News

Virus might cause Prostate Cancer

- A virus that is known to cause certain forms of cancer in animals has been found in the cancer cells of humans with prostate cancer.  This is according to an article in the September issue of the journal Proceedings of the National Academy of Sciences.
· Prostate Cancer is the most common form of cancer found in men in the United States and the second most common cause of cancer death in men.

· Investigators report that the virus, Xenotropic murine leukemia virus-related virus (XMRV) was discovered in human prostate cancer cells.  This virus was not previously known to infect humans.  In animals it is responsible for such cancers as feline (cat) leukemia.
The study authors examined 334 prostate tissue specimens, with 233 specimens from men with prostate cancer and 101 from men without prostate cancer.  Investigators found the virus in 27% of the specimens with prostate cancer.  Additionally, the specimens with the virus were associated with more aggressive forms of prostate cancer.

· The Xenotropic murine leukemia virus-related virus is a special type of virus that is able to infect the DNA of a cell which can lead to mutations and the development of cancer.

· The concept of an infection leading to cancer is not a new idea.  The Human papilloma virus (HPV) is another example of a virus that can cause cancer and is associated with the development of cervical cancer. Burkitt lymphoma is caused by the Epstein Barr virus which infects lymphocytes and causes a specific mutation of the DNA leading to lymphoma.

Although not all of the prostate cancer specimens were infected with the virus, this is a very important finding for at least some prostate cancer cases and indicates a probable association between this viral infection and prostate cancer.  Prostate cancer is one of the most common forms of cancer and this finding may lead to new forms of treatment in the future.

The fact that this animal virus was found in human cells is also very important and should lead to more research into whether this virus is a responsible for other forms of cancer.

Cristopher Geiler, M.D.

Reference
Proceedings of the National Academy of Sciences
Proc Natl Acad Sci U S A. Published online September 7, 2009.

Read more – September 11, 2009

Medication cuts risk of developing prostate cancer

-Investigators have reported that taking the medication Dutasteride lowers the risk of developing prostate cancer.
· According to the study “REDUCE,” regular use of the medication produced about 23% reduction in prostate cancer.
· The “REDUCE” study was a randomized placebo-controlled trial of 8,200 men over four years.
· The Dutasteride medication inhibits an enzyme that makes a form a testosterone that stimulates prostate cell growth.

· Study author Gerald Andriole, MD reported that “There is currently no approved treatment for risk reduction in prostate cancer.”

Additionally, authors report that “risk was most markedly reduced in the numbers of high-grade tumors, with absolutely no increase in incidence (of prostate cancer)”. He added “I would recommend chemoprevention for high-risk men based on these results. It is certainly enough to convince me.”

April 29th 2009

Reference
American Urological Association (AUA) 104th Annual Scientific Meeting

Read more – April 29, 2009

Non-Bacterial Prostatitis

by Julie Chacko, M.D.

• Definition: Inflammation of the prostate that is not due to infection.

• Overview:
· This syndrome should be distinguished from prostatodynia which is prostatic pain without evidence of inflammation or infection.
· Non-bacterial prosatitis is more common than bacterial prostatitis and can be far more bothersome for patients.
· The cause of chronic non-bacterial prostatitis is unknown.

• Types:
· This is distinct from acute bacterial prostatitis, chronic bacterial prostatis and prostatodynia.

• Symptoms:
· The symptoms are similar to chronic bacterial prostatitis with episodic or sometimes low-level chronic pain in the perineum between the scrotum and anus, low back, low abdomen and with ejaculation. Burning with urination and discomfort in the penis may be present.

• Complications:
· There usually are not complications associated with this diagnosis though patients with chronic pain can develop depression or anxiety related to the chronic pain syndrome.

• Clinical Findings/signs:
· The prostate is sometimes tender on examination.
· Prostate massage to obtain expressed prostatic secretions (EPS) or the urine collected after massage should demonstrate white cells indicative of the inflammation but the culture of that fluid should not grow any organism.
· There are few other physical signs or symptoms.

