The Prostate. Dr. John Bergman

Transcription

1 The Prostate Dr. John Bergman

2 Anatomy and Physiology The Prostate An exocrine gland of the male reproductive system. About the size of a walnut Gland that secretes alkaline fluid The Alkalinity helps to neutralize the acidity of the vaginal tract helping sperm to survive the journey to the ovum

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4 Skene s Gland (Female Prostate) Gland that plays an important role in sexual arousal and climax Located on the anterior wall of the vagina Drain into the urethra (source of female ejaculate) Gland swells during sexual arousal

5 The Nervous System The nerves that supply the prostate originate from S2-S4 They are parasympathetic fibers of the pelvic splanchnic nerves These nerves are involved in: sexual arousal and climax

6 Fun Mnemonic: S Keep the Ding Dong off the Floor

7 Autonomic Nervous system PNS (Rest, Digest, Repair) = Cranial-sacral Function : Stimulates immune system, repairs tissue Increases: blood supply to gut, and all repair mechanisms SNS (Fight or Flight) = Thoracic and lumbar Function: Keeps you alive under stress, increases Heart rate, blood pressure, blood sugar, LDL cholesterol, stress hormones Decreases: blood supply to the gut, immune system function

8 Point and Shoot Parasympathetic -Arousal Sympathetic -Climax

9 The Nervous System The Prostate contains smooth muscle to help expel semen during ejaculation These muscles are controlled by the Autonomic Nervous System

10 The Nervous System and the Pelvic Floor The Prostate is sheathed in the muscles of the pelvic floor which contract during the ejaculatory process Any nerve compression or interference involving the sacrum will cause dysfunction of the pelvic floor muscles A sedentary lifestyle is a huge factor in the weak pelvic floor muscles

11 Prostate Disorders Prostatitis Benign Prostatic Hyperplasia Cancer

12 Prostatitis Inflammation of the Prostate Classified as Acute, Chronic, Non-inflammatory, and Asymptomatic inflammatory Chronic: Accounts for 90-95% of all prostatitis Medical doctors suspect Bacteria as the main cause Affects 30-50% of Men

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14 Benign Prostatic Hyperplasia (BPH) Non-cancerous Enlargement of the prostate Most Common disorder of the prostate gland Restricts flow of urine from the bladder Common condition in older men (45-74) 50% of all men in their 50 s have BPH 60% of men over the age of 60 have BPH 80% of men in their 80 s have BPH

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16 Prostate Cancer The most common form of cancer in men Prostate Cancer affects 1 in 6 American men The 6th leading cause of cancer death in males worldwide 99% of cases occur in those over the age of 50 46% of men in the U.S. (ages 50-59) have prostate cancer Can develop into a painful and fatal condition Can also develop slowly and never cause problems According to Most Medical Journals: The majority of prostate cancer will never progress to a clinically meaningful stage if left undiagnosed and untreated during a man s lifetime

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18 Symptoms for Prostate Problems Dysuria: problems with urination Frequent urination Nocturia (increased urination at night) Difficulty urinating Urgency Leaking Dribbling Weak urine stream Pain in the abdomen, groin, low back, scrotum, rectum, penis, testicles Painful orgasms

19 Prostate Exams: The PSA Test PSA stands for Prostate- specific antigen a protein produced by the prostate Used to screen for prostate cancer The Theory Cancer cells produce more PSA so higher levels may indicate prostate cancer

20 Prostate Biopsy A biopsy is usually done when a blood test shows high levels of PSA Removes small samples of prostate tissue that are examined under a microscope A thin, hollow needle is inserted through the rectum, through the urethra, or through the area between the anus and scrotum (perineum) Trans-rectal is the most common Usually 6-12 samples are taken Procedures last about 30 to 45 minutes

21 Trans-rectal Prostate Biopsy A spring-loaded needle is attached to a probe which is inserted into the anus and the needle punctures through the rectum into the prostate.

22 Trans-urethral Prostate Biopsy A lighted scope (Cystocope) is inserted into your urethra and a cutting loop is passed through the cytoscope to remove small pieces of prostate tissue

23 Trans-Perineal Prostate Biopsy

24 The Controversy behind Prostate Screening Annual cost of PSA screening in the U.S. totals at least $3 billion PSA testing for prostate cancer screening is controversial because of the cost and uncertain long term benefits to patients. PSA tests have consistently shown false positive and false negatives results may lead to overtreatment of low-risk cancers "I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster." The test is hardly more effective than a coin toss. Dr. Richard J. Ablin, The Discoverer of PSA

25 The Controversy behind Prostate Screening The American Urological Association The controversy over prostate cancer should not surround the test, but rather how test results influence the decision to treat. A cancer cannot be treated if it is not detected. Testing empowers patients and their urologists with the information to make an informed decision.

