious about sexually transmitted diseases (STDs), which are also referred to as venereal diseases (VD). STDs are diseases that can be passed from one person [...] [...more]
Posted: under Men's Health-Erectile Dysfunction.
Tags: Men’s Health
We’ll be talking about health problems associated with the sex organs and sexual activity. The boys and girls in our classes have many questions about these subjects. They are especially curious about sexually transmitted diseases (STDs), which are also referred to as venereal diseases (VD).
STDs are diseases that can be passed from one person to another through sexual contact. There are many different types of STDs.
Gonorrhoea-This is a common STD that can easily be cured with antibiotics, provided it is detected and treated promptly. Males usually have symptoms severe enough to send them to the doctor (discharge from the penis, pain on urination, frequent need to urinate). Females may have an abnormal vaginal discharge and urinary symptoms if the germs spread from the vagina to the urethra, and these symptoms may be severe enough for them to seek medical treatment. However, the big problem with gonorrhoea is that some males and many females don’t have symptoms or have only mild ones that go away on their own. Even if there are no symptoms, the germs are still in the infected person’s body, and that person can still pass the disease to others. Undetected and untreated gonorrhoea can be especially serious in a female. If she doesn’t know she has the disease and is not treated, the germs may spread from the vagina to the uterus, Fallopian tubes, ovaries and other pelvic organs, causing PID, which can be very damaging and can lead to infertility, sterility and other serious medical problems.
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Mar 27
Some methods are safer and have fewer side-effects than others. NFP, for instance, is a ‘natural’ method because it doesn’t involve the use of pills, devices, or chemicals; therefore, it doesn’t cause any side-effects or pose any health risks to the women who use it. Sterilization doesn’t physically affect a person’s hormone levels, sex drive, [...] [...more]
Posted: under Men's Health-Erectile Dysfunction.
Tags: Men’s Health
Some methods are safer and have fewer side-effects than others. NFP, for instance, is a ‘natural’ method because it doesn’t involve the use of pills, devices, or chemicals; therefore, it doesn’t cause any side-effects or pose any health risks to the women who use it. Sterilization doesn’t physically affect a person’s hormone levels, sex drive, ability to experience orgasm or cause any other side effects. In rare cases there will be surgical complications such as infections or excessive bleeding and a few people find themselves emotionally upset by the loss of their ability to reproduce. Because there are no known long-term risks, sterilization is considered a very safe method.
Methods such as the cap, diaphragm, condom and spermicides are also very safe and have few side-effects. Occasionally, there will be an allergic reaction to the spermicide or the rubber in these devices, which can sometimes be cleared up by switching to another type of device or brand of spermicide. Occasionally, a diaphragm user is troubled by repeated bladder infections (due to the diaphragm’s pressure on the bladder), which can sometimes be cleared up by changing the size or type of diaphragm. Though bothersome, these allergic reactions and bladder infections are not considered serious because they aren’t major or life-threatening medical problems.
Other methods have a greater number of side-effects and are not as safe to use. The IU D, for instance, may cause side-effects such as period pains, heavier periods and bleeding between periods (breakthrough bleeding). These side-effects may disappear after a few months, but sometimes they are so severe that the device must be removed. The IUD may also cause serious, and even life-threatening, problems. The device can perforate (go through) the muscle wall of the uterus, into the pelvic cavity, although this is rare. Having an IUD in the pelvic cavity could lead to serious problems, so an operation is necessary to remove the device. Another serious problem is that women who do get pregnant despite the IU D may have ectopic pregnancies, pregnancies in which the fertilized ovum implants in the Fallopian tube or some other abnormal location instead of in the uterus. Ectopics can burst the tube, creating a medical emergency and requiring an operation to stop the internal bleeding. They can also cause permanent damage to the reproductive organs, causing infertility (difficulty in getting pregnant) or sterility (the inability to become pregnant at all). Fortunately, though, perforations and ectopics are rare.
If a woman already has, or gets, pelvic inflammatory disease (PID) – an infection of the uterus, Fallopian tubes and ovaries – an IUD can make it worse. PID can cause a woman to be hospitalized, damage her reproductive organs so that she’s infertile or sterile, lead to chronic pelvic pain and repeated infections, and in some cases it may be necessary to surgically remove the woman’s reproductive organs. In rare cases, PID can be fatal. Of course, most IUD users don’t ever develop PID. But, because of the risk of infertility, this method is not recommended for young women or any woman who may want to have children in the future. Because the chance of getting PID is also greater if a woman has more than one sexual partner, or a sexual partner who may have other partners, this method is not recommended for such women, regardless of their future childbearing plans.
The pill also causes side-effects in some women. Pill users sometimes experience weight gain, sore breasts, headaches and nausea, especially at first. There are also a number of other side-effects. Luckily, most women don’t have severe side-effects. When they do, switching to another type or brand of pill may help, but some women have to stop using the pill because of the side-effects.
The pill does not have as good a safety record as some of the other methods. For example, the mini-pill sometimes causes ectopic pregnancies in the small number of women who become pregnant while taking it. The combined pill has caused fatal and non-fatal blood clots in the heart or brain in some users. For a healthy, young pill-user who doesn’t smoke, the chances of a blood clot are very small. However, the risk for women over the age of 45 and smokers over 35 is much higher, which is why doctors usually don’t prescribe combined pills for such women.
The pill has also been associated with other fatal and non-fatal medical problems. In addition, some doctors think that the pill may cause certain kinds of cancer in a small number of the women who use it. Other doctors think that the pill doesn’t cause cancer and that it actually protects against certain kinds of cancer. More research is needed before we can say for sure what the long-term effects of the pill are. However, from what we know now, the pill appears to be safe for young, healthy women.
The injectable contraceptive can also cause side effects such as longer periods, spotting between periods, or no periods at all. Some women experience weight gain, headaches, dizziness, decreased sex drive or allergic reactions, though these are rare. It sometimes takes a number of months for women to begin ovulating, menstruating and being fertile again after they stop using this method. There have been some women who never resumed ovulating and menstruating, but it is not clear if the injectable contraceptive was responsible for the problem in these cases. Some doctors have been concerned that some users of this method might have an increased chance of breast cancer because of laboratory studies done on dogs; other experts don’t think there is any risk. Here again, more research is needed. But from what we know, this method is considered a very safe one, safer, in fact, than the pill.
When they hear about the side-effects and safety problems of some methods, the young people in our class often wonder why women don’t just use the safer methods, the ones with fewer side-effects. Some, of course, do choose these methods for just this reason. However, these other methods are often less convenient to use and sometimes less effective as well. Besides, the chances of having a serious or life-threatening medical problem are very small with all of the methods we’ve been discussing. In fact, a woman would be more likely to die from a complication of pregnancy or childbirth than she would from a problem caused by her method of birth control. So, although it’s true that there are risks with certain methods, the risks are relatively small for young, healthy women.
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