• Treatment:
· Lifestyle: If ejaculation is not painful, regular ejaculation may help to relieve symptoms in some patients. Stress reduction and warm baths (submerging the prostate area) can be helpful for some.
· Medication: Many patients are treated initially with antibiotics until it is clear that the symptoms are not infection-related. Antibiotics aimed at less common organisms may also be tried in an effort to define the condition. Antibiotics aimed at less common organisms may also be tried in an effort to define the condition. Once clear that there is no infection present, medications to relieve symptoms can be used and may include any of the following: anti-inflammatory medications, Flomax* or other alpha-blocker medications, anti-spasmodics for the bladder and urinary analgesic medications such as Pyridium* or Prosed*. Some patients may benefit from referral to a pain management specialist if symptoms are severe.

· Surgery: No clear indication for surgical intervention with this disease.

• Prognosis:
· Prognosis is fair.
· Many patients learn lifestyle modifications that help to control and alleviate symptomatology but this is generally a chronic condition that results in intermittent or chronic symptoms for many.

Read more – April 16, 2009

Chronic Bacterial Prostatitis

by Julie Chacko, M.D.

• Definition: Recurrent or persistent bacterial infection of the prostate gland.

• Overview:
· This is the most common source for recurrent urinary track infection (UTIs) in men.
· The most common organism being E. Coli.

• Causes:
· Incomplete treatment of an episode of acute bacterial prostatitis can contribute to the onset of chronic bacterial prostatitis.
· Often there are calcifications within the prostate that harbor the organism and prevent complete clearance with antibiotics.

• Symptoms:
· The typical symptoms include burning with urination, frequency of urination and pain in any number of areas including the low back, perineum (between the anus and scrotum), low abdomen and increased pain with ejaculation.
· Patients with chronic bacterial prostatitis tend not to be as acutely ill as those with acute prostatitis and fever, lethargy and fatigue are usually not present.

• Complications:
· The recurring infections can lead to fertility issues and occasionally to prostatic abscess formation.

• Clinical Findings/signs:
· The prostate is tender on examination.
· Prostatic massage may be performed to try to obtain a specimen from the prostate itself.
· If a drop of fluid is obtained from the prostate (EPS) or the urine immediately after massage is collected, it usually demonstrates elevated numbers of white cells and will be positive for an organism when cultured.
· PSA (prostate specific antigen) blood test will usually be elevated as well.

• Treatment:
· Lifestyle: There are no lifestyle modifications to treat chronic bacterial prostatitis.

· Medication: The primary treatment is antibiotic therapy for a prolonged course, often 3-6 months, in an effort to eradicate infection. During the treatment course anti-inflammatory medications may be useful in controlling pain related symptoms. If burning on urination is present, bladder analgesics such as Prosed* or Pyridium* may be prescribed.

· Surgery: Surgical management is rarely indicated for chronic bacterial infection. Transurethral resection of the prostate can be performed in an effort to remove prostatic calculi but may not be successful in eradicating infection.

• Prognosis:
· Clearance of the infection can be difficult.
· The prognosis depends on whether clearance of infection is attainable.
· If not, persistent symptomatology is the norm and frequency and control of symptoms is variable.

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Acute Bacterial Prostatitis

By Julie Chacko, M.D.

• Definition: Bacterial infection of the prostate gland.

• Overview:
· Tends to be diagnosed in younger men.

• Types:
· Acute bacterial prostatitis is one of a number of inflammatory conditions that can affect the prostate. See Chronic Bacterial Prostatitis and Non-bacterial prostatitis as well.

• Symptoms:
· Usually presents with fever, urinary frequency or urgency, pain with ejaculation, discomfort in the perineum (the area between the back of the scrotum and anus), and may have associated general fatigue.
· There may be associated difficulty emptying the bladder which may be perceived due the the irritative symptoms or actual due to obstruction of urinary flow due to the swollen gland.

• Complications:
· Bacteremia (infection spreading into the bloodstream) is a possible complication which, if not treated promptly, can result in sepsis.
· Prostatic abscess can form even when treated with appropriate antibiotics.

