Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0376358 (prostate cancer)
 59,338 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The relationship between lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia and sexual health in men participating in a national multicenter screening program was studied. A total of 12 679 men were screened for prostate cancer in the year 2003. Of these, 6641 men had completed both the American Urological Association Symptom Score (AUA-SS) and the Sexual Health Inventory for Men (SHIM) questionnaires. We assessed the apparent effect of comorbidities (ischemic heart disease, hypertension, hypercholesteremia and diabetes), smoking habits and testosterone level on the overall sexual health. Age and race were also assessed as factors affecting the SHIM score. We used a general linear multivariable regression analysis to express the effect of these variables on the sexual health in these men adjusting for the apparent effect of LUTS. The mean and median age of the population was 58.4 +/- 9.8 and 58 y, respectively. The median AUA-SS was 4/25 (mean=5.7 +/- 5.3) and SHIM score was 19/25 (mean=16.3 +/- 5.9). Of the men, 4948 (75%) were Caucasian and 1154 (17%) were from African-American racial origin. A high AUA-SS appears to have a negative effect on the overall sexual health (P<0.05) after adjusting for all other confounding factors. As expected, age showed a significant inverse correlation with SHIM score (P<0.05). Caucasian men on average appear to have a significantly higher SHIM score by 6.5 points when compared to African-American men after adjusting for age, comorbidities, smoking habits, and AUA-SS (P<0.05). However, with increasing age, the difference in SHIM score diminishes between the two groups. Further, smoking and comorbidities were strong predictors of poor sexual health performance. Interestingly, hypogonadism (testosterone <300 ng/dl) was not a significant risk factor (P=0.104) when adjusting for all other variables. Nonetheless, in a univariate analysis, testosterone levels significantly correlated with reported SHIM scores (P<0.05). The overall sexual health in aging men is substantially affected not only by age, but by the severity of their urinary symptoms after adjusting for the most common known risk factors, suggesting perhaps a common underlying pathophysiology. Moreover, race appears to constitute another neglected potential risk factor, which should be investigated further in future studies.
 ...
PMID:Correlation between LUTS (AUA-SS) and erectile dysfunction (SHIM) in an age-matched racially diverse male population: data from the Prostate Cancer Awareness Week (PCAW). 1588 21

Recent advances in treatment modalitiesfor breast and prostate cancer have resulted in an increasing number of patients that are cured or that, despite residual disease, live long enough to start experiencing complications from cancer treatment. Osteoporosis is one such problem that has been increasingly identified in cancer patients. Hypogonadism and glucocorticoid use are the two major causes of bone loss in these patients. Osteoporosis is characterized by low bone mass and abnormal bone microarchitecture, which results in an increased risk of fractures. Vertebral body and hip fractures commonly result in a drastic change of quality of life as they can result in disabling chronic pain, loss of mobility, and loss of independence in performing routine daily activities, as well as in increased mortality. In patients with prostate carcinoma, androgen-deprivation therapy by either treatment with a gonadotropin-releasing hormone (GnRH) or bilateral orchiectomy results in increased bone turnover, significant bone loss, and increased risk of fractures. Patients with breast cancer are at increased risk for estrogen deficiency due to age-related menopause, ovarian failure from systemic chemotherapy, or from the use of drugs such as aromatase inhibitors and GnRH analogs. Several studies have indicated that the prevalence of fractures is higher in breast and prostate cancer patients compared to the general population. Therefore, patients at risk for bone loss should have an assessment of their bone mineral density so that prevention or therapeutic interventions are instituted at an early enough stage to prevent fractures. This article will address the characteristics of bone loss observed in breast and prostate cancer patients and potential treatments.
 ...
PMID:Osteoporosis in breast and prostate cancer survivors. 1594 45

The aging of the world population has brought to the forefront of medical practice the diagnosis and treatment of hypogonadism in adult men. There is an increasing interest on the use of testosterone (T) and other androgens to manage men with clinical and biochemical evidence of hypogonadism. Although treatment with T has been used for 70 yr and it is, generally, safe and effective, there are a number of safety issues--ranging from cardiovascular and lipid alterations to hematological changes--that the physician needs to be aware of. Unquestionably, prostate safety constitutes the most important one. No evidence exists that appropriate androgen administration with knowledgeable monitoring carries significant or potentially serious adverse effects on the prostate gland. Men with symptomatic lower urinary obstruction need to be assessed carefully prior to androgen administration. The suspicion of prostate cancer is an absolute contraindication for T use. Recommendations are available for the judicious and safe use of T in aging men.
 ...
PMID:Monitoring androgen replacement therapy: testosterone and prostate safety. 1604 71