26 The Controversy behind Prostate Screening The United States Preventive Services Task Force (USPSTF) Prostate-specific antigen-based screening results in small or No reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary. And Still Medical Doctors are Confused The American Society of Clinical Oncology It is uncertain whether the benefits associated with PSA testing for prostate cancer screening are worth the harms associated with screening and subsequent unnecessary treatment

27 Why The Confusion? The American Cancer Society Recommend that men be informed of the risks and benefits of screening and they should talk about the benefits of testing with their doctor The American Cancer Society (ACS) does not support routine testing for prostate cancer at this time. Chief Medical Officer of the American Cancer Society, Dr. Otis Brawley The question is not as simple as: 'does prostate cancer screening work?' What we need to know is: what are benefits of prostate cancer screening and are they large enough to outweigh the harms associated with it? We still cannot say whether the benefits outweigh the risk."

28 No More Confusion New England Journal of Medicine Screening did not reduce the death rate in men 55 and over Most men with an elevated PSA level turn out not to have prostate cancer; only about 25 percent of men who have a prostate biopsy due to an elevated PSA level actually have prostate cancer The European Randomized Study of Screening for Prostate (ERSPC) Study involving 182,000 men ages After 9 years, they concluded that 1410 men would need to be screened and 48 additional cases of prostate cancer would need to be treated to prevent just one death from prostate cancer

29 No More Confusion The Journal of the American Medical Association (2009) After 20 years of screening for breast and prostate cancer, several observations can be made Screening may be increasing the burden of low-risk cancer without significantly reducing the burden of more aggressively growing cancers and therefore Not resulting in the anticipated reduction in cancer mortality. To reduce morbidity and mortality from prostate cancer and breast cancer, new approaches for screening, early detection, and prevention for both disease should be considered.

30 High-Grade Prostatic Intraepithelial Neoplasia High-Grade means you have an abnormal cellular pattern Many men have undergone unnecessary treatment for cancer because. These are now considered benign or indolent lesions of epithelial origin and should never have been, and should never be, termed carcinomas." National Cancer Institute (NCI) 2013

31 Statins Linked to Prostate Cancer One of the most widely prescribed drugs in the world 1 in 4 Americans over the age of 45 is taking a Statin medication Statins act by blocking a crucial enzyme in your liver that s responsible for making cholesterol This enzyme also makes CoQ10 which is essential for mitochondrial health There are Over 900 studies proving the adverse effects of Statins

32 Statins Linked to Prostate Cancer Journal of the American Medical Association, Connection between statin drugs and development of various cancers Longer-term clinical trials and careful post-marketing surveillance during the next several decades are needed to determine whether cholesterol-lowering drugs cause cancer in humans. In the meantime, the results of experiments in animals and humans suggest that lipid-lowering drug treatment, especially with the fibrates and statins, should be avoided. American Academy of Cardiology, Published in JAMA (2009) There is currently No evidence that ezetimibe (a statin medication), which reduces levels of low-density lipoprotein cholesterol, improves clinical outcomes such as myocardial infarction or death."

33 Cholesterol: The Vital Building Material for Hormones Cholesterol > pregnenolone > 17 hydropregnenolone > DHEA > Androstenidione > Testosterone

34 Testosterone Hormones are used for communication between organs and tissues The Hypothalamus controls all hormone secretions Testosterone is responsible for: Regulation of the prostate Development of reproductive tissues Sperm development Regulation of cognitive and physical energy Regulation Thromboxane A2: Tissue Healing Bone Health and Strength Maintains Cardiovascular Health

35 Low Testosterone Levels Associated with Diabetes and obesity Cardiovascular disease Alzheimer s disease and dementia Stroke and heart attacks Depression Sleep Disorders including Insomnia Reduced sex drive and Infertility Erectile Dysfunction