• Clinical Findings/signs:
· Fever is generally present.
· The prostate is warm and tender on examination.
· Bloodwork reveals an elevation in the white blood cell count as well as the PSA if it is checked during infection.
· The most common organism is E. Coli and the organism can be cultured from the seminal fluid and usually from the urine as well.
· When the infection has spread to the bloodstream blood cultures will also be positive.
· Imaging is usually not necessary to make the diagnosis though a CT or prostate ultrasound may be ordered if the clinical course warrants further evaluation.

• Treatment:
· Lifestyle: There is no lifestyle modification that can treat acute bacterial prostatitis though using a barrier method during anal intercourse may help reduce infection rates.

· Medication: Antibiotics are the mainstay of treatment. Depending on the severity of infection, admission to the hospital to start IV antibiotics may initially be indicated. The antibiotics are generally taken for at least four to six weeks to ensure complete eradication of the infection. Anti-inflammatories and fever reducing agents such as Tylenol* may alleviate symptoms. Stool softeners may be helpful as well.

· Surgery: If the patient is unable to urinate, a tube may be placed through the abdomen directly into the bladder (called a suprapubic tube). Otherwise, surgical intervention in rarely indicated unless a prostatic abscess forms.

• Prognosis: Prognosis tends to be good if caught early.

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Prostate Cancer Detection with a Urine Test

· According to the 2009 Genitourinary Cancers Symposium, a new urine test can detect the presence of prostate cancer by identifying the fusion of two genes associated with prostate cancer.

· The urine test; called T2:ERG urine test can detect the fusion of two genes: TMPRSS2 and ERG which is associated with prostate cancer. The goal of this test is not only to identify prostate cancer in men but also to identify aggressive, fast growing prostate cancer from slow growing, less aggressive prostate cancer.

· The urine test is not yet available for commercial use.

· This report discussed the usefulness of the test. Investigators report the next phase of investigation will include confirming a correlation with test results and aggressiveness of prostate cancer and to correlate T2:ERG urine results with pathologic features, such as tumor volume, stage, and grade in prostatectomy tissue.

Reference:
2009 Genitourinary Cancers Symposium: Abstract 3. Presented February 26, 2009

March 1, 2009

Read more – March 1, 2009

Prostate Cancer

• Definition
· Prostate Cancer is the disease of cancer of the prostate gland.

• Overview
· Prostate Cancer is the most common form of cancer found in men in the United States and the second most common cause of cancer death in men.
· Prostate Cancer can be detected with:
· blood test: PSA (prostate specific antigen)
· physical examination of the prostate gland

· Prostate Cancer risk factors include:
· family member with prostate cancer
· high dietary fat intake

• Symptoms
· Prostate Cancer symptoms include:
· difficulty urinating
· incomplete emptying of the bladder
· blood in urine or semen
· nodule or swelling of the prostate gland
· back pain

• Complications
· Prostate Cancer complications include metastatic spread of the disease

• Treatment
· Medications that stop the production of testosterone
· Surgical resection of the prostate gland
· Radiation

References
Albertsen PC et al. 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA. 2005 May 4;293(17):2095-101. [PMID: 15870412]
Hernandez J et al. Prostate-specific antigen: a review of the validation of the most commonly used cancer biomarker. Cancer. 2004 Sep 1;101(5):894-904. [PMID: 15329895]

Read more – September 24, 2008

Frequent urination (male)

• Frequent urination is the symptom of is the symptom of relative excessive urination frequency.

• Frequent urination in a man can be obstructed urine flow or incomplete bladder emptying due to:
· enlarged prostate
· prostate cancer
· prostatitis (infection or inflammation of the prostate)
· cystitis (inflammation or infection in the bladder)

• Frequent urination (Polyuria) can also be a symptom of:
· Diabetes mellitus
· Diabetes insipidus
· Hypercalcemia
· Psychogenic polydipsia (this is associated with psychosis)
· Hyperaldosteronism

• Urinary frequency should be evaluated by your doctor.

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