Despite nearly a half-century of research on aging and sex steroids in men, answers to key questions that would allow us to confidently assess risk:benefit ratios for androgen replacement in older men with the partial androgen deficiency of aging men (PADAM) syndrome remain uncertain. Although it is now reasonably clear that a significant percentage of otherwise healthy older men have decreases in testosterone and bioavailable testosterone to levels consistent with hypogonadism, the clinical implications of this change remain uncertain. Data suggest that low testosterone in older men is correlated to varying degrees with loss of lean body mass and muscle strength, and increased total and central body fat. Less certain, but suggestive, are data relating low testosterone levels to decreased bone density, loss of insulin sensitivity, and cognitive and affective deterioration, as well as reduced sexual function. Replacement of testosterone in older men has shown some positive effects on each of these variables, but findings have been inconsistent, perhaps because studies have employed different preparations and doses of androgens, treated for various durations, and defined their target populations in different ways. As important as beneficial effects is the potential for adverse effects, which may be greater in older men. Possible problems include sleep apnea, erythrocytosis, dyslipidemia with acceleration of atherosclerosis, and, of greatest concern, prostate cancer or hyperplasia. Studies to date have suggested that these outcomes are not major risks, but, in the absence of a large, randomized trial or trials, definitive information is not available. The US National Academies Institute of Medicine's recent report recommends that the National Institutes of Health support small efficacy trials aimed at treatment of androgen deficiency-related clinical conditions, but not a large, randomized trial to elucidate risk:benefit ratios. This recommendation, if adhered to, is likely to delay, rather than foster, progress in this important area.
 ...
PMID:Testosterone in older men after the Institute of Medicine Report: where do we go from here? 1609 68

Male hypogonadism is one of the most common endocrinologic syndromes. The diagnosis is based on clinical signs and symptoms plus laboratory confirmation via the measurement of low morning testosterone levels on two different occasions. Serum luteinizing hormone and follicle-stimulating hormone levels distinguish between primary (hypergonadotropic) and secondary (hypogonadotropic) hypogonadism. Hypogonadism associated with aging (andropause) may present a mixed picture, with low testosterone levels and low to low-normal gonadotropin levels. Androgen replacement therapy in hypogonadal men has many potential benefits: improved sexual function, an enhanced sense of well-being, increased lean body mass, decreased body fat, and increased bone density. However, it also carries potential risks, including the possibility of stimulating the growth of an occult prostate cancer. The benefits of androgen therapy outweigh the risks in men with classic hypogonadism. However, for men with mild hypogonadism or andropause, the balance between benefits and risks is not always clear. Unfortunately, studies to date have included too small a number of patients and have been too short in duration to provide meaningful data on the long-term risks versus the benefits of androgen replacement therapy in these populations. Several products are currently marketed for the treatment of male hypogonadism. Weekly-to-biweekly injections of testosterone cypionate (cipionate) or testosterone enanthate (enantate) are widely used, as they are economical and generally well tolerated. However, once-daily transdermal therapies have become increasingly popular and now include both patch and gel systems. Intramuscular injection of testosterone undecanoate is an attractive new therapy that can be administered quarterly. To confirm an adequate replacement dosage, assessment of clinical responses and measurement of serum testosterone levels generally suffice. For selected men, serial measurement of bone mineral density during androgen therapy might be helpful to confirm end-organ effects. For men aged >50 years, we advocate measurement of hematocrit for detection of polycythemia and a digital rectal examination with a serum prostate-specific antigen level measurement for prostate cancer screening during the first few months of androgen therapy. Subsequently, a hematocrit should be obtained yearly or after changes in therapy, and annual prostate cancer screening can be offered to the patient after a discussion of its risks and benefits.
 ...
PMID:Male hypogonadism : an update on diagnosis and treatment. 1618 98

With earlier detection and improved survival from early stage prostate cancer, it is likely that the numbers of men presenting with hypogonadal symptoms following curative surgery for their cancer will increase. Although testosterone supplementation is effective in improving symptoms of hypogonadism, traditionally such therapy has been contraindicated in patients who have had prostate cancer. This paper reviews the evidence that testosterone therapy can be safely given to selected men with hypogonadism who have had prostate cancer but currently have no evidence of disease by clinical and prostate-specific antigen (PSA) criteria. Such patients should be treated cautiously and followed closely.
 ...
PMID:A rational approach to androgen therapy for hypogonadal men with prostate cancer. 1620 1