36 Normal or above average Testosterone levels are associated with: Increased mental and physical energy Increased sexual vitality Improved Immune system function Lower blood pressure Decrease risk of heart attack Decrease risk of obesity Increased lean body mass Decreased risk of diabetes Increased muscle and bone mass Decreased risk of dementia and Alzheimer s (Journal of Neurology and JAMA)

37 Testosterone Replacement Therapy (Steroids) FDA Warning for Testosterone Products (2015): Neither the benefits nor the safety of testosterone have been established for low testosterone levels due to aging. -The FDA has required that testosterone pharmaceutical labels include warning information about the possibility of an increased risk of heart attacks and stroke. Excessive Testosterone associated with 30% increased risk of death and heart attack (National Institute of Aging)

38 The True Cause of Prostate Problems Nervous System disorder Immune System disorder Injury to prostate Pelvic Trauma Dehydration Stress

39 The Natural Solutions for a Healthy Prostate Stimulate the Nervous System Moist heat on the perineum Exercise Regularly Soak in a warm bath Strengthen the Immune System Improve bowel movements Hydrate properly Limit or avoid alcohol or caffei Healthy Sex Life Avoid prolonged Sitting Prostate Massage Increase vitamins and minerals Natural Anti-inflammatories Deep REM Sleep

40 Vitamin D Men with prostate cancer are 7 times less likely to die if they have high levels of vitamin D British Journal of Cancer Vitamin K2 Vitamin K2 may reduce your risk of prostate cancer by 35% American Journal of Clinical Nutrition Results suggest that general dietary modification has a beneficial effect on the prevention of prostate cancer. Journal of Human Nutrition and Dietetics

41 The Healthy Prostate Diet Eliminate Sugar, especially processed sugar Reduce environmental toxins and sources of heavy metals Detox your Body Eliminate all processed/package non-organic foods Animal based Omega 3 s (Krill or fish oil) Selenium (400mcg per day) Vitamin E (400 units per day)- Only natural, no synthetic Fresh vegetables or veggie juice daily Broccoli and broccoli sprouts: help control excess estrogens Walnuts: can reduce prostate cancer growth by 30-40%

42 The 5 Keys to Health and Healing Proper nerve supply Regular Exercise Proper Nutrition Sufficient Rest Prayer and Meditation

43 The CDC states: And Mental and Emotional Stress 85% of all disease is caused by emotions Up to 90% of the doctor visits in the USA may be triggered by a stress-related illness.

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46 References 41. Vigen R, O'Donnell CI, Barón AE, Grunwald GK, Maddox TM, Bradley SM, Barqawi A, Woning G, Wierman ME, Plomondon ME, Rumsfeld JS, Ho PM (Nov 2013). "Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels". JAMA 310 (17): Basaria S, Coviello AD, Travison TG, Storer TW, Farwell WR, Jette AM, Eder R, Tennstedt S, Ulloor J, Zhang A, Choong K, Lakshman KM, Mazer NA, Miciek R, Krasnoff J, Elmi A, Knapp PE, Brooks B, Appleman E, Aggarwal S, Bhasin G, Hede-Brierley L, Bhatia A, Collins L, LeBrasseur N, Fiore LD, Bhasin S ( ). "Adverse events associated with testosterone administration". The New England Journal of Medicine 363 (2): (January 31, 2014). "FDA evaluating risk of stroke, heart attack and death with FDA-approved testosterone products" U.S. Food and Drug Administration. 44. Habermacher GM, Chason JT, Schaeffer AJ (2006). "Prostatitis/chronic pelvic pain syndrome". Annu. Rev. Med. 57: (6 October 2011). "U.S. Panel Says No to Prostate Screening for Healthy Men". New York Times. 47. Wolf, AM; Wender, RC; Etzioni, RB; Thompson, IM; D'Amico, AV; Volk, RJ; Brooks, DD; Dash, C; Guessous, I; Andrews, K; DeSantis, C; Smith, RA; American Cancer Society Prostate Cancer Advisory, Committee (Mar Apr 2010). "American Cancer Society guideline for the early detection of prostate cancer: update 2010". CA: a cancer journal for clinicians 60 (2): Basch, E; Oliver, TK; Vickers, A; Thompson, I; Kantoff, P; Parnes, H; Loblaw, DA; Roth, B; Williams, J; Nam, RK (Jul 16, 2012). "Screening for Prostate Cancer With Prostate-Specific Antigen Testing: American Society of Clinical Oncology Provisional Clinical Opinion." (PDF). Journal of clinical oncology : official journal of the American Society of Clinical Oncology 30 (24): Chou, MD, Roger; Croswell, MD, MPH, Jennifer M.; Dana, MLS, Tracy; Bougatous, BS, Christina; Blazina, MPH, Ian; Fu, PhD, Rongwei; Gleitsmann, MD, MPH, Ken; Koenig, MD, MPH, Helen C.; et al. (7 October 2011). "Screening for Prostate Cancer - A Review of the Evidence for the U.S. Preventive Services Task Force". United States Preventive Services Task Force. 50. Esserman, Laura; Shieh, Y; Thompson, I; et al. (2009). "Rethinking screening for breast cancer and prostate cancer". JAMA 302 (15): Cooperberg, MR; Carroll, P. R.; Klotz, L.; et al. (2011). "Active surveillance for prostate cancer: progress and promise". J Clin Oncol 29 (27): Marcione, Marilyn (12 October 2011). "Prostate testing's dark side: Men who were harmed". Associated Press. Retrieved Collins MM, Barry MJ (December 1996). "Controversies in prostate cancer screening. Analogies to the early lung cancer screening debate". JAMA 276 (24): Ablin RJ ( ). "The Great Prostate Mistake". The New York Times. 55. Anthony Horan (August 2009). The Big Scare: The Business of Prostate Cancer. STERLINGHOUSE Schröder, Fritz H.; Hugosson, Jonas; Roobol, Monique J.; Tammela, Teuvo L.J.; Ciatto, Stefano; Nelen, Vera; Kwiatkowski, Maciej; Lujan, Marcos; Lilja, Hans; Zappa, Marco; Denis, Louis J.; Recker, Franz; Berenguer, Antonio; Määttänen, Liisa; Bangma, Chris H.; Aus, Gunnar; Villers, Arnauld; Rebillard, Xavier; van der Kwast, Theodorus; Blijenberg, Bert G.; Moss, Sue M.; de Koning, Harry J.; Auvinen, Anssi (26 March 2009). "Screening and Prostate-Cancer Mortality in a Randomized European Study". New England Journal of Medicine 360 (13):

47 References 58. Roobol, Monique; Kerkhof, Melissa; Schröder, Fritz H.; Cuzick, Jack; Sasieni, Peter; Hakama, Matti; Stenman, Ulf Hakan; Ciatto, Stefano; et al. (2009). "Prostate Cancer Mortality Reduction by Prostate- Specific Antigen Based Screening Adjusted for Nonattendance and Contamination in the European Randomised Study of Screening for Prostate Cancer (ERSPC)". Eur Urol 56 (4): Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011). "Global cancer statistics". CA A Cancer Journal for Clinicians 61 (2): Science Daily March 22, Am J Clin Nutr Apr;87(4): JAMA. 2008;299(19):2266. doi: /jama Gomella LG, Liu XS, Trabulsi EJ, Kelly WK, Myers R, Showalter T, Dicker A, Wender R (2011). "Screening for prostate cancer: The current evidence and guidelines controversy". The Canadian journal of urology 18 (5): American Cancer Society Guidelines for the Early Detection of Cancer statement March 2009 following publication of U.S. and European large scale screening effectiveness trial results 66. USPSTF (December 2002). "Screening for Prostate Cancer". Agency for Healthcare Research and Quality. USPSTF (December 3, 2002). "Screening for prostate cancer: recommendation and rationale" (PDF). Ann Intern Med 137 (11): Kolata, Gina (20 Oct 2009). "NY Times article:cancer Society, in Shift, Has Concerns on Screenings". The New York Times. 68. "LA Times article:did the American Cancer Society really change its tune on screening?". Los Angeles Times. 21 Oct Barry MJ. Clinical practice. Prostate-specific-antigen testing for early diagnosis of prostate cancer. New England Journal of Medicine 2001;344(18): Loeb S, Carter HB (2012). Early detection, diagnosis, and staging of prostate cancer. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp Philadelphia: Saunders. 71. Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders. 72. Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins. 73. Pagana KD, Pagana TJ (2010). Mosby s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier. 74. British Journal of Cancer 2009; 100: Journal of Human Nutrition and Dietetics June 2009; 22(3): USA Today, March 22, Prostate Dec;71(16): doi: /pros Epub 2011 Apr JAMA Jan 3;275(1):

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