Androgen deprivation therapy improves survival of patients with prostate cancer and leads to hypogonadal state. Gonadal hormones are essential for skeletal integrity and hypogonadism constitutes a major risk factor for osteoporosis. To examine the bone loss secondary to androgen deprivation therapy, we reviewed the bone mineral density (BMD) studies of 152 patients with prostate cancer with mean duration of androgen deprivation therapy of 58 months. Among them 55 subjects had follow-up BMD measurement at 12-15 months with 39 of them on antiresorptive therapy. Osteoporosis was noted at least at one site in 92 (60.5%), among which 74 (48.7%) had changes at hip with the more prominent changes at ward's triangle, 18 (11.8%) at other sites. Osteopenia was present in 37 (24%) and only 17 (11%) were normal. The duration of antiandrogen therapy did not correlate with the degree of bone loss. Significant in improvement in the BMD is noted at 12-15 month follow-up on antiresorptive therapy. We conclude that men treated with androgen deprivation therapy are at risk for bone loss and should have BMD measured at the time of initiation of androgen deprivation therapy and periodically.
Prostate Cancer Prostatic Dis 2006
PMID:Bone mineral density changes on androgen deprivation therapy for prostate cancer and response to antiresorptive therapy. 1627 50

Androgen deprivation therapy (ADT) for prostate cancer is now used in earlier disease stages and as adjuvant treatment. Recognizing and reducing the toxicity of this therapy, including worsened lipid levels and cardiovascular disease (CVD) risks, has become an important clinical concern. Oral estrogen therapy induces hypogonadism and mitigates many side effects of ADT, but has a high thrombosis risk. Transdermal estrogen therapy (TDE) has a lower thrombosis risk than oral estrogen and may improve CVD risk compared with ADT. This prospective pilot study of 18 men with androgen-independent prostate cancer receiving ADT measured effects of TDE on lipid and inflammatory CVD risk factors before and after 8 weeks of TDE (estradiol 0.6 mg/day). During treatment, estradiol levels rose 17-fold; total cholesterol, LDL cholesterol, and apolipoprotein B levels decreased. HDL2 cholesterol increased, with no changes in triglyceride or VLDL cholesterol levels. Dense LDL cholesterol decreased and LDL buoyancy increased in association with a decrease in HL activity. Highly sensitive C-reactive protein levels and other inflammatory markers did not worsen. Compared with ADT, short-term TDE therapy of prostate cancer improves lipid levels without deterioration of CVD-associated inflammatory markers and may, on longer-term follow-up, improve CVD and mortality rates.
 ...
PMID:Effects of transdermal estrogen on levels of lipids, lipase activity, and inflammatory markers in men with prostate cancer. 1629 98

The intended therapeutic effect of gonadotropin-releasing-hormone (GnRH) agonists is hypogonadism, which is a leading cause of osteoporosis in men. Observations are consistent with this effect: GnRH agonists decrease bone mineral density and increase fracture risk in men with prostate cancer. Estrogens play a central role in homeostasis of the normal male skeleton and evidence suggests that estrogen deficiency is primarily responsible for the adverse skeletal effects of GnRH agonists. The mechanism of treatment-related bone loss involves acceleration of physiologic bone turnover. In small, randomized, controlled trials, bisphosphonates (pamidronate, zoledronic acid) and selective estrogen-receptor modulators (raloxifene, toremifene) increased bone mineral density in GnRH-agonist-treated men. Two ongoing large, randomized, placebo-controlled studies will prospectively define fracture outcomes in men with prostate cancer and assess the efficacy of novel pharmacologic interventions (AMG 162, toremifene) in GnRH-agonist-treated men.
 ...
PMID:Therapy Insight: osteoporosis during hormone therapy for prostate cancer. 1647 48

Prostate cancer is often treated with androgen deprivation therapy (ADT). Although this treatment is effective the associated hypogonadism causes accelerated bone loss, osteoporosis and increased fracture risk in men with prostate cancer, even in the absence of bone metastases. In addition to the negative effects of ADT on bone metabolism, men with prostate cancer are at increased risk of osteoporosis due to advanced age, poor nutrition and vitamin D deficiency. Some treatments for prostate cancer avoid this side effect and these are discussed, together with treatment strategies to minimise the impact of ADT on bone health.
 ...
PMID:Prostate cancer, osteoporosis and fracture risk. 1650 18


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>